How to fight head and neck cancer

April 7-14 is celebrated as Global Head and Neck Cancer Awareness Week. In the wake of this, an oncologist tells us how we can be better prepared to fight this disease.

Head and neck cancer is the sixth most common cancer in the world. In central Asia, it is the most common one.

Smoking, consumption of alcohol, and chewing of tobacco are the main causes. Human Papilloma Virus (HPV) infection is also a risk factor.

Persistent mouth ulcers, painful ulcerative lesion on the lip, a hoarse voice, dysphagia, and lump in the throat are the major symptoms.

The disease can be diagnosed by clinical examination, CT scan, MRI, and biopsy. After the diagnosis and staging of the disease, head and neck cancer is treated through surgery, radiotherapy, and chemotherapy.

In the early stages, the disease is mainly treated by surgery. In certain clinical situations, radiotherapy is the treatment of choice. Bulky tumours are generally best treated with a combination of surgery and radiotherapy. More than 60% of head and neck cancers are advanced locoregional diseases. 

The use of radiotherapy with concurrent chemotherapy has been demonstrated to be associated with survival advantage over radiotherapy alone.

Although platinum-based chemotherapy is a preferred choice of treatment for fit patients, targeted therapies for platinum-unfit patients come with good survival advantages. 

Recently, targeted therapies and immune-oncology drugs have also shown promising results in relapsed cases. 

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Immunotherapy keeps some advanced head and neck cancer patients alive for over three years

A new immunotherapy can greatly extend the lives of a proportion of people with advanced head and neck cancer, with some living for three years or more, a major new clinical trial reports. 

Overall, the drug pembrolizumab had significant benefits for patients, with 37 per cent of patients who received it surviving for a year or more, compared with only 26.5 per cent of those on standard care.

But the results were particularly exciting among the group of people who did respond to pembrolizumab—with a median length of response of 18.4 months, compared with five months for standard care.


The large international clinical trial was led by a team and involved 97 medical centres in 20 countries.

The drug was evaluated in a trial of nearly 500 patients with very advanced head and neck cancer that had spread around the body and had already become resistant to platinum chemotherapy, the first-line treatment for the disease. Some 247 patients were randomised to pembrolizumab and 248 to standard of care—chemotherapy or the targeted agent cetuximab.

When chemotherapy or targeted therapies stop working, treatment options for people with advanced head and neck cancer are limited, and they are normally expected to survive for less than six months.
Patients on the trial who received pembrolizumab survived for a median of 8.4 months with pembrolizumab, and 6.9 months with standard treatment.

But a minority of patients responded extremely well to pembrolizumab—36 patients saw their cancer partially or completely disappear, and some are still cancer free three years after first receiving the drug.

Pembrolizumab also caused fewer serious side-effects than currently approved drugs—13 per cent of people who received the immunotherapy experienced serious side-effects, compared with 36 per cent of people given standard treatment.

Researchers hope pembrolizumab could be a much needed smarter, kinder treatment option for people with advanced head and neck cancer.

Pembrolizumab works by taking the brakes off the immune system's ability to attack cancer cells, and is already approved for use in some people with lung cancer, skin cancer and lymphoma.

Professor  said: "Head and neck cancer is extremely hard to treat once it comes back or spreads, and the outlook for patients once other therapies have stopped working is very poor." 

"Our findings show that the immunotherapy pembrolizumab extends the life of people with advanced head and neck cancer overall, and in a group of patients has really dramatic benefits. It is also a much kinder treatment than those currently approved.

"I would like to see pembrolizumab approved for use in the clinic, so that people with advanced head and neck cancer can be offered the chance of a longer life and improved quality of life. There is also an urgent need to work out how we can identify in advance which patients are likely to benefit, given that some of these people may do much better than they do on standard treatment."

Professor  said:"Immunotherapies are already revolutionising treatment for several cancer types, and I am excited to see the new drug pembrolizumab now showing benefit in advanced head and neck cancer."

"The next big challenge is to design immunotherapies that can work for many more people, so that more patients can benefit from the kinds of dramatic responses that we saw in some patients in this trial."
A, 69 year old man, is alive and well after two years of treatment on the pembrolizumab trial . He said:"I was first diagnosed with cancer of the larynx back in 2011 but quickly went into remission after having standard treatments. I went back to enjoying my retirement, until I started having symptoms again, like coughing up blood, in January 2014. I thought it was the reoccurrence of the same cancer, but it turned out three or four tumours had spread to my right lung. I was told I had squamous cell carcinomas of the head and neck, which was inoperable and probably incurable. "The standard treatments of radiotherapy and chemotherapy weren't really doing much for me this time around. My tumours were still getting larger and I was told there wasn't much more the doctors could do.

"I was really lucky to get a place on the pembrolizumab trial and started treatment in May 2015. I traveled down from my home every three weeks for two years. My tumour was shrinking all the time and I felt a bit better every time I went—it made a huge difference to my life and I was able to return to normality.

"Now I have CT scans every nine weeks, which are still showing stable disease and slight tumour shrinkage each time. It's remarkable how I've responded to the drug and I don't think I'd be here without it."

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Cancer-causing virus can lurk in your throat

It has come to light that cancer causing virus may hide in small pockets on the surface of tonsils in throats of unsuspected people.

The virus known as Human Papilloma Virus (HPV) is the culprit behind cervical and some form of head and neck cancer.

The new study, carried out by researchers , claimed to be pivotal for the prevention of oropharyngeal cancers, i.e. tonsils and tongue cancers.

The study noted that by mid-adulthood, most people have been exposed to HPV. The same strains that are known to cause cervical cancer, mainly HPV 16 and 18, cause head and neck cancers.

