JOIN USThe enormity of the cancer of head and neck have prompted a global outcry on the need to collectively address this scourge. Head and neck cancers account for more than 5,60,000 cases all over the world, ranking sixth in number in comparison to all cancers. Due to increase in alcohol consumption and tobacco, there is an alarming increase in its incidences over the past decade, especially in developing countries like India.
Due to high consumption of tobacco in our country, 30-50 per cent of these cancers are seen in the oral cavity. The largest number of oral cavity cancers occur in South and Central Asia, with nearly 1,20,000 cases. Two thirds of these cancers are actually found in India. Very soon, our nation will become the oral cancer capital of the world, with the largest incidence of cases.
Smoking
The risk of developing head and neck cancer is increased by 5 to 25 times for smokers. Individuals who smoke more than one packet of cigarettes every day increase their risk of developing head and neck carcinomas by 13 times. Initiation of smoking before the age of 18 years and smoking for a period of more than 35 years are considered high-risk factors. Even passive smokers who are exposed to smoke for more than 15 years increase their risk of developing head and neck cancers, and throat cancer as well.
TobaccoChewable tobacco is known to cause oral cancers and has 28 known carcinogens as against the smoke form, which has 60 and are more implicated in throat carcinomas. The maximum number of tongue cancers is seen in the city of Bhopal in Madhya Pradesh followed by Goa.
Assam and Goa together see high incidences of oral cavity carcinoma due to the practice of chewing betel quid.
Alcohol
Alcohol increases the incidence of oral, pharyngeal and throat cancer by a great margin. When taken in moderation, implicating an amount less than 30 gm per day in males, the risk of developing this cancer does not increase. But an intake of more than 50 gm per day increases the risk by five to six folds. On the contrary, levels as low as 10-20 gm per day have a significant increased risk in females. For people who consume both alcohol and tobacco, the risk increases by a great margin.
Unhealthy diet
Deficiency of vitamins A, C, E, beta-carotene, iron, selenium and zinc can also cause head and neck cancer. High temperature cooking, which leads to loss of vitamins especially Vitamin C, should be avoided. Fresh fruits and vegetables have a known protective effect against these cancers. Preserved meat with high content of nitrates should also be avoided.
Occupational hazards
Exposure to certain substances like asbestos, formaldehyde, wood, leather, paint and diesel also has a contributory role in these cancers, especially nose and paranasal sinuses. Certain head and neck cancers like the thyroid, salivary gland and sarcomas are associated with radiation exposure. The source of the radiation could be environmental, occupational or therapeutic. The incidences of lip and skin cancers are known to increase due to too much of exposure to sunlight. History evidently shows an increase in thyroid cancer by 6.7 per cent in the survivors of Hiroshima and Nagasaki.
Harmful viruses
Apart from lifestyle choices, there are many viruses that can cause cancer. Epstein-Barr virus causes nasopharyngeal carcinoma, HPV is responsible for oropharyngeal cancer and HIV causes Kaposi’s sarcoma and lymphoma. People infected with HIV have a two to three fold increased risk of head and neck cancer. Herpes simplex virus is also a potential cause for oral cancers.
Most of these cancers produce early symptoms. Quitting smoking, drinking and chewing tobacco at an early stage can delay or stop the spread of cancer. Good counselling, along with the right medications, can help in kicking these harmful habits. Further, good oral and dental hygiene, regular physical activity, healthy dietary practices, and avoidance of exposure to toxic chemicals and safe sexual practices can prevent the genesis of cancer.
(The author is a senior consultant, surgical oncology, BLK Super Speciality Hospital, Delhi)