Nonsurgical Management Of Locally Advanced Head & Neck Cancers In The Elderly

Head and neck cancers (HNC) refer to a group of cancers affecting areas such as the throat, mouth, nose, and sinuses. Locally advanced head and neck cancer is characterised by the spread of cancer to nearby tissues or lymph nodes, but not to distant parts of the body. These cancers are a significant portion of cancer cases diagnosed in India and primarily affect individuals over 50 years of age, with a higher incidence in men.

HNC presents unique challenges for elderly patients, leading to a marked deterioration in quality of life due to its impact on essential functions like swallowing, speaking, and breathing. Additionally, elderly patients often have multiple comorbidities that complicate management. Public awareness of the condition, its symptoms, and treatment options is crucial, as timely and appropriate care is necessary for the elderly.

Symptoms

Symptoms of head and neck cancer vary based on tumour location but commonly include a persistent sore throat, difficulty swallowing, unexplained weight loss, voice changes, and persistent lumps or sores. Often, minor illnesses or cold symptoms are overlooked, leading to delayed diagnosis as the cancer progresses to a more advanced stage. In elderly patients, these symptoms can severely impact daily activities and overall health.

Causes and Risk Factors

Key causes and risk factors for HNC include tobacco use, alcohol consumption, HPV infection, and increased sun exposure. In India, widespread tobacco use is a major contributing factor. Elderly individuals who have a history of heavy smoking or alcohol consumption are at higher risk. Other risk factors include low socioeconomic status, poor oral hygiene, occupational hazards such as exposure to certain chemicals, and a family history of cancer.

Diagnosis

Diagnosing head and neck cancers involves a series of physical exams and diagnostic tests. Initial physical examination focuses on the head and neck regions. If cancer is suspected, imaging studies such as CT, MRI, and PET scans, as well as endoscopy and biopsy, are performed. Early diagnosis is crucial as it offers the best chance for successful treatment and favourable outcomes. Early detection is especially important for elderly patients to manage the disease effectively and plan less invasive treatments.

Treatment

For elderly patients, it is crucial to carefully consider treatment options due to their frail condition and potential side effects from aggressive treatments. Non-surgical treatments are often recommended and are less invasive with shorter recovery times. These treatments include radiation therapy, chemotherapy, and targeted therapy, either alone or in combination.

•    Radiation Therapy: Targets and destroys fast-growing cancer cells and can be used in combination with chemotherapy.
•    Chemotherapy: Uses drugs to kill cancer cells and is often combined with radiation therapy to enhance effectiveness.
•    Targeted Therapy: Involves drugs that specifically attack cancer cells while minimising effects on normal cells, resulting in fewer side effects.

These treatment options can be used alone, alongside surgery, or as palliative care if surgery isn't possible due to health or age.

These non-surgical treatments have proven effective for elderly patients, controlling cancer growth and spread, managing symptoms, and improving quality of life. Advances in these treatments are making them more precise and tailored to individual patient needs, reducing the burden on elderly patients.

Managing locally advanced head and neck cancers in the elderly requires a comprehensive approach stressing  early diagnosis and effective, less invasive treatment options. Increasing the use of non-surgical treatments like radiotherapy, chemotherapy, and targeted therapy can make treatment more tolerable for elderly patients. Awareness of symptoms and risk factors is crucial for early diagnosis and improved care, significantly enhancing the quality of life for elderly patients with HNC.

The author is Chairman, ENT, Head and Neck Surgery, Medanta, Gurugram

Dr. K. K. Handa

Guest Author