Head and neck cancer. An update

T he term head and neck cancer describes a wide range of malignancies that arise from the mucosa of the upper aerodigest ive tract and salivary glands, as well as the skin and lymphatic system of the head and neck region (Figures 1a and b). Around 4000 people in Australia are diagnosed with head and neck cancer each year (70% men and 30% women). Head and neck mucosal squamous cell carcinoma (HANMSCC) arises from the squamous mucosal cells that line the upper aerodigestive tract and accounts for around 90% of head and neck cancers. It is the focus of this article. Exposure to carcinogens such as tobacco smoke and alcohol are well known risk factors for HANMSCC. However, research over the past decade has strongly implicated human papillomavirus (HPV) as a major causative agent in oropharyngeal (tonsil and tongue base) carcinoma. Epidemiological studies in Western countries have shown that there has been a gradually decreasing incidence of laryngeal and hypopharyngeal cancer, almost certainly attri butable to reducing smoking rates, simultaneous with a rising incidence of HPV-related oropharyngeal cancers. Treatment decisions in HANMSCC are often complex and involve input from multiple specialists, such as medical and radiation oncologists, head and neck surgeons, plastic surgeons and oral and maxillofacial surgeons. GPs are responsible for detecting most head and neck cancers in patients in the community and play a crucial role in co-ordinating their Key points • Around 4000 people are diagnosed with head and neck cancer each year in Australia. • Well-known risk factors include smoking and excess alcohol use; human papillomavirus infection has now been identified as the major risk factor for oropharyngeal cancer. • Early diagnosis and treatment improve outcomes; GPs play a crucial role in detecting most head and neck cancers in patients in the community. • Persistent upper aerodigestive tract symptoms, a nonhealing ulcer in the oral cavity or a persistent neck lump warrant further investigation and patient referral to an ENT, head and neck surgeon. • Treatment is often complex, and patients are best evaluated in multidisciplinary head and neck clinics, located in most major teaching hospitals. MedicineToday 2014; 15(12): 27-37