February has been designated head and neck cancer awareness/prevention month and included under this broad heading are cancers of the lip, mouth (oral cavity), nose (nasal cavity), paranasal sinuses, brain, pharynx (the cavity behind the nose and mouth that connects to the oesophagus) and larynx (voice box). This group of cancers are strongly associated with certain environmental and lifestyle risk factors, including tobacco smoking, alcohol consumption, over exposure to the sun's ultra-violet rays, as well as certain strains of viruses, specifically the Human Papillomavirus (HPV). The awareness color for cancer of the head and neck is grey.
What is head and neck cancer?
The vast majority, 90 percent, of head and neck cancers are Squamous Cell Carcinomas. They begin primarily in the epithelium, the mucous lining of our mouth, nose and throat. Head and neck cancers are frequently very aggressive and often a second primary tumor develops.
Who is at risk for these cancers?
In general, these types of cancers occur most often in men at a rate of 66 to 95 percent. Factors which can significantly impact this incidence ratio include the location of the specific cancer, and the increasing numbers of female smokers. For example, the male to female ratio for oral and pharyngeal cancers is currently three to one. However, in patients with Plummer-Vinson Syndrome (a disease that occurs mainly in people with chronic iron deficiency anaemia), which causes difficulty in swallowing, due to small, thin growths of tissue that partially block the upper oesophagus (food tube), the position is reversed, with 80 percent of the cancers occurring in women.
The incidence also increases with age. Most patients are between 50 and 70 years. There are more women and fewer smokers in younger patients. Also, people with HPV-associated head and neck cancer tend to be younger -- in their 30s and 40s -- when first diagnosed.
In the United States (US), the incidence of laryngeal cancer is significantly higher in African Americans relative to white, Asian and Hispanic populations. Also in African Americans, this type of cancer is associated with lower survival for similar tumor stage. For example, the overall survival rate is 56 percent in whites versus 34 percent in African Americans. It is estimated that each year, over 1,700 new cases of HPV-associated head and neck cancers are diagnosed in women, and some 5,700 are diagnosed in men.
In 2011 alone in the US, approximately 39,400 men and women (27,710 men and 11,690 women) were diagnosed with cancer of their oral cavity and pharynx, and some 7,900 died as a result. Further, an estimated 12,740 men and women (10,160 men and 2,580 women) were diagnosed with laryngeal cancer and approximately 3,560 died. Additionally, most patients with head and neck cancer have metastatic disease at the time of diagnosis. That is, their cancer had already spread to other parts of their body.
The risk factors associated with head and neck cancers
There are a wide range of factors that can put an individual at greater risk for head and neck cancer. Lifestyle risk factors such as tobacco chewing and smoking (cigar and cigarette); irresponsible alcohol consumption; over exposure to the sun's ultraviolet (UV) rays; as well as dietary factors, such as a poor diet and/or the high consumption of processed and red meats are also associated with increased rates of head and neck cancers. Environmental risk factors include exposure to asbestos, textile fibers as well as prolonged exposure to wood dust and paint fumes. Cigarette smokers have a lifetime increased risk for head and neck cancers that is increased five to 25 fold over the general population.
Additionally, the presence of gastroesophageal reflux disease (GERD), or acid reflux disease, has also been found to be a major contributing factor. In such cases, stomach acid flows up into the oesophagus and damages its lining, thus making the affected individuals susceptible to throat cancer.
Signs and symptoms of head and neck cancers
There are many factors that would cause an individual to seek professional help, and they can all be caused by something other than cancer. However the watchwords of the Cancer Society of The Bahamas (CSOB) are "early detection," so please check with your doctor or health clinic, early, if you are experiencing any of the following: Swelling in your neck that may or may not be accompanied with pain; Bleeding from your mouth; Persistent sinus congestion; Persistent bad breath -- even with good oral health care; Sore tongue; Painless ulcers or sores in your mouth that do not heal; Dark, red or white patches in your mouth that will not go away; Persistent earache; Unusual bleeding or numbness in your mouth; Lump or swelling in your lip, mouth or gums; Enlarged lymph glands (swelling) in your neck; Slurring of speech (if the cancer is affecting the tongue); Hoarse voice which persists for more than six weeks; Sore throat which persists for more than six weeks; Difficulty swallowing food, and change in diet or unusual weight loss.
Reduce your risk of developing head and neck cancers
The most effective primary prevention would be to avoid as many of the risk factors. Do not chew or smoke tobacco. If you engage in these activities, you should stop now. Do not drink alcoholic beverages, or limit your intake to two drinks daily for adult men over 18 years old or one drink for adult women. Apply protective sunscreen with a sun protection factor (SPF) of at least 15 with three stars, to the skin before going outdoors. Eat a nutritious, well-balanced diet daily that includes lots of leafy green vegetables, fruits, especially citrus fruits, complex carbohydrates such as sweet potatoes, cassava, pumpkin, etc., and fish. Also, drink lots of liquids such as water, coconut water, fruit juice, low fat milk, tea and coffee daily. Additionally, exercise daily, for at least a half hour.
You should also have regular, annual medical examinations, including annual dental examinations. Ensure that you get adequate sleep each night and time for relaxation each day. Limit your intake of foods such as hot dogs (which are high in nitrates); processed meats such as bacon and corn beef (which are high in sodium nitrate); donuts (made with white flour, sugar and hydrogenated oils, then fried at very high temperature); French fries (fried in hydrogenated oil at very high temperature), and chips, crackers and cookies (all made with white flour and sugar). Also limit your daily intake of salt, never adding any to your food at the table.
Should you experience one or more of the signs and/or symptoms outlined above, visit your doctor or health clinic right away
In secondary prevention, when diagnosed early, head and neck cancers can be treated more easily, and the chances for survival and a return to a normal productive life would be greatly increased. The goal of the CSOB is regular screening for prevention, early detection and effective treatment of all cancers.
Waiting for the results of a biopsy and listening to your doctor confirm your "worst nightmare", that you do have cancer must be one of the most devastating experiences for an individual to have. Fortunately, most often these days, this confirmation is quickly followed by the reassuring words: "It's in the early stage and we have a number of options to choose from, all with excellent/very good possible outcomes". Working together with the Cancer Society of The Bahamas, you can help to ensure that there are even more positive outcomes every time a diagnosis of cancer is confirmed.
oFor more information on the work of the CSOB, telephone 323-4441 or 323-4482 or visit the website at www.cancersocietybahamas.com.
Click here to read more at The Nassau Guardian
