Head and Neck Cancer: Q&A with Apollo's Dr Anil D'Cruz


Name: Koshik Sengupta

Location: Kolkata

Question: Does smog or pollution increase the chances of an individual getting cancer?

Answer:Smog or pollution can cause cancer. If you have a lot of pollution around, particularly particles like asbestos, you are predisposed to cancer. Also, if there are pollutants with large molecule permeability, it has been shown to have an effect on your health and cause an increased risk of cancer. However, the percentage of people who get this kind of cancer is minimal and very specific. These cancers affect the lungs and the respiratory system and not the head and neck region.

Name: Rachel George

Location: Kottayam

Question: How does secondhand smoke affect a person's chances of getting cancer? Especially the family members of a chain smoker?

Answer:When you smoke, the particles go inside your lungs which is called mainstream smoke. 50% of smoke is mainstream smoke. The other 50% smoke is side stream smoke which is the smoke inhaled from the exhaled smoke of a smoker along with the burning tip of the cigarette. It must be remembered that side stream smoke also has the carcinogens & co-carcinogens that cause cancer. So, if you are living in the vicinity of a smoker, you are inhaling the carcinogens & that is why there is an increased risk of getting cancer.

Name: Anand Shankar

Location: Mumbai

Question: If identified at the early stage itself, how long will it take to cure head n neck cancer?

Answer:Head and neck cancers have 4 stages. If identified in the first stage, we can have a 90% cure rate with minimal single modality treatment with least problems in daily activities and cosmesis of the patient. The treatment is soon and effective with. It’s a one-stage treatment. We therefore encourage people to come for regular checkups if they have certain signs and symptoms for early diagnosis and treatment.

Name: Preetha

Location: Vellore

Question: What are the causes of head and neck cancer. Are there any ways we can prevent them?

Answer: The main cause of head and neck cancer is substance abuse, tobacco and alcohol. They are responsible for close to 85-90% of all cancers. A new cause of cancer is viral infection that affects the oropharynx (base of the tongue) or the tonsil. It is caused by the Human Papilloma Virus (HPV). Oropharyngeal cancers due to this virus is a big cause of concern in the western countries but in our country, about 20-25% are HPV positive but please remember that these cancers are only related to the tonsils and the base of the tongue. It must be remembered that this virus is transmitted or spread through sexual intercourse & it is primarily in individuals who have multiple cancers, unprotected sex and oral sexual activities. Ill-fitting dentures have also been found to cause oral cancers.

Preventive measures include adoption of healthy lifestyle measures and avoiding the above-mentioned risk factors and causes of head and neck cancer. One should regularly consult a dentist for oral and dental hygiene.

Name: Christina Elizabeth

Location: Delhi

Question: What are the latest advancements in the diagnosis and treatment of head and neck cancer?

Answer: There are a lot of advancements in head and neck cancer both for diagnosis & treatment. But the old time-tested tool for diagnosis still remains- which is a good clinical examination to pick the lesion in a pre-malignant stage. Oral cancer, which is the most common head and neck cancer, is first manifested by a change in the colour of the lining of the mouth. Usually, it is pink in colour. The moment you get a change in colour, a white or a red or a combination of white and/or red, it may be a sign of pre-malignant condition and needs to be seen by a specialist and these lesions can then be biopsied. In the newer advances, there have been some light-shining devices which use Autofluorescence. There has also been the ‘Brush Cytology’ to scrape cells. There have been technologies to address changes in the molecules within the spit of an individual. But as of now, all of these advancements are experimental and are not standards of care for early diagnosis.

For treatments, the main course of treatments are surgery, radiotherapy and chemotherapy. They continue to be the same but in surgery, we now have the LASER, the 4th generation Da Vinci Xi robotic system, microvascular reconstructions and a lot of endoscopic methods of tackling a tumor. So, we don’t do a lot of surgeries, they can be easily done through such endoscopes. For radiotherapy, we have better methods of delivering radiotherapy in the form of IGRT, IMRT, etc., which are finer forms of delivery of radiotherapy. These radiotherapies use photons but now the latest development is the use of protons that are heavy ions which go into the tumor and lodge there. So, there are minimal chances of complications. Proton therapy is only available at Apollo Hospitals in Chennai. In chemotherapy, the drugs have changed. We now have Immunotherapy and Targeted chemotherapy to add to the backbone of conventional chemotherapies.

Name: Shweta

Location: Mumbai

Question: How exactly does tobacco lead to cancer?

Answer: Tobacco has a number of carcinogens and co-carcinogens. Carcinogen is an agent that changes the genetic makeup of your cell and then the cell undergoes uncontrolled proliferation which is also known as cancer. This is because tobacco has carcinogens and co-carcinogens, which predispose to cancer. The exact mechanism by which tobacco leads to cancer is very scientific and out of the scope of this column.

Name: Anvika

Location: Goa

Question: Can paan give me cancer?

Answer: Yes. Paan is a composition of tobacco and supari (areca nuts). Both of these are group 1 carcinogens as putforth by the International Agency for the Research of Cancer-a wing of the WHO. So, if your paan has these two components, it can cause cancer. Apart from these, the other components of the paan, like the line and the katechu may not directly be carcinogens but they are rarely taken without tobacco and supari. These are astringents and irritants of the mucosa and hence are not advisable to take.

