Definition

The term head and neck cancer refers to a group of cancers found in the head and neck region. This includes tumors found in:

—      The oral cavity (mouth): the lips, the tongue, the teeth, the gums, the lining inside the lips and cheeks, the floor of the mouth (under the tongue), the roof of the mouth, and the small area behind the wisdom teeth are all included in the oral cavity.

—      The oropharynx: includes the back one-third of the tongue, the back of the throat, and the tonsils.

—      Nasopharynx: includes the area behind the nose.

—      Hypopharynx: the lower part of the throat.

—      The larynx (voice box, located in front of the neck in the region of the Adam’s apple): in the larynx, the cancer can occur in any of the three regions—the glottis (where the vocal cords are); the supraglottis (the area above the glottis), and the subglottis (the area that connects the glottis to the windpipe).

The most frequently occurring cancers of the head and neck area are oral cancers and laryngeal cancers. Almost half of all the head and neck cancers occur in the oral cavity, and a third are found in the larynx. By definition, the term “head and neck cancers” usually excludes tumors that occur in the brain.

Description

Head and neck cancers involve the respiratory tract and the digestive tract, and they interfere with the functions of eating and breathing. Laryngeal cancers affect speech. Loss of any of these functions is significant. Hence, early detection and appropriate treatment of head and neck cancers is of utmost importance.

Roughly 10% of all cancers are related to the head and the neck. For cancer of the pharynx and oral cavity, there was an estimated 30,200 new cases in 2000. Incidence rates are highest in women and men over age 40, and more than twice as high in men as in women. The rates of oral cancers and deaths due to this cancer have been declining.

Among the major cancers, the survival rate for head and neck cancers is one of the poorest. Less than 50% of the patients survive five years or more after initial diagnosis. This is because the early signs of head and neck cancers are frequently ignored. Hence, when they are first diagnosed, these types of cancers are often in an advanced stage and not very amenable to treatment.

The risk for both oral cancer and laryngeal cancer seems to increase with age. Most of the cases occur in individuals over 40 years of age, the average age at diagnosis being 60. While oral cancer strikes men twice as often as it does women, laryngeal cancer is four times more common in men than in women. Both diseases are more common in African Americans than among Caucasians.

Causes and symptoms

Although the exact cause for these cancers is unknown, tobacco is regarded as the single greatest risk factor: 75–80% of the oral and laryngeal cancer cases occur among smokers. Heavy alcohol use has also been included as a risk factor. A combination of tobacco and alcohol use increases the risk for oral cancer by six to 15 times more than for users of either substance alone. In rare cases, irritation to the lining of the mouth, due to jagged teeth or ill-fitting dentures, has been known to cause oral cancer. Exposure to asbestos also appears to increase the risk of developing laryngeal cancer.

In the case of lip cancer, just like skin cancer, exposure to sun over a prolonged period has been shown to increase the risk. In the Southeast Asian countries (India and Sri Lanka), chewing of betel nut has been associated with cancer of the lining of the cheek. An increased incidence of nasal cavity cancer has been observed among furniture workers, probably due to the inhalation of wood dust. A virus (Epstein-Barr) has also been shown to cause nasopharyngeal cancer.

Head and neck cancers are one of the easiest to detect. The early signs can be both seen and felt. The signs and symptoms depend on the location of the cancer:

—      Mouth and oral cavity: a sore that does not heal within two weeks, unusual bleeding from the teeth or gums, a white or red patch in the mouth, or a lump or thickening in the mouth, throat, or tongue.

—      Larynx: persistent hoarseness or sore throat, difficulty breathing, or pain.

—      Hypopharynx and oropharynx: difficulty in swallowing or chewing food or ear pain.

—      Nose, sinuses, and nasopharyngeal cavity: pain, bloody discharges from the nose, blocked nose, and frequent sinus infections that do not respond to standard antibiotics.

When detected early and treated appropriately, head and neck cancers have an excellent chance of being cured completely.

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There are three main types of treatment for head and neck cancer:

—      surgery

—      radiotherapy

—      chemotherapy

—      Two other treatments may sometimes be used:

—      photodynamic therapy (PDT)

—      biological therapies

Sometimes the treatment of head and neck cancers will involve two or more treatments combined together.

