Head & Neck Cancer Awareness Month: Combining Treatments to Create Best Outcomes
April is Head & Neck Cancer Awareness Month. This is a good time to learn about this group of cancers, as well as risk factors, prevention, symptoms, detection, and treatments. Head and neck cancers are a large group of many cancers that affect different areas of the head or neck. Some cancers affecting areas of the head or neck are NOT included in the group of head and neck cancers, such as cancers of the brain, eyes, esophagus, thyroid, and skin.
Head and neck cancers account for about 4 percent of cancer cases in the United States. It is estimated that 68,000 people in the United States were diagnosed with head and neck cancers in 2021, and 14,600 people died from head and neck cancers in the United States. Men are twice as likely to be diagnosed with head and neck cancer compared to women. Symptoms for head and neck cancer can include lumps, sores, a sore throat that does not go away, difficulty swallowing, voice changes or hoarseness, etc. Dentists should check for signs of oral cancer during routine check-ups, but other head and neck cancers don’t have routine screening tests.
There are many different types of head and neck cancers. The most common head and neck cancers affect the squamous cells in surfaces that line the head and neck, such as the mouth, throat, and voice box. These are also called squamous cell carcinoma. Head and neck cancers can also affect salivary glands, as well as sinuses, muscles, and nerves in the head and neck. Each type of head and neck cancer has a different name for the part of the body affected. Some examples include laryngeal cancer (voice box), hypopharyngeal cancer (lower throat), oral cavity cancer (mouth), oropharyngeal cancer (throat), nasopharyngeal (upper throat), nasal cavity (nose) cancer, paranasal sinus cancer (sinus), and salivary gland cancer.
Heavy and frequent alcohol consumption and tobacco use (cigarettes, cigars, pipes, chewing tobacco, snuff, etc) are significant risk factors for head and neck cancers. About 70-80 percent of head and neck cases are linked to tobacco use. Human papillomavirus (HPV) infection, particularly HPV Type 16, is another common risk factor for certain head and neck cancers, especially for those in the throat. Other risk factors include poor oral and dental hygiene, radiation exposure, poor nutrition, environmental inhalants, Epstein-Barr virus infection, and certain ancestry. Prevention strategies include quitting smoking and other tobacco products, decreasing alcohol consumption, HPV vaccination, and regular dental care.
Head and neck cancer, like many other cancers, is typically treated with chemotherapy, drugs that kill and stop the growth of cancer cells, or radiation, a cancer therapy that uses high doses of radiation to kill cancer cells and shrink tumors. Some of the first studies that showed the effectiveness of chemotherapy or radiation on head and neck cancer were published in 1970. However, in many cases, cancer cannot be treated with one therapy alone. Instead of one cure-all, many cancer treatments consist of multiple forms of treatments over time. As a result, clinical trials are needed to not only test individual treatments but multiple treatments together.
After more than two decades of using chemotherapy or radiation alone as the standard treatment for head and neck cancer, researchers began to examine the idea of chemotherapy and radiation as a combination therapy called chemoradiation. With this new combination therapy, a patient would receive both chemotherapy and radiation concurrently, or at the same time, instead of receiving chemotherapy alone, radiation alone, or chemotherapy and radiation at separate times.
In 1990, a study tested chemoradiation as a treatment on 124 participants with advanced squamous cell carcinoma of the head and neck. Tumors completely disappeared in 71 percent of patients. The therapy was especially effective in participants with cancer of the nasopharynx, with tumors disappearing in 89 percent of those patients. After one year, 68 percent of patients survived. Survival rates later decreased to 34 percent after four years. These results were superior to data from previous studies examining treatment with radiation alone.
As a result of this and similar studies, a randomized clinical trial was needed to fully compare chemoradiation to radiation alone. From 1994 to 1997, a study was conducted and randomly assigned 222 participants with advanced oropharynx carcinoma (a type of head and neck cancer) to receive either radiation alone (Arm A) or chemoradiation (Arm B). Those receiving chemoradiation experienced more side effects than those receiving radiation alone.
Despite greater side effects, participants receiving chemoradiation had a three-year overall survival rate of 51 percent compared to 31 percent survival rate for those receiving radiation alone. Furthermore, 42 percent of participants receiving chemoradiation were disease-free after three years, compared to 20 percent of participants receiving radiation alone. This study was monumental in proving that chemoradiation was an effective treatment for head and neck cancer, leading to better outcomes and ultimately longer lives for patients. Chemoradiation soon became the standard of care for certain types of head and neck cancer as a result, especially for tumors that could not be removed with surgery.
More recent research has examined different types of chemotherapy and which drugs work best for head and neck cancer. Immunotherapy, using the body’s immune system to fight cancer, is another growing field of research that can benefit head and neck cancer patients. Recent studies have also examined the effectiveness of immunotherapy combined with chemotherapy to treat head and neck cancer. These studies, as well as studies throughout history on chemoradiation, illustrate the importance of research on multiple treatments; there often is not one single cure-all for cancer, and clinical trials are necessary to find out how different treatments can work together and create the best outcomes so patients can live longer and more comfortable lives.