Updated Review of Head and Neck Cancer : Indian Scenario

UPDATED REVIEW ON HEAD AND NECK CANCER: INDIAN SCENARIO

Head and Neck Cancer (HNC) is very common in India and originates from squamous cells located in the mucosal epithelium inside the head and neck, including tumors of the oral cavity, nasopharynx, oropharynx, hypopharynx and larynx.

Symptoms:

HNC can manifest with various symptoms depending on the location and stage of the cancer. Some common signs and symptoms include swelling or lumps, pain, difficulty swallowing, changes in Voice, persistent sore throat, ear pain, difficulty breathing, unexplained weight loss, bleeding, and numbness

The incidence of HNC in India:

In India, the number of cancer cases is rising. According to GLOBOCAN 2020, there will be

2.1 million new cancer cases in India by 2040, an increase of 57.5% from the year 2020.

The all-site cancer incidence rate was 103.7 and 102.4 per 100,000 population for males and females, respectively. (Ref: e-Cancer, 2023)

The ASIR (Age-Standard Incidence Rate) for HNC was 25.9 (95% CI25.7-26.1) and 8.0 (95% CI79-8.1) per 100,000 population for males and females, respectively. The burden of HNC as compared to all-site cancer is mentioned Figure 2.

Risk Factors:

India has the highest number of oral cavity cancer patients in the world. This could be related to the widespread use of tobacco in India. Tobacco use has been identified as a risk factor in 80 to 90% of patients with oral cancer.

Tobacco use in India is characterized by a high prevalence of combustible (in the form of smoking) and smokeless tobacco use, with dual use also contributing a noticeable proportion.

Challenges in Diagnosis

One of the significant challenges in combating HNC in India is the late presentation of cases. Due to a lack of awareness, limited access to healthcare facilities in remote regions, and sociocultural beliefs, patients often seek medical help at advanced stages of the disease, reducing treatment options and chances of successful outcomes.

Prevention

• Avoiding consumption of tobacco (in any form) and alcohol is the best strategy for oral and head & neck cancer prevention.
• Maintenance of good oral hygiene
• Also, the HPV vaccine is now available that helps in the prevention of HPV-associate oropharyngeal cancer.

Survival Rates of HNC

According to the National Cancer Institute, the five-year survival rates for oral cavity and pharynx cancers are as follows:

• 83 percent, for localized cancer
• 64 percent, for cancer that’s spread to nearby lymph nodes
• Overall, 60 percent of all people with oral cancer will survive for five years or more. The earlier the stage at diagnosis, the higher the chance of survival after treatment.

 Treatment Modalities:

Treatment for head and neck cancer typically involves a multidisciplinary approach, including

• Surgery
• Radiation therapy
• Chemotherapy
• In recent years, advancements in medical technology have led to targeted therapies and immunotherapy
• A study in India has found that an ultra-low dose of the immunotherapy drug nivolumab helped people with advanced head and neck cancer live longer
• Proton therapy. Proton therapy can be added to a treatment plan to reduce the damage done to healthy tissue

Recent Updates:

De-escalation in HPV-Associated HNC: Updated results from the Quarterback trial, resented at ASCO 2023, showed that response to induction chemotherapy may be a reasonable way to select patients for dose-reduced chemoradiotherapy, but further randomized studies are needed to evaluate this approach.

Conclusion:

• Head and neck cancer continues to be a significant health concern in India,
• Addressing the risk factors through preventive measures, early detection, and ensuring access to quality healthcare services are pivotal in reducing the burden of this disease.

Dr. Rajat Saha
Sr. Consultant & Unit Head – Medical Oncology
RGCIRC, DelhiP

Frequently Asked Questions (FAQs)

What is the prevalence of head and neck cancer in India?

Head and neck cancer is a significant cancer burden in India, with oral cavity cancers being particularly common. Its prevalence is associated with factors such as tobacco use, alcohol consumption and other lifestyle and environmental risks.

What is the incidence of oral cancer in India?

India has one of the highest burdens of oral cancer globally. The high incidence is strongly associated with widespread use of tobacco, including both smoking and smokeless tobacco products.

How common is head and neck cancer in India?

Head and neck cancer accounts for a substantial proportion of cancer cases in India, particularly among men. The burden varies by cancer type, location and population, with oral cavity cancers contributing significantly.

What are the major risk factors for head and neck cancer in India?

Tobacco use is one of the major risk factors, particularly for oral cancer. Alcohol consumption, poor oral hygiene, certain HPV infections and prolonged exposure to other risk factors may also contribute to the development of head and neck cancers.

What are the common symptoms of head and neck cancer?

Symptoms may include a persistent lump or swelling, mouth sores that do not heal, difficulty swallowing, persistent sore throat, voice changes, ear pain, unexplained weight loss, bleeding, numbness or difficulty breathing.

Why is head and neck cancer often diagnosed at an advanced stage in India?

Limited awareness, delayed medical consultation, restricted access to healthcare in some areas and sociocultural factors can contribute to late diagnosis. Recognising persistent symptoms and seeking medical evaluation early can support timely diagnosis and treatment.

How can head and neck cancer be prevented?

Avoiding tobacco in all forms and limiting or avoiding alcohol are important preventive measures. Maintaining good oral hygiene, following a healthy lifestyle and getting HPV vaccination where appropriate may also help reduce certain risks.

What are the treatment options for head and neck cancer?

Treatment depends on the cancer’s location and stage and may include surgery, radiation therapy, chemotherapy, targeted therapy and immunotherapy. A multidisciplinary cancer team may combine different treatments according to the patient’s condition.

What is the survival rate of head and neck cancer?

Survival varies considerably depending on the cancer type, stage, location and response to treatment. In general, cancers diagnosed at a localised stage tend to have better outcomes than cancers that have spread to nearby lymph nodes or distant organs.

What recent advances are available for head and neck cancer treatment in India?

Recent developments include targeted therapies, immunotherapy, proton therapy and treatment approaches designed to reduce treatment-related effects in selected patients. These options are considered based on the cancer type, stage and individual treatment requirements.