—      For most people, the treatment is aimed at:

—      removing the visible cancer

—      reducing the chances of the cancer coming back

Cancers affecting the head and neck are uncommon and therefore people with this type of cancer are usually treated in specialist cancer hospitals (centres). This may mean that you have to travel for your treatment.

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More than 55,000 Americans will develop cancer of the head and neck (most of which is preventable) this year; nearly 13,000 of them will die from it.

Find it early - and be cured

Tobacco is the most preventable cause of these deaths. In the United States, up to 200,000 people die each year from smoking-related illnesses. The good news is that this figure has decreased due to the increasing number of Americans who have quit smoking. The bad news is that some of these smokers switched to smokeless or spit tobacco, assuming it is a safe alternative. This is untrue-they are merely changing the site of the cancer risk from their lungs to their mouth. While lung cancer cases are down, cancers in the head & neck appear to be increasing. Cancer of the head and neck is curable if caught early. Fortunately, most head and neck cancers produce early symptoms. You should know the possible warning signs so you can alert your doctor to your symptoms as soon as possible. Remember-successful treatment of head and neck cancer can depend on early detection. Knowing and recognizing the signs of head and neck cancer can save your life.

Here’s what you should watch for:

A lump in the neck…

Cancers that begin in the head or neck usually spread to lymph nodes in the neck before they spread elsewhere. A lump in the neck that lasts more than two weeks should be seen by a physician as soon as possible. Of course, not all lumps are cancer. But a lump (or lumps) in the neck can be the first sign of cancer of the mouth, throat, voice box (larynx), thyroid gland, or of certain lymphomas or blood cancers. Such lumps are generally painless and continue to enlarge steadily.

Change in the voice…

Most cancers in the larynx cause some change in voice. Any hoarseness or other voice change lasting more than two weeks should alert you to see your physician. An otolaryngologist is a head and neck specialist who can examine your vocal cords easily and painlessly. While most voice changes are not caused by cancer, you shouldn’t take chances. If you are hoarse more than two weeks, make sure you don’t have cancer of the larynx. See your doctor.

A growth in the mouth…

Most cancers of the mouth or tongue cause a sore or swelling that doesn’t go away. These sores and swellings may be painless unless they become infected. Bleeding may occur, but often not until late in the disease. If an ulcer or swelling is accompanied by lumps in the neck, be very concerned. Your dentist or doctor can determine if a biopsy (tissue sample test) is needed and can refer you to a head and neck surgeon to perform this procedure.

Bringing up blood…

This is often caused by something other than cancer. However, tumors in the nose, mouth, throat or lungs can cause bleeding. If blood appears in your saliva or phlegm for more than a few days, you should see your physician.

Swallowing problems…

Cancer of the throat or esophagus (swallowing tube) may make swallowing solid foods difficult. Sometimes liquids can also be troublesome. The food may “stick” at a certain point and then either go through to the stomach or come back up. If you have trouble almost every time you try to swallow something, you should be examined by a physician. Usually a barium swallow x-ray or an esophagoscopy (direct examination of the swallowing tube with a telescope) will be performed to find the cause.

Changes in the skin…

The most common head and neck cancer is basal cell cancer of the skin. Fortunately, this is rarely a major problem if treated early. Basal cell cancers appear most often on sun-exposed areas like the forehead, face, and ears, although they can occur almost anywhere on the skin. Basal cell cancer often begins as a small, pale patch that enlarges slowly, producing a central “dimple” and eventually an ulcer. Parts of the ulcer may heal, but the major portion remains ulcerated. Some basal cell cancers show color changes. Other kinds of cancer, including squamous cell cancer and malignant melanoma, also occur on the skin of the head and neck. Most squamous cell cancers occur on the lower lip and ear. They may look like basal cell cancers and, if caught early and properly treated, usually are not much more dangerous. If there is a sore on the lip, lower face, or ear that does not heal, consult a physician. Malignant melanoma classically produces dense blue-black or black discolorations of the skin. However, any mole that changes size, color, or begins to bleed may be trouble. A black or blue-black spot on the face or neck, particularly if it changes size or shape, should be seen as soon as possible by a dermatologist or other physician.

Persistent Earache…

Constant pain in or around the ear when you swallow can be a sign of infection or tumor growth in the throat. This is particularly serious if it is associated with difficulty in swallowing, hoarseness or a lump in the neck. These symptoms are best evaluated by an otolaryngologist.