Name: C R Menon

Location: Kerala

Question: Neck cancer is one disease which is still not commonly discussed. What are the general symptoms?

Answer: Cancers that primarily affect the neck are different from the head and neck cancers that usually affect tobacco and alcohol users causing cancers of lining of the throat and the mouth etc. In the neck, these cancers can spread to the lymph nodes in the neck, but they are not primarily neck cancers. The most common neck cancer that we would get in the neck is thyroid cancer. The incidence of thyroid nodules is common, and the incidence of thyroid cancer is on the rise. Neck cancers can also affect the salivary glands, the tail of the parotid i.e., the major salivary glands at the angle of your jaw or two other salivary glands that are below the jaw in the upper part of the neck. Apart from these structures, other tissues in the neck like blood vessels, soft tissues, etc., but these are very rare.

Name: Sandhya Ravi

Location: Bangalore

Question: At the initial stages, how do we differentiate the symptoms of neck and head cancer from usual minor inconveniences?

Answer: The symptoms of head and neck cancers are quite often similar to day-to-day minor inconveniences in the head and neck area. These include ulcers in the mouth, hoarseness of voice, cough, pain when swallowing, swelling in the neck, etc. However, if these symptoms occur in tobacco and alcohol users and if they persist for more than couple of weeks despite medical treatment (antibiotics, anti-inflammatory), the patient must consult a specialist. It is also to be remembered that ulcers in the mouth which are non-malignant are usually shallow, occur at different sites and are recurrent.

Name: Maria Celine

Location: Kottayam

Question: What are the symptoms and does the medication have huge side effects?

Answer: The symptoms of head and neck cancers are varied because these cancers involve multiple subsites. The symptoms therefore depend on which site is involved. Some examples are-

A. Sinuses and nose- Blockage which is usually unilateral (one side) or epistaxis (nose bleeding) which is again unilateral.

B. Mouth- ulcers (sores), growth and loosening of the teeth.

C. Larynx (voice box)- hoarseness or changes in the voice.

D. Throat- difficulty in swallowing or pain when swallowing

E. Thyroid and salivary glands- swelling in the front of the neck or in the region of salivary glands in front of the ear.

Head and neck cancers are usually treated surgically and if chemotherapy is given, it depends on drugs and dosage which can cause side effects.

Name: Bunty Singh

Location: Delhi

Question: How long do you have to be a smoker for you to get cancer?

Answer: The longer the duration of consumption and the larger the quantity of consumption, the higher the probability of getting cancer. However, medical science does not know what quantity and duration of consumption can lead to cancer. There are people who consume tobacco just for a few months in small quantities and get cancer. Therefore, it is best to not take up this habit at all.

Name: Stephen Saxena

Location: Prayagraj

Question: Can vaping cause head and neck cancer?

Answer:yes, vaping can cause head and neck cancer. It is a different form of tobacco consumption. Infact, a lot of youth are misguided that vaping is a safe form of tobacco consumption . There is no proof to support this belief.

Name: Ritcha

Location: Mumbai

Question: what is the cause and prevention of head cancer? does head cancer have to do with using electronic gadgets.

Answer:The main cause of head and neck cancers are tobacco (smoke and smokeless), alcohol and areca nuts (supari). Thyroid and salivary glands are difficult cancers, and their cause is elucidated in a different question. Electronic gadgets are not known to cause head and neck cancer.

Name: Navya Rajan

Location: Kottayam

Question: How important a role does diet play in preventing and treating head and neck cancer?

Answer:Diet is important in preventing and treating all cancers including head and neck cancers. A diet rich in chemo preventive agents (Vitamin A, C, E) which are abundant in green leafy vegetables and brightly colored fruits. Also, though not very important for head and neck cancer, obesity does predispose to different types of cancers particularly in women.

Name: Neethu Felix

Location: Hyderabad

Question: There seems to be a rise in thyroid cancer cases, apparently due to lifestyle issues and pollution. How do these lead to thyroid cancer? Are there any other causes for the same?

Answer:The main reason attributed to an increase in thyroid cancers and there has been an advisory by WHO on the same that it is due to over investigation like doing unnecessary sonography or other imaging of the neck. Lifestyle issues and pollution are not major factors for thyroid cancer specifically. Other factors for thyroid cancer are hereditary causes and radiation in childhood.

Name: Vishnu S

Location: Kottayam

Question: Apart from smoking, what can cause lung cancer? How can one prevent it?

Answer:Smoking is the main cause of lung cancer. It is also important to note that secondhand smoke can also cause cancer. In addition, certain pollutants, particularly asbestos, etc., can cause lung cancer along with pollution. One can prevent it by staying away from tobacco.

Name: Reshma Sabu

Location: Bangalore

Question: Can intake of alcohol or spices cause oral cancer? How?

Answer:Alcohol consumption is an important factor for oral cancer. Those who smoke or use tobacco and drink alcohol are at a heightened risk of oral cancer. Spices are not particularly known to cause oral cancer.