Your 10 must-know facts about Head and Neck cancers

Did you know that in 2018, it was estimated that there would be over 650,000 new cases of HNCs diagnosed world-wide? The World Health Organization reports that the annual, global incidence of HNCs is more than 550,000 cases with around 300,000 deaths each year.

These common lifestyle habits, in particular, put you at risk of these cancers:

1. Tobacco use, whether from smoking or chewing tobacco/betel quid (which causes mouth cancer) increases your risk of a HNC 15-fold
2. Alcohol use is a risk factor on its own, but people who use both tobacco and alcohol are at even greater risk than people who use only one or the other
3. Multiple oral sexual partners put you at significant risk of acquiring the human papillomavirus (HPV). This virus is responsible for the rise in cancers of the oropharynx (tonsils and base of tongue) in younger people who are non-smokers. The more oral sex partners that someone has, the greater the risk of HPV-associated throat cancer.

Ready for Oral, Head and Neck cancer awareness week SA?

• This year, Global Head and Neck cancer awareness week runs from 8 to 15 April 2019. Keep reading to find out more about a free HNC screening event on 10 April 2019 and 26 July 2019, for Gauteng residents.

“We don’t have proper statistics on the incidence of these cancers in South Africa, nor a central registry for these cancers. Unlike more common cancers (breast, prostate or colon), there is no population-wide screening process for HNC,” says Head and Neck Surgeon, Dr Johann Kluge, who works in both the private (Life Groenkloof Hospital) and public healthcare sectors (Steve Biko Academic Hospital) in Pretoria. “So, it is critical that we raise public awareness around these cancers.” Since 2018, Dr Kluge has conducted screening days for HNC, also registering ‘Oral Head and Neck cancer awareness week SA (OHANCAWSA)’ to bring together colleagues in both the private and public healthcare sectors (through the University of Pretoria), to be able to determine accurate South African statistics around local HNC incidence. These HNC screening days are accredited by the International board of OHNCAW, USA.

“There is also under-reporting of many cases in many countries in Africa,” adds Ear, Nose and Throat Surgeon (ENT), Professor Christopher Joseph who is also the current President of The South African Head and Neck Oncology Society (SAHNOS) and is based at Morningside Mediclinic in Sandton, Johannesburg. “But it would seem that the incidence of these cancers – which account for up to 5% of all cancers that present globally - is on the rise in sub-Saharan Africa.”

• Access Dr Johann Kluge’s handy brochure on HNCs here.

10 must-known facts about Head and Neck cancers

1. Head and neck cancers refer to many types of cancers, including those that arise in the tonsils and oropharynx (throat), nasal cavity, sinuses – the symptoms for which include frequent nose bleeds, numbness in a cheek, facial swelling and pain as well as a lack of response to repeated antibiotics course. HNCs also include cancers of the lips, mouth, voice box (larynx), thyroid and salivary glands. These cancers can spread to the lymph nodes of the neck after which the cancer is likely to spread to the rest of the body (lungs, liver and, rarely, the brain). Most thyroid cancers respond very well to treatment.
2. Further symptoms of HNCs include sores in the mouth that don’t heal, lumps or patches in the mouth, trouble swallowing, changes in the voice or hoarseness that lasts longer than two weeks, lumps in the neck and red or white patches in the mouth. “If your symptoms persist more than two to three weeks, or if you have any lumps in the mouth or throat area, then you should be referred to an ENT,” says Prof. Joseph.
3. Pain cannot be your guide as to the seriousness of symptoms: “Feeling pain may take you to a doctor sooner, but these cancers can be painless,” explains Prof. Joseph. “A painless but persistent symptom must be checked soonest.”
4. Early-presenting HNCs are widely treatable. The problem with HNCs is that 66% percent of the time, they will be found as late stage making them far more difficult to treat, and a patient’s prognosis far worse. Treatment can cause morbidity, with severe implications, from the removal of parts of the tongue, jaw and teeth or even the larynx (voice box) as a whole. “This can lead to consequences such as speech impairment, difficulty eating, drinking, swallowing and speaking.” explains Dr Johann Kluge. “Patients need to know when to seek help. Their healthcare providers - whether a General Practitioner or Registered nurse etc. - must know what to look out for and to refer a patient on to a Specialist of the Head and Neck region, the moment there are worrying signs of a HNC.”
5. Only specialists have the equipment needed to properly diagnose an HNC: “If a patient presents, for example, with an ulcer of tongue and doesn’t respond to antibiotics, this must be referred to an ENT to exclude cancer and to catch any malignancy early,” says Prof. Joseph.
6. “Men who have never smoked but who have had five or more oral sexual partners have a 7.4% percent prevalence of oropharyngeal HPV infection. The highest incidence of infection – up to 15% - is present among men who have smoked and also have a history of five or more oral sexual partners,” says Dr Kluge. “The incidence of HPV-positive HNC is exploding globally. In leading USA- and UK-based hospitals, around 90% and 50% respectively, of all oropharyngeal cancers are HPV-positive. OHANCAWSA aims to shine light on SA trends,” adds Prof. Joseph. “Personally, I am seeing an increasing number of patients - people as young as in their 40s with oropharyngeal cancer as a result of HPV,” says Dr Kluge. “The virus can take up to ten years to present as a HNC, so they would have acquired it in their 30s. It’s critical that we pay attention to this risk factor in SA where our HIV incidence is high - as HPV is sexually transmitted.” When caught early, these cancers have a better chance of responding to Chemoradiation than non-HPV linked HNCs, but these odds diminish for smokers. “Immunising both male and female children and teens against the cancer-causing strains of the HP virus, before they are sexually active, has been shown to reduce the incidence of HNCs and also cancers of the cervix in females,” adds Prof. Joseph.