Identifying High Risk of Head and Neck Cancer

As many as 90 percent of head and neck cancers arise after prolonged exposure to specific factors. Use of tobacco (cigarettes, cigars, chewing tobacco or snuff) and alcoholic beverages are closely linked with cancers of the mouth, throat, voice box and tongue. (In adults who neither smoke nor drink, cancer of the mouth and throat are nearly nonexistent.) Prolonged exposure to sunlight is linked with cancer of the lip and is also an established major cause of skin cancer.

What You Should Do…

All of the symptoms and signs described here can occur with no cancer present. In fact, many times complaints of this type will be due to some other condition. But you can’t tell without an examination. So, if they do occur, see your doctor-and be sure.

REMEMBER: When found early, most cancers in the head and neck can be cured with relatively little difficulty. Cure rates for these cancers could be greatly improved if people would seek medical advice as soon as possible. So play it safe. If you think you have one of the warning signs of head and neck cancer, see your doctor right away.

BE SAFE: See your doctor early! And practice health habits which will make these diseases unlikely to occur.

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Head and neck cancer is the fifth most common cancer in the U.S. with an overall survival rate of approximately 40–50%. In an effort to improve patient outcomes, research efforts designed to maximize benefit and reduce toxicities of therapy are in progress. Basic research in cancer biology has accelerated this endeavor and provided preclinical data and technology to support clinically relevant advances in early detection, prognostic and predictive biomarkers. Recent completion of the Human Genome Project has promoted the rapid development of novel “omics” technologies that allow more broad based study from a systems biology perspective. However, clinically relevant application of resultant gene signatures to clinical trials within cooperative groups has advanced slowly. In light of the large numbers of variables intrinsic to biomarker studies, validation of preliminary data for clinical implementation presents a significant challenge and may only be realized with large trials that involve a significant patient numbers. The Radiation Therapy Oncology Group (RTOG) Head and Neck Cancer Translational Research Program recognizes this problem and brings together three unique features to facilitate this research; 1) availability of large numbers of clinical specimens from homogeneously treated patients through multi-institutional clinical trials, 2) a team of physicians, scientists and staff focused on patient-oriented head and neck cancer research with the common goal of improving cancer care, and 3) a funding mechanism through the RTOG Seed Grant Program. In this position paper we outline strategic plans to further promote translational research within the framework of the RTOG.

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PR Newswire Europe

COPENHAGEN, Denmark –Genmab A/S (OMX: GEN) announced today the initiation of a Phase III study of HuMax-EGFr(TM) (zalutumumab) to treat head and neck cancer in cooperation with the Danish Head and Neck Cancer Group (DAHANCA). The study will include approximately 600 previously untreated head and neck cancer patients to assess whether concomitant therapy with HuMax-EGFr can improve the efficacy of primary curative radiotherapy.

“We are excited for DAHANCA to begin the largest HuMax-EGFr trial to date,” said Lisa N. Drakeman, Ph.D., Chief Executive Officer of Genmab. “We hope that HuMax-EGFr provides additional benefit to head and neck cancer patients receiving radiotherapy.”

About the trial Patients in the study will be randomized to treatment with radiotherapy or HuMax-EGFr plus radiotherapy. All patients will receive treatment with accelerated radiotherapy plus nimorazole and may also receive cisplatin chemotherapy. Patients receiving HuMax-EGFr will receive six weekly doses of 8 mg/kg of HuMax-EGFr. Patients will be followed for at least 5 years and will be clinically evaluated at months 2, 5, 8 and 12 after completion of treatment. Evaluations will continue every 4 months in the second year and every 6 months the third and fourth year and once a year thereafter.

The objective of the study is to determine the efficacy of HuMax-EGFr in combination with radiotherapy in treating patients with squamous cell carcinoma of the head and neck. The primary endpoint is loco-regional control and secondary endpoints are overall survival, disease free survival and acute and late side effects.

Head and neck cancers may affect the mouth, nasal cavities, sinuses, larynx and pharynx. Most are squamous carcinomas but others include lymphoepithelioma and lymphoma. Head and neck cancers account for 3 % of all cancers in the U.S., with 40,000-60,000 cases diagnosed and 12,000 deaths annually. Worldwide incidence is about half a million with nearly 250,000 deaths.