While verified tests exist to detect HPV in people before they develop cervical cancer, the same cannot be said for HPV-related head and neck cancers, which are expected to outnumber cervical cancer cases by 2020.

Only about five percent of HPV-infected people will develop cancer of the mouth or throat, suggesting most people's immune systems can easily hold back HPV infections.

Associate professor of Otolaryngology and Neurosurgery , found HPV encased in biofilm inside pockets on the tonsil surface, called tonsil crypts, which is where the HPV-related head and neck cancers often originate.

The study co-author and an Otolaryngology resident , studied tissue samples from 102 patients who had elective tonsillectomies.

Five of those samples contained HPV and four contained high-risk strains, HPV 16 and 18. In every case, HPV was found in tonsil crypts biofilm.

The group claimed to believe that HPV is shed from the tonsil during an active infection and gets trapped in the biofilm, where it may be protected from immune attack. In the crypts, the virus likely lays in wait for an opportunity to reinstate infection or invade the tonsil tissue to develop cancer.

"Given the lack of universal HPV immunization and the potential for the virus to evade the immune system even in individuals with detectable HPV in their blood, our findings could have far-reaching implications for identifying people at risk of developing HPV-related head and neck cancers and ultimately preventing them," Miller said.

Now, the team plans to further investigate potential screening tools, such as an oral rinse, to detect HPV in the mouth and throat. The next step would be to develop topical anti-microbials that would disrupt the biofilm and allow the immune system to clear the virus.

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Head and Neck Cancers Are on the Rise— Young Men Are at Risk

You’ve probably heard of human papilloma virus/ HPV,  which is the most common sexually transmitted infection .

For a long time, experts knew that HPV could raise a woman’s risk for cervical cancer. But there didn’t appear to be much risk for HPV-infected men. That’s changed. New research shows HPV is fueling a massive spike in oropharyngeal (head and neck) cancer among men. And surprisingly, some doctors say this form of cancer is showing up more and more among guys in their 20s and 30s.

“Traditionally, we thought of head and neck cancers as mostly due to excessive smoking and drinking,” says  an assistant professor of otolaryngology, as well as a surgeon.

Dr.  says that in the past, these cancers tended to show up during a man’s 50s, 60s, and beyond. “But for the past 20 years, we’ve seen those smoking- and drinking-related cancers go down, while HPV-related cancers have gone up,” he says.

At the same time, he says his patient population has shifted. “We’re seeing a lot of men in their 30s, and some even in their 20s, coming in with cancer at the base of their tongue, on their tonsils, and in their throat,” he says.

One recent study found the incidence of HPV-related oropharyngeal cancer jumped 225% between 1988 and 2004. In fact, this type of head and neck cancer is now the fastest growing form of cancer in young men. Another concerning study from 2014 points to a big jump in oropharyngeal cancers among men in their 30s and early 40s.

So how does HPV cause cancer? In a nutshell, some strains of the HPV virus can shut down genes in the cells of your head and neck that suppress the growth of cancer cells, Dr. explains.

“The human body, all the time, is trying to make cancer, but usually there are genetic safety mechanisms in place to keep cancer cells from proliferating,” he explains. “When you get a virus like HPV, it can turn off some of those mechanisms, and so allow cancer to proliferate.”

Signs of Cancer

The cancer is often diagnosed when "someone will come in with a big neck mass or mass on their tonsils or pain in the throat,” Dr.  says. Once other causes are eliminated—common stuff like mono or tonsillitis, or enflamed lymph nodes due to a cold—a doctor can take a biopsy from the guy’s throat or tongue to check for cancer cells. If cancer is identified, the treatment could involve surgery, radiation, chemotherapy—or all three, Dr.  says.

The good news: “The young men we treat usually respond really well,” he says. There may be some chronic after-effects—stuff like dry mouth, sore throat, or issues swallowing—but the disease isn’t typically fatal, he adds.

Roughly 43 percent of men aged 18 to 59 are infected with some form of HPV,says a report. “HPV is so common that nearly all sexually active people get it at some point in their lives,” .

Dr.  says rates of HPV infections have been rising for decades, partly because there’s no way to tell if you’re infected. There are no obvious symptoms or red flags, so people spread it without realizing it.
But just because you may be infected with HPV doesn’t mean you have to freak out about cancer. 

Again, there are different forms of the HPV virus, and only a few of them seem to promote head and neck cancers, Dr.  says.

“About 7 percent of people carry the HPV virus that causes these cancers, but only 1% of those carriers develop cancer,” he adds.

It’s the fastest growing cancer, but your relative odds of contracting lung cancer or prostate cancer are still far greater, a report says.

There’s an effective vaccine against HPV, and taking it can cut a young person’s risk for oral HPV infections by 88 percent, according to a recent study.

But if you’re over 21 or have been sexually active for a while, the study doesn't recommend the vaccine. “It tends not to work as well if you’re older,” Dr. says. “It’s usually recommended for kids prior to age 12.”

Using a dental dam or a condom during oral sex may be one way to limit your risks. “We think oral sex raises the likelihood you’ll get it,” he says. “If semen or vaginal fluids are going in the throat and touching those tissues, that could lead to the infection.” If your partner is female, you could ask them to get an HPV test. But a negative test doesn't ensure your partner isn't carrying the virus, and there is no HPV test for men, according to researchers.

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As of right now, there’s no way to have yourself screened for head and neck cancers in order to identify them early. “That would be incredibly painful, and we would never do it unless there was a mass or pain, or something to indicate the presence of existing cancer,” Dr.  says.

“I wish I had a better solution, but there’s really nothing you can do right now to protect yourself, other than limiting your number of sexual partners, which is easier said than done,” he adds.

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