By – Dr. Tejinder Kataria, Chairperson Radiation Oncology & Cancer center, Medanta – The Medicity
Head and neck cancer (HNC) is the seventh most common cancer worldwide accounting for an estimated 888,000 new cases and 453,000 deaths. HNCs begin in the squamous cells of inner lining of surfaces and include cancers of the oral cavity, nasopharynx, oropharynx, hypopharynx, and larynx. Overall 57.5% of HNCs occur in Asia, with 30% of incidence reported from India. India has the highest oral cavity cancer burden with 1,19,992 new cases and 72,616 deaths. This seems to be related to the widespread use of tobacco in India.
Tobacco use has been identified as a key risk factor in 80 to 90% of patients. According to the recent Global Adult Tobacco Survey data, 42.4% of men, 14.2% of women, in India currently use tobacco. Tobacco use in India is characterized by a high prevalence of smoking and smokeless tobacco use, with a lot of people using both. Smoking tobacco can be either in the form of beedis, cigarettes, cigars, tobacco rolled in maize leaf and newspaper, hookah, pipes, chillum or chutta (reverse smoking with burning end of the beedi or chillum kept in the mouth) Smokeless tobacco includes tobacco leaf, betel quid with tobacco, khaini or tobacco lime mixture, gutkha, pan masala with zarda, gul, gudaku, and mishri.
Prevalence of tobacco use is quite high in Tripura with 64.5 per cent
The prevalence of tobacco use varies in different states ranging from 9.7% in Goa to 64.5% in Tripura.
Worldwide there is an emergence of Human Papilloma Virus(HPV) related oropharynx cancers but in India, still a large proportion of cancers are tobacco related. Alcohol is responsible for a certain percentage of floor of mouth (oral cavity) cancers and the highest incidence has been reported from France.
Head & neck cancer treatment includes radiation therapy, Surgery, chemotherapy, targeted medicines and immunotherapy. Early stage HNCs are curable with either Radiation or Surgery while advanced stages need Radiation along with chemotherapy for nasopharynx, larynx, oropharynx and hypopharynx cancer. The combination of Radiation & chemotherapy results in organ preservation treatment. For advanced oral cavity cancers Surgery followed by Radiation +/- chemotherapy is recommended.
In cases of elderly age group patients>70 years either targeted or immunotherapy along with Radiation is recommended. The goal of treatment for HNCs is to eradicate the cancer and preserve the aesthetics & functionality of this area. The functions that need to be preserved are speech, chewing, taste, swallowing and breaerences. The challenges in advanced disease are to have a proper reconstruction with a dedicated team of Head & neck and Plastic/Reconstructive surgeons.
The technique of 3-D printing has been deployed for the last 5 years at Medanta to fabricate near normal facial geometry with every effort towards preserving functionality. This is aided by precise Radiation, to preserve the salivary glands and bony architecture, using dedicated individualized planning and delivery of treatment with CT/MR/PET-CT based imaging. The main frame treatments are supported by a team of dental surgeons, nutritionists and rehabilitation staff for speech and swallowing therapy.