   Vitality members aged 16 – 65, earn 2 500 points in the year of their Pap smear  and for two years thereafter. Vitality members aged 9 - 25 also earn 1000 Vitality points for having the cervical cancer vaccine. Find out more here.

7. Multidisciplinary medical teams should surround a patient: Dr Kluge, who is part of two such teams in private and public healthcare sectors, says, “We meet every second Thursday to present our patient cases to a panel of colleagues including surgeons, radiologists, chemotherapists and radiotherapists, pathologists, physicians, speech and swallowing therapists, physiotherapists, prosthodontists and orthodontists. Together we establish individualised patient-management plans for each patient. This approach aligns to global standards of HNC care.” Prof. Joseph founded the Sandton Head and Neck Forum and adds, “Our team has 25 specialists and five allied professionals for the full treatment cycle and rehabilitation of head and neck cancer patients.”
8. Patient treatment plans depend on staging: Surgery and radiation therapy are the most common treatments for HNCs and chemotherapy is used as an adjunct to these, or in the case of advanced disease. “We develop a treatment plan linked to the staging (how advanced the cancer is) and site of origin,” says Prof. Joseph. “Generally late-stage HNCs (beyond stage 3 and 4) will need a combination of treatment modalities. Early stage cancers (stage 1 or 2) usually respond to a single modality therapy – either chemotherapy, surgery, radiation. The exception is HPV-positive oropharyngeal cancers as they do very well with both chemotherapy and radiation – if they are not also underpinned by tobacco and alcohol use, in which case the prognosis worsens.”
9. Occupational risk factors can also cause HNCs, sometimes presenting as long-term blockage in the sinuses, where people have been exposed long-term to particles from dust, glue, certain heavy metals, radium, asbestos, some synthetic fibres, or to nickel and formaldehyde. “Radiation exposure also causes damage to the thyroid,” adds Prof. Joseph.
10. The Epstein Barr virus, responsible for causing glandular fever or infective mononucleosis, is also a risk factor for a form of HNC called nasopharyngeal cancer (referring to the space behind the nose).

Free HNC screening: 10 April and 26 July 2019

Over 400 South African and international healthcare facilities have joined forces to screen people, free of charge this year, over the 2nd South African Oral, Head & Neck Cancer Awareness Week, taking place from 8 to 15 April, worldwide. The Universities of Pretoria (UP) and MEDUNSA will participate in offering free screening:

• on 10 April 2019 at Menlyn Maine, Pretoria, from 09:00 to 16:00
• on 26 July 2019 at the Steve Biko Academic Hospital, Pretoria from 08:00 to 15:00

For more information about these screening events visit screening events visit the OHANCAWSA Facebook page or Dr Kluge’s Facebook page.