The above are some of the early warning signs of Head and Neck Cancers (HNCs) including cancers of the mouth, lips, throat, larynx (voice box), nose, and salivary glands. “There is a serious lack of awareness that HNCs are part of the leading cancers in incidence and cause of death and disability, in most parts of the world,” says Professor Jos Hille, Oral and Head & Neck Pathologist at the NHLS (Tygerberg Hospital) and honorary secretary of the South African Head & Neck Oncology Society (SAHNOS). “Many HNCs escape proper reporting to cancer registries. We estimate that the annual global incidence exceeds 680 000 with a death rate over 350 000.”
The Discovery Health shares global concerns around the lack of awareness and high incidence of debilitating and often lethal HNCs. “In 2016, these cancers were the 11th most common solid tumour cancers amongst members and 6th most common cancers among male members,” says Discovery Clinical Specialist Dr Sandile Mhlongo. “Discovery Health Medical Scheme funded over R110 million in 2016 for treatment for Head and Neck Cancer, this included radical head & neck surgery, chemotherapy as well as treatment with specialised radiation therapy which usually costs between R 95 000 and R130 00 for five to seven weeks of treatment.”
“Most people associate tobacco and alcohol (ab)use with lung cancer and heart diseases,” explains Professor Hille. “Yet tobacco and alcohol (which enhances the carcinogenic effect of tobacco) also cause oral and throat cancer.”
Moreover, what few people realise is that Human Papilloma Virus (HPV) infection, responsible for 99% of cervical cancers in women, is linked with cancer of the oropharynx (back of the tongue and the surrounding throat). “HPV is the most common sexually transmitted disease. Over 85% of sexually active adults have been exposed to the virus,” says Dr Marco Torres-Holmes, Ear, Nose and Throat surgeon (ENT) and member of the multidisciplinary head and neck surgical and rehabilitation team at Mediclinic Morningside in Johannesburg. “The more vaginal and oral sexual partners one has the more you are at risk of developing oropharynx cancer. The HP virus often hides in the tonsils and takes a good 20 years to cause a detectable tumour. In both the first and third world, sexual practices of past decades are fuelling the current spike in oropharynx cancers.”
HPV-caused head and neck cancer may be easily missed unless the patient or doctors are specifically looking for it. “Typically, the ENT is referred a patient from a GP – often a 55-year old or younger, non-smoking male. Various visual and manual examinations and imaging can locate the tumour and a knife or needle biopsy of any oral, throat or neck masses allow for the laboratory assessment of HPV status,” adds Dr Torres–Holmes. His team optimally plans treatment (often surgery followed by radiation therapy but sometimes radiation supplemented by chemotherapy) to minimise the inevitable complications like difficulties in chewing, swallowing, and permanent damage to vital structures of the mouth, throat and face. Much research is currently underway to establish why HPV-positive cancers show a somewhat better response to treatment than do cancers caused by smoking and alcohol use: 83% versus 57% five-year survival respectively.
Dr Torres Holmes praises the work of support group Face Value, which focuses on early detection and support for HNC patients and caregivers. Former business man Howard Butler, an HNC survivor and one of Face Value’s founders explains: “Earlier detection would have changed so much of my journey.” From 2010 to 2012 this smoker (who also drank in moderation), visited a host of mainstream and holistic medical practitioners in a desperate attempt to treat recurring and debilitating sinusitis. “I could not breathe when lying down so had to sleep sitting upright,” he recalls. Finally, an ENT saved his life by sending him for a CT-scan and diagnosing a naso-pharyngeal cancer. Howard has, since first diagnosis in 2012, had 62 sessions of radiotherapy and seven incidences of recurrent cancer over the last five years. He has lost all his teeth and the treatment has affected his thyroid and pituitary glands making hormone therapy compulsory for this cancer survivor.
Howard chooses to use his ordeal as a life-giving force: “My one passion has become early detection, and diagnosis. I personally know its value, the cost of failure and the keys to a good quality life after diagnosis,” says Howard.
Pre-sexually active girls have long been immunised against HPV to prevent cervical cancers. In the US and Australia young boys now receive the same vaccine. This is not yet policy in South Africa. “Unfortunately, there is no screening test for throat cancer,” says Dr Torres-Holmes. “Testing whether one has or had HPV does not predict the risk of getting a throat cancer, and is also not recommended.”
Conversely, most HNCs can be prevented by tobacco and alcohol cessation, or cured if detected very early – with some patients needing surgery alone. “HNC’s are generally very aggressive tumours which can carry a poor prognosis even after reaching a relatively small size and remaining undetected. Intermediate- and large-sized tumours are often fatal. Ignorance means millions of people suffer delayed diagnosis, inadequate treatment, inappropriate rehabilitation, horrible palliation and finally death,” explains Professor Hille.
The best preventative medicine for HPV-positive HNCs? “Practice excellent dental hygiene. Don’t smoke. Don’t drink. Practice abstinence until married and stay faithful in marriages. And, vaccinate your pre-sexually active children” says Dr Torres-Holmes.