Head & Neck Cancers: High Incidence In Indian Men & Women

Head and neck cancers have emerged as a significant health burden in India, ranking second only to lung cancer in men and third after breast and lung cancers in women. 

In anticipation of World Head and Neck Cancer Day on July 27, healthcare professionals, along with cancer survivors, gathered at Amrita Hospital Faridabad to raise awareness and discuss the critical importance of addressing this pressing health issue. This year’s theme, “Close the Care Gap,” emphasises the necessity for widespread education and improved access to care.

Head and neck cancers include a range of cancers originating in the mouth, neck, throat, nose, sinuses, ear, voice box, salivary glands, thyroid gland, and skin. Symptoms vary by location; oral cancers often present as painful ulcers that don't heal within 2-3 weeks, while voice box cancers typically cause changes in voice. Common symptoms include non-healing mouth ulcers, spontaneous tooth loosening, painful swallowing, voice changes, difficulty swallowing food, breathing difficulties, neck lumps, and bleeding from the nose or mouth. Early detection and treatment are crucial for better outcomes.

Shikhar Sawhney, Consultant, Head & Neck Cancer, Amrita Hospital, Faridabad, highlighted, “The epidemiology and incidence of head and neck cancer differ between India and the West. Oral cancers are more prevalent in India, earning it the title 'Oral Cancer Capital of the World.' It is the second most common cancer in India, unlike in the West, where better tobacco control has reduced its incidence. Conversely, HPV-related oropharyngeal cancer has surged in the West, reaching epidemic proportions, while in India, it remains a minority at 5-10 per cent. There is a strong likelihood that HPV-related cancers will rise in India in the coming decade. Globally, cancer rates are rising due to unhealthy lifestyles, increased longevity, and better medical facilities. In India, the highest surge is predicted to be seen in oral cancers, particularly among males.”

The incidence of different cancers varies across India due to local practices and carcinogen exposure. Oral cancers are more prevalent in states like Uttar Pradesh, Bihar, Gujarat, and Maharashtra due to high tobacco use. Pharyngeal cancers are disproportionately high in northeastern states. In rural Andhra Pradesh, a unique smoking method called reverse smoking leads to higher rates of palatal cancers. These regional differences highlight the impact of lifestyle and environmental factors on cancer incidence across the country.

Subhramania Iyer, HoD, Head & Neck Cancer, Amrita Hospital, Faridabad, emphasised, “Since  90 per cent of head and neck cancers are lifestyle-related, limiting exposure to the said causes will go a long way to prevent these cancers. Cancer is curable if detected early. The importance of early diagnosis and timely treatment cannot be overemphasised. It is perhaps the single most important factor that determines outcomes. Early diagnosis not only significantly improves cure rates, but it also decreases the side effects and toxicity of cancer-directed treatment immensely. For instance, for oral cancers, the chance of successful cure drops down from 70-80 per cent for early (stage 1&2) oral cancers to 40-50 per cent in stages 3 & 4.”

Rishabh Kumar, Senior Consultant, Radiation Oncology, Amrita Hospital, Faridabad, stated, “There are three main cancer treatment options: surgery, radiotherapy, and chemotherapy. The choice of treatment depends on the cancer's site, stage, and the patient's overall health. Oral cancers are primarily treated with surgery, adding radiotherapy/chemoradiotherapy in advanced stages, while pharyngeal cancers often use non-surgical methods due to surgical morbidity. With regards to radiotherapy, newer and more advanced radiotherapy machines and techniques like IMRT, IGRT, and proton therapy have massively reduced radiation-related toxicities while delivering efficient and precise radiation to destroy cancer cells. Similarly, the availability of newer drugs like immunotherapy and targeted therapy has made it possible to target very precise mutational changes specific to each cancer, addressing the problem without the excessive side effects conventional chemotherapy often has.”

Over the past decade, advancements in all three treatment modalities have improved precision and reduced side effects. Robotic surgery enables access to previously unreachable areas with minimal incisions, and intraoperative nerve monitoring preserves important nerves during surgery. Advanced radiotherapy techniques like IMRT, IGRT, and proton therapy have reduced radiation toxicity, while new drugs such as immunotherapy and targeted therapy address specific cancer mutations with fewer side effects than conventional chemotherapy.

One survivor shared, “My journey with head and neck cancer began when I noticed a persistent sore in my mouth that wouldn't heal. The diagnosis was devastating, and the prospect of treatment was overwhelming. However, the dedicated team at Amrita Hospital, Faridabad, provided me with exceptional care and unwavering support. The expertise of doctors like Subhramania Iyer, along with the advanced treatment options, played a crucial role in my recovery. They employed state-of-the-art techniques such as robotic surgery and precise radiotherapy, which minimised side effects and improved my quality of life. Today, I am cancer-free and grateful to the incredible team at Amrita Hospital for helping me overcome this challenging journey. Their commitment to early diagnosis and innovative treatment gave me a second chance at life.”