Genmab is a leading international biotechnology company focused on developing fully human antibody therapeutics for unmet medical needs. Using unique, cutting-edge antibody technology, Genmab’s world class discovery and development teams have created and developed an extensive pipeline of products for potential treatment of a variety of diseases including cancer and autoimmune disorders. As Genmab advances towards a commercial future, we remain committed to our primary goal of improving the lives of patients who are in urgent need of new treatment options. For more information on Genmab’s products and technology, visit www.genmab.com

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At the Cedars-Sinai Head and Neck Cancer Center trained specialists use state-of-the art techniques for treating cancer, including:

—      Buccal Mucosa Cancer Surgery

—      Chemotherapy

—      Endoscopic transoral laser surgery

—      Floor of Mouth Cancer Surgery

—      Image-guided surgery

—      Minimally invasive parathyroidectomy

—      Neck Dissection

—      Salivary gland surgery (parotid gland, submandibular gland, sublingual gland)

—      Thyroidectomy

—      Tongue Cancer Surgery

—      Tonsil Cancer Treatments

In addition, Cedars-Sinai’s Head and Neck Cancer Center also offers a Tumor Board that meets monthly to review individual patient cases and provide recommendations on the most optimal treatment alternatives. The Tumor Board provides unparalleled expertise, allowing physicians to consult with a variety of specialists in one setting.

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Each year, about 40,000 people are diagnosed with a cancer of the head and neck - that part of the body that includes the mouth, nose, sinuses, ears, throat and neck. Head and neck cancers are life-threatening, complex diseases that can best be treated by a team of specialists in an advanced practice setting.

“Although the number of people who develop theses cancers is not huge, these diseases are often devastating,” said Dr. Clarence Sasaki, chief of otolaryngology at Yale-New Haven and the Charles W. Ohse Professor of Surgery at the Yale University School of Medicine. “Speech makes us unique as humans, and our faces are the signature of our individuality. Head and neck cancer attacks both.”

The Head and Neck Cancer Program at Yale-New Haven Hospital is in the vanguard for the techniques it has developed and introduced to treat people with head and neck cancers. Reconstructive surgeons perform surgeries that enable patients to continue to eat, swallow, speak and interact with others - without debilitating facial deformities that can result when cancerous tissue is removed.

“Many of the advances that have been introduced or developed at Yale-New Haven contribute to patient comfort and lifestyle,” said Dr. Sasaki.

One of several pioneering approaches to head and neck cancer developed at YNHH, sentinel node radiolocalization, is a minimally invasive technique that makes it possible to examine a patient’s lymph nodes - the part of the neck where cancer is most likely to spread - to determine what type of neck surgery, if any, is needed.

“Our primary goal is still eliminating the cancer, of course, but also we’re focusing on the quality of life by preserving swallowing and speaking functions and minimizing disfigurement,” said Dr. Sasaki.

A new issue of a Yale-New Haven publication, Ahead of the Curve, highlights the latest advancements available at the hospital’s Head and Neck Cancer Program which includes diagnosis, treatment, reconstruction, psychosocial support, pain management, rehabilitation and assistance in returning to life after cancer. To obtain a free copy of Ahead of the Curve or to learn more about the health care advances at the Head and Neck Cancer Program at YNHH, please call (203) 688.2000 or toll free 1.888.700.6543 or visit the Head and Neck Cancer Program

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Patients with head and neck cancer may have poorer functioning in some driving proficiency compared to healthy individuals, according to a preliminary study published in Archives of Otolaryngology-Head & Neck Surgery (JAMA/Archives), September issue.

The authors explain “Driving is a complex task that requires adequate cognitive, psychomotor and visuoperceptualmotor functions that work together. These functions can be compromised to a greater or lesser extent in patients with cancer in the head and neck region who have received cancer treatment.”

Cancer treatment is such that a patient’s head and neck mobility may be impede. Cancer treatment might also produce cognitive impairments, pain and psychological distress - exposing the driver to greater risks.

Hon K. Yuen, Ph.D., O.T.R./L., Medical University of South Carolina, Charleston, and team evaluated the driving skills of ten head and neck cancer patients, whose average age was 56, as well as 50 members of the community, whose average age was 48. They used a virtual reality driving simulator - the scientists monitored their average speed, break reaction times, how much their vehicles offset from the center of the driving lane (steering variability), total collisions and the Simulator Driving Performance Scale. The Simulator Driving Performance Scale assesses the driver’s driving behavior and skills.

