Head and neck tumors represent 20% of all malignant neoplasms in humans and are mainly born from scaly cells of the tissues of organs such as lips, oral cavity, tongue, throat, larynx, pharynx, nasal cavities and paranasal sinuses, but also from salivary glands, thyroid, skin of the face and neck, and orbit. What are the main risk factors and how do you intervene? We discussed this topic with Professor Giuseppe Spriano, Head of Otorhinolaryngology at Humanitas and Professor at Humanitas University, Member of the Board of IFHNOS.
Risk factors
“In the last ten years oropharyngeal tumors have increased by 250%, especially in relation to their own increase in Papilloma virus infections. In Italy, there are about two thousand new cases of oropharyngeal tumors a year and the causes, smoking and HPV, cover 60% and 40% of cases respectively. In the United States this proportion is 15% and 85% and therefore in Italy we expect a further increase in the incidence of these tumors linked to human papilloma virus infection. This is the basis of the current availability in Italy of HPV vaccination not only for girls but also for males. Unfortunately, the reduction in incidence due to vaccination immunization will take decades and only after 2060 will these tumors decrease,” explained Professor Spriano. 70% of head and neck cancers are related to alcohol consumption and smoking. Alcohol and smoking are therefore two of the main risk factors for the onset of this group of neoplasms, especially those originating from the mucous membranes. Human Papilloma Virus infection also plays a central role in recent decades, particularly in patients with oropharyngeal cancer the presence of HPV infection has been observed, especially HPV16.
Diagnosis must be early
As with other types of cancer, early detection is valuable for head and neck cancer. Depending on the location of the onset, different symptoms may occur. Often these are non-specific signs, which are in danger of being underestimated because they are traced back to something else. In the presence of one of the following signals, which last for more than three weeks, it is advisable to undergo an otorhinolaryngological examination to ascertain the nature of the disorder:
- Neck nodule.
- Pain at the tongue.
- White or red patches at the level of the oral mucosa.
- Sore throat.
- Swallowing pain.
- Voice lowering
- Monolateral nasal obstruction.
- Epistaxis
Robotic surgery at the forefront of treatments
Surgery is generally the first choice treatment for this type of cancer, but chemotherapy, radiotherapy or a combination of the different options may also be indicated. In recent years, robotic surgery has also opened up new horizons in the otorhinolaryngology field, particularly in the treatment of oropharyngeal tumors.
“Generally, HPV tumors occur in younger subjects than smoking tumors – concluded Prof. Spriano – this is important because for the younger patient the aesthetic and functional need can have a greater weight. Robotic surgery can respond to this by introducing small mechanical arms that replicate the movement of the surgeon’s hands, removing the tumor through the mouth, without the need for external surgical access. This is where robotic surgery makes the difference compared to classical surgery, where the tumor was removed by opening the neck, lip, and jaw to reach the base of the tongue, where HPV tumors usually form. In fact, the virus is localized in the lymphatic tissue of the lingual tonsil or palatine, where it causes a chronic inflammation that can then evolve into cancer: 1% of people who have the virus then develop the tumor. The higher cost of robotic surgery is only apparent because it is compensated not only by aesthetic and functional advantages, but also by a reduction in hospital stay of about a third and a resumption of family and working life well in advance”.
