Head and neck tumors: early diagnosis and modern therapy increase the chance of cure

What is head and neck cancer?

Head and neck cancers are a group of malignant tumors that arise in the oral cavity, tongue, pharynx (pharyngeal carcinomas), larynx (laryngeal carcinomas), nose and paranasal sinuses, salivary glands, and lymph nodes in the neck (Figure 1). Most of these tumors are squamous cell carcinomas, which arise from cells in the mucous membrane.

This group of tumors accounts for about 4–5% of all malignant tumors and most commonly affects men between the ages of 50 and 70. However, in the last decade, they have been diagnosed more frequently in younger patients, which is associated with an increase in human papillomavirus (HPV) infections.

Figure 1. Anatomical representation of the head and neck area.

Who is at increased risk?

There are several clearly defined risk factors for developing head and neck tumors, the most important of which are:

• Smoking: The greatest single risk. Long-term smoking exposes the mucous membrane to chronic irritation and damage that can eventually lead to malignant transformation of cells. The risk increases with the number of years and the number of cigarettes smoked.

• Alcohol consumption: Alcohol, especially when consumed in large quantities, further damages the mucous membrane. When combined with smoking, it synergistically increases the risk of developing cancer by up to 30 times compared to people who consume neither.

• HPV infection: Most often the HPV-16 subtype. The infection is transmitted by oral contact, and HPV-positive tumors more often affect the oropharynx (the area of ​​the throat, especially the tonsils and base of the tongue). These tumors have a different biological profile, more often affect younger patients, and have a better prognosis.

• Poor oral hygiene and chronic inflammation: Long-term inflammation and irritation of the oral cavity, as well as irregularities in the bite or sharp edges of teeth or dentures, can contribute to the development of tumors, especially in the oral cavity.

• Occupations with exposure to chemicals: People who work in the wood, textile, or chemical industries are exposed to some carcinogens that can increase the risk of developing tumors of the sinuses and nasal cavity.

What symptoms indicate the disease?

Symptoms of head and neck tumors are often nonspecific and can easily be mistaken for harmless problems such as infections or irritations, which is why the disease is often detected at an advanced stage.

Signs to look out for include:

• Hoarseness that lasts longer than 3 weeks, especially in people who smoke or drink alcohol. It may be the first sign of laryngeal cancer.

• Difficulty swallowing (dysphagia), a feeling of a “lump in the throat,” or pain when swallowing, especially if it lasts for weeks.

• Non-healing sores or growths in the mouth, often painless but persistent. Such lesions, especially white or red patches (leukoplakia/erythroplakia), should always be treated.

• Frequent earache without infection, especially in pharyngeal cancer, where the pain is reflected through the nerve connections.

• Enlarged lymph nodes in the neck: Head and neck tumors often spread to the regional lymph nodes first.

• Unexplained weight loss, fatigue and poor appetite in the later stages of the disease.

How is the diagnosis made?

The diagnostic process begins with a clinical examination and taking a detailed history. This is followed (Figure 2):

• Endoscopic examination (e.g. fiberendoscopy) that allows direct insight into the mucous membrane of the larynx, pharynx and nasal cavity.

• Biopsy of suspicious changes – the gold standard in making a diagnosis. The sample is sent for pathological analysis.

• Radiological work-up includes CT and/or MR of the neck and head, and when widespread disease is suspected, a PET/CT scan showing active tumor foci throughout the body.

• In the case of tumors of the oropharynx, testing for HPV is increasingly done by means of immunohistochemistry (p16) or PCR test.

Figure 2. Basic diagnostic algorithm.

Treatment: individualized and team approach

Therapy depends on the location of the tumor, its size, extent, presence of metastases, as well as the general condition of the patient. Treatment is led by a multidisciplinary team that includes an oncologist, otolaryngologist, radiation therapist, surgeon, pathologist, speech therapist, and nutritionist.

• Surgery: For smaller, localized tumors, especially in the oral cavity and salivary glands, surgical removal of the tumor may be the only therapeutic procedure. Larger and more aggressive tumors often require more radical surgery with reconstruction.

• Radiotherapy: Often used as a primary form of treatment or in combination with chemotherapy (radiochemotherapy), especially for tumors of the larynx or pharynx. Modern forms of radiation such as IMRT (intensity-modulated radiotherapy) allow for precise targeting of the tumor while preserving surrounding healthy tissues.

• Chemotherapy: Most often used in combination with radiation for locally advanced tumors (cisplatin as the standard), or alone for metastatic disease. It is also used as neoadjuvant therapy before surgery or radiation.

• Immunotherapy: In recurrent or metastatic disease, immunotherapy drugs such as pembrolizumab and nivolumab are becoming the treatment of choice, especially in patients with high PD-L1 status. These drugs activate the body's own immune system to recognize and destroy tumor cells.

• Targeted therapy: In certain patients, cetuximab, a monoclonal antibody that binds to the EGFR receptor and slows tumor growth, is used.

HPV-positive tumors - a different disease

HPV-associated tumors (especially oropharyngeal) have a better prognosis and are characterized by a better response to therapy. Since they often affect younger people who do not have other risk factors, clinical trials are underway to examine de-escalation of therapy, i.e. the possibility of carrying out treatment with fewer side effects without losing effectiveness.

Rehabilitation: the key to quality of life

Treatment of head and neck tumors can have a significant impact on the patient's speech, swallowing, breathing, and appearance. That is why rehabilitation is an integral part of treatment.

• Nutritional support: many patients lose their appetite and weight due to pain and difficulty swallowing. A nutritionist helps maintain their diet, and enteral nutrition is introduced if necessary.

• Speech therapy: helps restore speech and swallowing, especially after laryngeal surgery.

• Psychological support: coping with the diagnosis and the consequences of treatment is challenging, so psychological help significantly contributes to the quality of life.

Prevention and early detection

Although not all tumors can be prevented, certain measures significantly reduce the risk:

• Quitting smoking and alcohol: two of the most important changeable habits that dramatically reduce the risk.

• HPV vaccination: available for girls and boys, recommended in adolescence before the onset of sexual activity.

• Regular check-ups: especially in people who have risk factors or have had symptoms for more than 2–3 weeks.

• Oral hygiene: regular brushing, examination of teeth and mucous membranes, and avoidance of sharp dentures or irritation.

In conclusion

Head and neck tumors are a serious diagnosis, but with early detection and modern therapeutic approaches, more and more patients have a chance of cure or long-term disease without progression. A multidisciplinary approach, along with public education and prevention, are key steps in the fight against this disease.

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