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Most head-and-neck cancers that recur locally after prior full-dose conventional radiation therapy respond to Boron Neutron Capture Therapy (BNCT). These results were obtained in a Phase I/II study at the Helsinki University Hospital, Finland. The scientific director of the research program, professor Heikki Joensuu, University of Helsinki, considers the results clinically significant and very interesting. They open a new field for BNCT, since thus far BNCT has been evaluated only in the treatment of some brain tumours.

The follow-up results of 12 patients diagnosed with cancer of the head-and-neck and treated in a prospective clinical trial were reported in the International Journal of Radiation Oncology, Biology & Physics (online version available: http://www.redjournal.org/). All patients had cancer of the head-and-neck that had recurred locally after surgery and conventional radiation therapy. Ten out of the 12 patients had substantial tumour shrinkage following BNCT, and in 7 cases the tumour disappeared completely. Adverse effects of treatment were moderate and resembled those of conventional radiation therapy.

The study has been expanded, and up to 30 subjects will now be allowed to enter the study protocol.

Boron neutron capture therapy (BNCT) is a form of targeted radiation treatment for cancer. It is still considered experimental. In this method a boron-containing compound (boronophenylalanine) is first infused into a peripheral vein, following which the compound accumulates in cancer tissue. Cancer is subsequently irradiated with neutrons obtained from a nuclear reactor, which causes boron atoms to split within the cancerous tissue as a result from a boron neutron capture reaction. The resulting smaller particles cause a large radiation effect within the tumour tissue, which destroys cancer cells.

The technique allows targeting of a high dosage of radiation to the tumour while allowing sparing of the adjacent normal tissues from the highest doses of radiation. Boron-mediated targeting of radiation allows treatment of patients who can no longer be treated with conventional radiation therapy. BNCT is administered as single one-day treatment that may be repeated.

The study was sponsored by Boneca Corporation, the spinoff company operating on the medical campus of the Helsinki University and the University Central Hospital (http://www.boneca.fi/). The treatments are carried out in collaboration with the Department of Oncology, Helsinki University Central Hospital, at the BNCT facility constructed at the VTT research nuclear reactor site located at Otaniemi, Espoo. The neutron radiation used in the treatment is provided by VTT.

Boneca Corporation’s clinical research program includes also a phase I/II study that evaluates BNCT in the treatment of primary glioblastoma (a highly malignant brain tumour) and another clinical trial that assesses safety and efficacy of BNCT in the treatment of glioblastomas and anaplastic astrocytomas (a type of brain tumour) that have recurred after conventional radiation therapy.

“Our plan is to investigate BNCT in the treatment of cancers located elsewhere in the body that cannot be effectively managed by any known treatment,” says professor Heikki Joensuu.

“The current treatment is a result of a long period of research, a proof of academic expertise, and a model for effective collaboration between Helsinki University Central Hospital, University of Helsinki, VTT Technical Research Centre of Finland, and the company”, says Boneca Corporation’s managing director Markku Pohjola.

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Patients with head and neck cancer may have poorer functioning in some driving proficiency compared to healthy individuals, according to a preliminary study published in Archives of Otolaryngology-Head & Neck Surgery (JAMA/Archives), September issue.

The authors explain “Driving is a complex task that requires adequate cognitive, psychomotor and visuoperceptualmotor functions that work together. These functions can be compromised to a greater or lesser extent in patients with cancer in the head and neck region who have received cancer treatment.”

Cancer treatment is such that a patient’s head and neck mobility may be impede. Cancer treatment might also produce cognitive impairments, pain and psychological distress - exposing the driver to greater risks.

Hon K. Yuen, Ph.D., O.T.R./L., Medical University of South Carolina, Charleston, and team evaluated the driving skills of ten head and neck cancer patients, whose average age was 56, as well as 50 members of the community, whose average age was 48. They used a virtual reality driving simulator - the scientists monitored their average speed, break reaction times, how much their vehicles offset from the center of the driving lane (steering variability), total collisions and the Simulator Driving Performance Scale. The Simulator Driving Performance Scale assesses the driver’s driving behavior and skills.

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