Cancers of the mouth and throat have a harrowing effect on daily life Mortality rates for these cancers have changed little in 20 years, Iva Pocock reports
The majority of people who develop head and neck cancers are smokers and because the less well-off smoke more than the rest of the population these cancers mainly occur among the lower socio-economic sector of society.
As a result they are not high on the political agenda, says Prof Con Timon, consultant in head and neck surgery in St James's Hospital in Dublin.
Unlike breast and prostate cancer, there's little awareness of neck and head cancers, which make up about 5 per cent of all cancer, and mortality rates have changed little in the past 20 years.
"We cure about 40-50 per cent of patients but unfortunately the rate hasn't improved because many people tend to present late, although the quality of care is better. We've even had patients referred to us by bartenders: 'Johnny's been coughing up blood etc'," he says.
"Twenty-five years ago the male/female ratio would have been about 15:1 as it was mainly men who smoked but in the next 20 years it's more likely to become 50:50," says Prof Timon. "It's following the smoking trends of 10 or 15 years ago."
Some non-smokers can develop head and neck cancers. "There is a certain small number of young women that get this cancer but it's rare," he says.
There is also a geographical pattern to these cancers with France and Scotland having high rates, while in China nasopharyngeal cancer (cancer behind the nose in the highest part of the throat) is more common.
There was a huge increase in thyroid cancer around Chernobyl after the nuclear accident and here thyroid cancer has probably gone up a bit, says Prof Timon.
Cancers of the head and neck, such as cancer of the mouth, the throat, the nasal cavity, the larynx or the salivary gland, have a major effect on daily life, affecting swallowing and speech.
"It can be very harrowing, especially as it can be very obvious," says Prof Timon.
A quarter of patients will have a tracheostomy (an operation in which a tube is permanently inserted into the neck) or a peg which allows for feeding and breathing.
Symptoms include ulcers or sores in the head or neck that do not heal within a few weeks, pain when chewing or swallowing, trouble with breathing, a numb feeling in the mouth, persistent blocked nose, nose bleeds or earache and swellings, lumps or pain in the face or upper jaw.
If patients get to a doctor quickly, up to 90 per cent of such cancers can be cured, says Prof Timon, adding that in this case, the definition of cure is no recurrence of tumours within five years.
The mainstay of treatment is local surgery or radiotherapy. In small tumours just one treatment is usual, but for more advanced tumours chemotherapy may be used with radiotherapy.
"Cancers in the oral cavity and voicebox tend to spread locally to glands in the neck. If you can get control of them, you can cure people; if not, they tend to die a nasty death."
The biggest advance in the treatment of head and neck cancers has been the development of organ function preserving options through the use of radiation, says Prof John Armstrong, consultant radiation oncologist and chairman of the Irish Cancer Society.
"The traditional approach to moderately advanced tongue cancer was to take it out but with radiation and chemotherapy you get to keep the tongue," he says.
"There is very clear evidence that the survival rates with chemotherapy and radiation are just as good as surgery and with a better quality of life."
At the very early stages of cancer, radiation is now the treatment of choice, he says.
"That's not to say it's perfect as it has side-effects but they are not as dramatic as removing the voice box."
For those who need it, surgery is often long and complicated, requiring two teams of surgeons - one to remove the tumour, another to reconstruct.
"It's often done in conjunction with plastic surgeons," says Prof Timon.
Skin grafts or thicker pieces of skin, known as flaps, may be taken from other parts of the body such as the abdomen or thigh, in order to rebuild the face or mouth.
He stresses that treatment is multidisciplinary involving speech therapists, dieticians, tracheostomy care.
For further information please contact the Irish Cancer Society, freephone 1800 200 700 or www.cancer.ie. Daffodil Day, the main fundraising event of the ICS, will take place on Friday, March 11th, 2005.