#Cancer of the Head and Neck Screening Guidelines

Cancer of the head and neck is the 6th most common cancer worldwide, the 5th most common in men and the 10th most common in women. The incidence of head and neck tumours in Spain is higher than the European average, it is estimated that between 12,000 and 14,000 new cases are diagnosed in Spain each year. The average age of onset is over the age of 50, although nasopharyngeal and salivary gland tumours may develop earlier.

What is cancer of the head and neck?

Cáncer de cabeza y cuello The term “cancer of the head and neck” encompasses a wide range of tumours that occur in several areas of the head and neck region, including the nasal passages, paranasal sinuses, mouth, throat, larynx, and salivary glands. Oesophageal, skin, brain, nervous system and thyroid tumours are excluded from this definition.

This type of cancer is closely connected to nutrition, occurring in areas where food and drink are ingested and modified. Tumours in this area of the body can pose a challenge to the normal way of eating, drinking and the enjoyment of food.

How does it usually start?

Lupa Symptoms produced by cancer of the head and neck depend on the area in which it originates.

In the larynx and pharynx it may cause one or more of the following symptoms:

Hoarse voice (dysphonia). Anyone with a hoarse voice which lasts for more than 15 days, especially if a smoker, should consult a specialist (ear, nose and throat), as there could be a problem with the vocal cords, situated in the larynx.
Difficulty swallowing (dysphagia).
Blood in the saliva.
Pain or irritation in the neck and/or in one of the ears.
Development of a lump in any part of the neck.
In advanced cases only – difficulty breathing (dyspnoea).

In the nose, paranasal sinuses and nasopharynx (the most posterior part of the nasal cavity), it may result in one of the following symptoms:

Blocked nose.
Change in voice.
Bleeding from the nose, mixed with mucous.
Feeling as though an ear is blocked.

In the mouth, tongue, tonsils, palate it can cause one or several of the following symptoms:

An ulcer in any area of the mouth. Any ulcer which does not resolve within 15 days, painful or not, in a smoker and/or drinker, or in a patient who has any type of prosthesis in the mouth which causes irritation, needs to see the ENT specialist.
A mark, or white (leukoplakia) or red plaque, in any area of the mouth.
A lump in the lip, mouth or in the neck under the jaw.
Difficulty or pain on swallowing and/or chewing.

What are the risk factors?

Factores de riesgo Risk factors directly related to the development of head and neck cancer include:

Tobacco use: Whether smoked (cigarettes, pipe or cigar) or chewed, it increases the risk of cancer in the oral cavity, oropharynx, hypopharynx and larynx. It is related to the quantity used and the length of time of the habit.

Alcohol consumption: mainly in addition to tobacco, resulting in a 20 times increased risk in those who consume both substances when compared to those who do not consume either. It is involved in the development of laryngeal, oropharyngeal, hypopharyngeal cancer and cancer of the oral cavity.

Lifestyle and diet: Poor oral hygiene is associated with cancer of the oral cavity. Some nutritional deficiencies, especially vitamins A and C, may contribute to the development of cancer of the oral cavity, larynx and pharynx. Diets high in salted fish and cured meat release substances (nitrosamines) which are related to cancer in the paranasal sinuses, nasal cavity and nasopharynx.

Infections: Epidemiological data has linked the Epstein-Barr virus (EBV) to the development of carcinoma of the nasopharynx. In patients infected with HIV and in immunocompromised patients the frequency of carcinoma of the oral cavity may be increased.

Infection due to some types of the human papilloma virus (HPV) may lead to cancer of the cervix, vagina, anus, vulva and penis. It has also been demonstrated that it increases the risk of oropharyngeal cancer, especially of the tonsils.

Radiation: Exposure to sunshine has been linked to cancer of the lower lip in those who work outside (such as farmers) and in those with fair skin.

Inhalation of substances: Those who work in the nickel, timber, petroleum or tanning industries have an increased risk of suffering from cancer of the paranasal sinuses and nasopharynx. Inhalation of hydrocarbons in urban areas appears to be linked to an increased risk of cancer of the larynx. Exposure to asbestos and lead increases the risk of cancer of the salivary glands.

Family and genetic factors: Population studies have shown a three to eight times increased risk of head and neck cancer in those with a first degree relative who has been affected, implying a genetic susceptibility to its development.

What methods are used to detect it?

Diagnóstico Currently there are no screening methods which have been shown to increase survival rates in head and neck cancer. A physical examination for detection in the neck, oropharynx (the middle section of the throat which includes the soft palate, base of the tongue and tonsils) and the mouth has been broadly adopted as part of the routine dental examination. However, there is no evidence that this reduces mortality from oral cancer. It is likely that over the next few decades this routine screening will allow earlier identification of oral cancer, but this has still not been shown in clinical studies.

There are no head and neck screening guidelines from the American Cancer Society or the National Cancer Institute. Currently there are no proven effective blood or saliva tests for the detection of head and neck cancer.

Our head and neck screening guidelines at HC Marbella

Our experts advise everyone to have an annual physical examination of the head and neck and oropharynx by their GP, as well as an annual dental check-up including examination of the neck, oropharynx and mouth.

And for high-risk patients

For high risk patients who have recovered from head and neck cancer, our doctors use the following guidelines to rule out both recurrence of the initial cancer and appearance of new tumours:
Physical examination
- Year one: every one to three months
- Year two: every two to four months
- Years three to five: every four to six months
- Year five onwards: every six to twelve months
Annual chest X-ray
If an individual has been treated with radiation to the thyroid, an annual thyroid function test must be performed.
For high risk patients with non-surgical recurrent dysplastic oral leukoplakia, our doctors recommend observation at the frequency described, with biopsy if there are suspicious changes in the lesions.

HC Marbella International Hospital

At HC Marbella we understand the importance of evaluating cancer risk and early detection of disease when the possibility of a cure is at its highest.

If there is a history of cancer in your family, we can provide you with information on hereditary cancer and genetics. Our Oncology Department’s specialist doctors and counsellors in are able to analyse the risk in each case to advise on reducing the possibility of cancer as much as possible.

Detection is also an essential part in the prevention and treatment of cancer. Our doctors have developed screening guidelines for the most common cancers: breast, cervical, colorectal, head and neck, ovarian, prostate and skin, in line with our experience in the treatment of patients at HC Marbella.