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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New way to remove toxic mercury from drinking water can be reused many times

Considering mercury is highly toxic, it not only needs a whole lot of caution when handling or disposing it, it can also be quickly absorbed by the skin or lungs if inhaled. No amount of boiling can remove Mercury from water, but a new study proposes a radically different way to filter it from contaminated water.

The filtering works using electrochemistry — chemical interactions where electricity is used to move electrons from one atoms or molecule to another. Much like the positive and negative electrodes in a battery, a platinum electrode is dipped into the contaminated water as electricity is run through the electrode.

The surface of the platinum rod can attract a large number of mercury or other heavy metal atoms. Platinum, which is a noble, unreactive metal under normal circumstances, forms an alloy with mercury atoms when electricity is involved in the process. The contaminated water gets progressively cleaner as more mercury from the water is taken up with the platinum to form an alloy. The alloy, being very stable, doesn’t allow mercury to re-enter the water.

Mercury can find its way into our water supply quite easily. The largest source of mercury in water supply is from discarded devices that contain the heavy metal being throw away without taking extra safety measures. Heavy metals can trickle into water bodies and spread over larger areas very quickly.

Not only is this effective in ridding water of mercury, it can also be re-used, making it a scaleable concept for commercial water purifiers.

“Another great thing with our technique is that it is very selective. Even though there may be many different types of substance in the water, it just removes the mercury,”  author of the study said.

“Therefore, the electrode doesn’t waste capacity by unnecessarily taking away other substances from the water.”

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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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