Head and neck cancers: Know your risks

How much do you know about these cancers? And when last did you undergo cancer screening for them?

Would you ignore any of the following symptoms for longer than a month?

• A red or white patch in the mouth that does not heal
• A lump or bump or mass in the head or neck area - with or without pain
• A persistent sore throat, hoarseness, difficulties in swallowing
• Nasal obstruction and difficulty breathing or persistent nasal congestion, particularly single-sided
• Sudden loosening of teeth (or dentures that no longer fit)
• Chronic bleeding from the mouth or nose
• Chronic earache
• Tingling or numbness of part of the head

The above, are some of the early warning signs of head and neck cancers (HNCs) including cancers of the mouth, lips, throat, larynx (voice box), nose, and salivary glands.

"There is a serious lack of awareness that HNCs are part of the leading cancers in incidence and cause of death and disability, in most parts of the world," says Professor Jos Hille, Oral and Head & Neck Pathologist at the NHLS (Tygerberg Hospital) and honorary secretary of the South African Head and Neck Oncology Society (SAHNOS). "Many HNCs escape proper reporting to cancer registries."

According to the American Cancer Society's publication, Cancer Facts & Figures 2022, an estimated 562 328 people were diagnosed with head and neck cancers worldwide, in 2020 - a year during which there was an average drop of 90% in cancer screening in the United States, according to the Epic Health Research Network.

Which lifestyle behaviours put you at risk of head and neck cancers (HNCs)?

Globally, concern is growing around the lack of awareness and increasing incidence of these potentially debilitating cancers. "Most people associate tobacco and alcohol abuse with lung cancer and heart diseases," explains Prof. Hille. "Yet tobacco and alcohol (used together, alcohol enhances the carcinogenic effect of tobacco) also cause oral and throat cancer. And what few people realise is that Human Papillomavirus (HPV) infection, responsible for 99% of cervical cancers in women, is linked with cancer of the oropharynx (back of the tongue and the surrounding throat)."

"HPV is the most common sexually transmitted disease. Over 85% of sexually active adults have been exposed to the virus," says Dr Marco Torres-Holmes, Ear, Nose and Throat surgeon (ENT) and member of the multidisciplinary head and neck surgical and rehabilitation team at Mediclinic Morningside in Johannesburg. "The more vaginal and oral sexual partners one has, the more you are at risk of developing oropharynx cancer. HPV often hides in the tonsils and takes a good 20 years to cause a detectable tumour in some patients. In both the first and third world, sexual practices of past decades are fuelling the current spike in oropharynx cancers."

Prof. Hille adds that it has now been officially recognised that tongue cancer is linked to chronic irritation resulting from habitual biting and long-term irritation from sharp teeth, broken fillings, and ill-fitting dentures.

HPV-linked head and neck cancers (HNCs) - easily missed unless you're looking for it

Dr Torres- Holmes explains that typically a patient, often a non-smoking male, 55 years of age or younger, is referred from the GP to an ENT. Various examinations and imaging are undertaken to locate the tumour and to biopsy the tissue for the laboratory to determine the nature of the mass and HPV status.

His team would then optimally plan treatment (often radiation supplemented by chemotherapy but sometimes surgery followed by radiation therapy or surgery alone) to minimise some expected complications such as difficulties in chewing, swallowing, and permanent damage to the mouth, throat, and face.

Preventive screening makes for an excellent prognosis

Head and neck cancer can be difficult to diagnose because symptoms are often mild and can mimic less serious conditions. The positive aspect of these diseases is that they are treatable if caught early enough. Your best chance of survival depends on early diagnosis, which is why regular cancer screening is so important.

It is recommended that if you drink alcohol regularly, use tobacco products, or have used tobacco products in the past, you should undergo a general health screening examination for head and neck cancer at least once a year. During this screening, your healthcare provider will examine your nose, mouth, and throat for abnormalities and will feel for lumps in your neck.

If anything concerning is found, further tests will be recommended, which can include:

• An endoscopy that examines your voice box, throat, nasal cavity, or other areas where you are experiencing symptoms.
• Laboratory tests on blood, urine, or other body samples.
• Head and neck X-rays, CT scans, MRIs or PET scans that capture visuals of the areas inside your head and neck.
• A biopsy during which a small sample of tissue is removed for a pathologist to study under a microscope. (This is the only sure way to diagnose cancer.)

Further information on the above tests can be found here.

Keeping up with your health checks gives you access to additional screening cover

When you and the family members on your plan all complete a Health Check, you will automatically gain access to the Discovery Health Medical Scheme WELLTH Fund, which makes screening more accessible and convenient than ever before.

The correct screening and prevention behaviour, through completing a Health Check, will be rewarded through the activation of the Discovery Health Medical Scheme WELLTH Fund. This is a once-in-a-lifetime benefit that covers a comprehensive list of discretionary healthcare services for all scheme members, in addition to the cancer screening which is already covered by the Screening and Prevention Benefit.

With a maximum provision of R10 000 per family being made available for use for a wide range of screening services, understanding your health status is now more affordable too.

For more about the WELLTH Fund, what it covers and how to unlock it, read here.

Most HNCs can be prevented by avoiding tobacco and excess alcohol use. The best preventative medicine for HPV-positive HNCs? "Practice excellent dental hygiene. Maintain a good dental condition. Don't smoke. Don't drink. Practice abstinence until married and stay faithful in marriages. And vaccinate your pre-sexually active children," concludes Dr Torres-Holmes.

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