New Perspectives in the Diagnosis and Treatment of Head and Neck Cancer: From Classification Analysis to Breakthroughs in Precision Therapy

Introduction to Head and Neck Cancer

Head and neck cancer encompasses a group of malignancies arising in the head and neck region, including cancers of the oral cavity, larynx, pharynx, salivary glands, nasal cavity, sinuses, and, in some classifications, thyroid cancer. Symptoms vary widely and may include non-healing oral ulcers, voice changes, difficulty swallowing, red/white patches on oral mucosa, or neck masses.

Most cases are linked to tobacco or alcohol use, with emerging risks from e-cigarettes. HPV infection is increasingly associated with these cancers, particularly oropharyngeal cases. Other risk factors include betel nut chewing, radiation exposure, malnutrition, and occupational exposure to carcinogens. Over 90% of head and neck cancers are squamous cell carcinomas. Diagnosis involves biopsy, imaging, and blood tests to assess disease progression.

Preventive measures include abstaining from tobacco/alcohol, regular dental check-ups, and HPV vaccination. Treatments combine surgery, radiotherapy, chemotherapy, and targeted therapy. Early-stage cancers have high cure rates, but approximately 50% of patients present with advanced-stage disease.

Classification of Head and Neck Cancer

Malignancies in the head and neck region include:

• Oral cancers: Tongue, buccal mucosa, gingiva, and lip cancers.
• Laryngeal and hypopharyngeal cancers: Tumors of the vocal cords, larynx, and hypopharynx.
• Nasopharyngeal carcinoma: Strongly associated with Epstein-Barr virus (EBV), prevalent in Asian populations.
• Oropharyngeal cancer: Includes tonsillar and base-of-tongue cancers, increasingly linked to HPV.
• Salivary gland cancers: Parotid, submandibular gland tumors.
• Thyroid cancer: Included in some classifications.
• Nasal and sinus tumors: Squamous cell carcinoma, adenocarcinoma, etc.

The WHO 5th edition classification introduces dedicated sections for familial tumor syndromes (e.g., Gorlin syndrome, Cowden syndrome) and soft tissue tumors.

According to Hong Kong Cancer data (2010–2020), head and neck cancer incidence rose by 25% in Hong Kong. In China, head and neck squamous cell carcinoma (HNSCC) accounts for over 90% of cases:

• HPV-associated oropharyngeal cancer: Represents >70% of cases in Western countries; China reports 25%–37% HPV positivity, rising annually.
• Nasopharyngeal carcinoma: Endemic in southern China, linked to EBV, contributing to >40% of global cases.
• Key risk factors: Smoking, alcohol, betel nut chewing, HPV/EBV infection.

Latest Advances in Head and Neck Cancer Treatment

Immunotherapy

• PD-1/PD-L1 inhibitors: Pembrolizumab and nivolumab are now first-line treatments for recurrent/metastatic cases, improving 2-year survival rates to >50%.
• Combination therapies: Immunotherapy combined with chemotherapy or targeted drugs enhances efficacy.

Precision Radiotherapy and Surgical Innovations

• Intensity-modulated radiation therapy (IMRT): Reduces damage to healthy tissues, ideal for early-stage patients.
• Transoral robotic surgery (TORS): Used for early oropharyngeal cancer, offering precise resection with functional preservation (though long-term quality of life may slightly lag behind radiotherapy).
• Endoscopic surgery: For recurrent nasopharyngeal carcinoma, improves survival by 17.8% compared to re-irradiation, with fewer side effects.

Targeted Therapy

• EGFR inhibitors: Cetuximab for advanced-stage patients.
• Anti-angiogenic drugs: Inhibit tumor blood vessel formation.

Molecular Testing-Guided Treatment

• HPV/p16 testing, PD-L1 expression analysis, and EBV detection inform personalized treatment strategies.

For ENT concerns, contact ENT Head and Neck Surgery Centre or call 3100 0555 for specialized care.

Source:

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