Friday, July 27 is celebrated as the World Day of Head and Neck Cancer, an opportunity to raise awareness and inform the public about these cancers, sponsored by the International Federation of Head and Neck Oncology Societies (IFHNOS), the World Society that brings together all the Societies of Cervical and Facial Oncology.

Head and neck tumors are a group of neoplasms that originate mainly from the scaly cells of the tissues of organs such as lips, mouth, tongue, throat, larynx, pharynx, nasal cavities and paranasal sinuses, but also from salivary glands, thyroid gland, skin of the face and neck. They account for 20% of all malignancies in humans.

What are the risk factors for these cancers and how do we intervene today? We talk about this topic with Professor Giuseppe Spriano, Head of Otorhinolaryngology at Humanitas and Professor at Humanitas University, Member of the Board of IFHNOS and a reference person for this day in Italy.

 

Smoking, Alcohol, and HPV Infection

More than 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 (HPV) infection has also played a central role in recent decades: HPV infection has been observed in particular in patients with oropharynx cancer, especially HPV16.

“In the last ten years oropharynx 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 oropharynx 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 of HPV vaccination in Italy 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,” Professor Spriano explained.

 

Signs that should not be underestimated

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. These are often non-specific signs, which risk 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 examination with an otorhinolaryngologist to ascertain the nature of the disorder:

  • Neck nodule.
  • Pain in the tongue.
  • White or red patches at the level of the oral mucosa.
  • Sore throat.
  • Swallowing pain.
  • Voice lowering.
  • Monolateral nasal obstruction.

 

Treatment options and the role of robotic surgery

The choice of treatment depends on the type of neoplasm, the site and stage, but also on the general condition of the patient. In Humanitas the offer of the therapeutic path is the result of a multidisciplinary work, which involves several specialists. Surgery is generally the first choice treatment, 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 oropharynx tumors.

“In general, HPV-induced cancers occur in younger subjects compared to smoking cancers, which is important because for the younger patient, esthetic and functional need may be more important. Robotic surgery can respond to this by introducing – directly into the patient’s mouth – small mechanical arms that replicate the movement of the surgeon’s hands, removing the tumor through the mouth, without the need to resort to 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 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,” concluded Prof. Spriano.