Facing Up to Head and Neck Cancer

The recent news that Michael Douglas' oral cancer may have been caused by the sexually transmitted disease, Human papillomavirus (HPV), has attracted international media attention, but it has also revealed low awareness about the condition.

The recent news that Michael Douglas' oral cancer may have been caused by the sexually transmitted disease, Human papillomavirus (HPV), has attracted international media attention, but it has also revealed low awareness about the condition. Many people have no idea that oral sex can lead to an increased risk of head and neck cancer, and equally low numbers know what symptoms to check for - even though around 16,000 people in the UK are diagnosed with it each year, and the fatality rates are just as high as for breast cancer.

What is head and neck cancer?

There are over 30 different places that cancer can develop in the head and neck area, affecting any of the tissues or organs, including the mouth, lip or tongue, or the upper parts of the throat. Head and neck cancers also include some rare forms such as cancers of the salivary gland, nose, sinuses, and middle ear, and cancers of the nerves and bones of the head and neck.

While they may not be as common as breast cancer, the incidence of many types of head and neck cancer has risen by more than 30% in the last 15 years and the fatality rates remain high with only 60% of patients alive five years after treatment. A lot of this is down to the fact that people just do not know what they should be looking out for. Treatment for head and neck cancers is most successful if they are diagnosed and treated early.

What are the symptoms?

This is why we implemented an awareness raising campaign at University Hospitals Coventry and Warwickshire NHS Trust (UHCW) to help ensure more people know about what signs to spot. If you are concerned about a symptom or sign on this list, please talk with your doctor. Symptoms can include:

•Swelling or sore that does not heal (the most common symptom)

•Red or white patch in the mouth

•Lump, bump, or mass in the head or neck area (with or without pain)

•Persistent sore throat

•Foul mouth odour not explained by hygiene

•Hoarseness or change in voice

•Nasal obstruction or persistent nasal congestion

•Frequent nose bleeds and/or unusual nasal discharge

•Double vision

•Numbness or weakness of a body in the head and neck region

•Pain or difficulty chewing, swallowing, or moving the jaws or tongue

•Ear and/or jaw pain

•Blood in the saliva or phlegm

•Loosening of teeth

•Dentures that no longer fit

Many of these symptoms, such as a sore throat or mouth ulcers, are not in themselves a sign of a serious illness. However, if experienced for more than two or three weeks - particularly in combination with other symptoms on the list - it is important to seek a professional medical opinion.

What can trigger head and neck cancer?

With all types of cancer, there are certain things that can increase the risk of it occurring but it is usually difficult to determine the exact cause. However, there are ways you can limit your chances of developing head and neck cancer.

For example, alcohol and tobacco can play a significant role and should always be consumed in moderation. In addition, excessive consumption of processed meats and red meat have been associated with increased rates of cancer of the head and neck in one study, while consumption of raw and cooked vegetables seemed to be protective.

There has also been recent evidence pointing to a viral origin for some head and neck cancers. Human papillomavirus (HPV) is a virus from the papillomavirus family that can cause warts and in some cases lead to cancer, such as cervical cancer. It seems there is now also a risk of head and neck cancers by HPV that is sexually transmitted, usually through oral sex.

How can head and neck cancer be treated?

For most people, the aim of treatment is to remove or destroy all of the cancer and to reduce the chances of it coming back. The treatment offered will depend on where the cancer is in the head or neck, the stage of the cancer, its size and the patient's general health.

I work with a team of specialists at UHCW to determine the best way to treat each individual patient. For example, small cancers in the mouth can often be removed with surgery, whereas radiotherapy may be the preferred treatment for cancers in areas of the head and neck that are difficult to reach. Larger cancers may also require chemotherapy in addition to surgery and radiotherapy. Each new patient is discussed at a weekly meeting involving specialists from the whole trust including radiologists, pathologists and oncologists as well as surgeons and specialist cancer nurses to agree the best treatment plan

Following surgery, patients may need reconstructive surgery to rebuild damaged or surgically removed areas, or specialised dentistry to restore or help preserve the dentition after the tumour has been treated. We have a team of consultants that specialise in dental restoration techniques, prosthetics and reconstructive surgery that will help to provide the best treatment outcome for each individual patient.

UHCW is committed to raising awareness of head and neck cancers, and dedicated a month-long campaign in May to doing so. They held web chats with various specialists at the Trust, including myself, and tweeted facts and figures about the cancers so people are more aware of what to look out for.

Keep in touch with the UHCW to find out more: uhcw.nhs.uk