Head and neck cancer
Head and neck cancers are divided into two groups. The first group, the most important, includes cancers of the oral cavity, pharynx, and larynx. These cancers make up 90% of head and neck tumors. They are most often promoted by tobacco and alcohol. In recent years, there has been an increase in oropharyngeal cancers caused by the HPV (Human Papilloma Virus). In Belgium, approximately 35% of oropharyngeal cancers are due to the HPV.
The remaining 10% are rarer tumors located in the nasal cavity or paranasal sinuses, in the middle ear, and in the salivary glands. Finally, a particular form of cancer located at the back of the nasal cavity, the cancer of the nasopharynx (or cavum), is found mainly in Asian countries located in the Far East or in North Africa around the Mediterranean Basin and is often induced by a virus, the Epstein Barr virus (EBV), which infects patients during the first weeks of life.
Head and neck cancers, which are less common in women, represent about 7% of cancers in men. In Belgium, their annual incidence is around 2000 new cases.
The treatment of these cancers is often complex. It depends on the extent and characteristics of the tumor, which guide the choice between surgery, chemotherapy, and new drugs that specifically target the cancer. These treatments are used alone or in combination depending on the stage of extension of the tumor. Defining the best strategy requires a consultation between physicians specialized in these different fields and gathered within a multidisciplinary team.
The vast majority of head and neck cancers are related to smoking and excessive alcohol consumption.
While a small consumption of alcohol does not entail any real danger in terms of cancer, the risk increases considerably if large quantities are consumed (a bottle of wine, ten to fifteen beers per day, etc.). Heavy smoking and excessive alcohol consumption, when coupled, do not simply have an additional effect: the risk is multiplied by a factor of 5 to 10.
The manifestations of head and neck cancers are rather delayed and depend on the location of the tumor. A persistent hoarse voice is sometimes a sign of lesion in the larynx. A lesion of the back of the throat (pharynx) can give rise to difficulties or pain when swallowing.
Dental complaints, discomfort with food contact and speech problems are sometimes related to oral cavity damage. A sore throat that does not heal despite a well-conducted antibiotic treatment should arouse attention. Sometimes, the cancer is expressed by the appearance of a non-painful lymph node at the level of the neck. All in all, the symptoms of head and neck cancers are usually, at the beginning, not specific: they are observed in diseases other than cancer. A medical consultation will clarify the origin of these symptoms. Unfortunately, the warning signs are often overlooked so that two-thirds of cancers are diagnosed at an advanced stage.
Small and medium-sized tumors are treated by surgery or radiation therapy. The probability of cure is high and the consequences of the therapeutic procedure are not very important: the voice is generally preserved and eating after the therapeutic procedure is soon easy.
The choice between surgery and radiation therapy is based on a multidisciplinary discussion during which the surgeon and the radiation specialist define, with the help of experts who have identified the characteristics of the cancer (its size, aggressiveness, etc.), the most appropriate approach. The patient's wishes are also taken into account: the modalities of the two treatments, such as the duration of the treatment or the need for hospitalization, are somewhat different, which may have an impact on the professional activity.
Regular follow-up is essential since there is a risk of another tumor appearing in the same area. In addition, smoking and excessive alcohol consumption, if they persist, increase the risk of lung cancer and esophageal cancer.
More advanced cancers usually require a combination of surgery and radiation therapy. However, it is common to combine radiation therapy with chemotherapy or drugs that specifically target the tumor. These combinations are intended to increase the effectiveness of radiation therapy.
The choice between the different options takes into account both their effectiveness and their functional consequences. In case of advanced laryngeal tumor, radiation therapy combined with chemotherapy or accelerated radiation therapy, can sometimes be proposed as an alternative to total laryngectomy which results in a complete removal of the larynx. For moderately advanced tumors, both treatment options have a comparable efficacy, but the first one allows to spare the larynx and thus to better preserve the voice.
For tumors of the oral cavity, surgery is often proposed and is sometimes followed by radiation therapy or radiation therapy and chemotherapy, depending on the results of the operation.
Research / Innovation
Treatment of head and neck cancers is advancing on all fronts. Surgeons are developing innovative techniques not only to remove the tumor but also to reconstruct the mutilated organ. In the field of radiation therapy, tomotherapy makes it possible nowadays to irradiate the tumor with great precision, which allows the use of very high doses to treat the cancer while preserving the surrounding healthy tissue. Our group also has a proton therapy center at the Gasthuisberg site (Leuven) where patients for whom this treatment is indicated can receive it.
Our experts from the Head and Neck multidisciplinary group have published recommendations on how to determine the tumor volume to be irradiated. These recommendations have been validated and are now used internationally.
Finally, drug treatments are not outdone. New molecules act specifically on cancer cells, which leads to both a significant gain in efficacy and a reduction in toxicity. New drug treatments are very promising in combination with chemotherapy or radiation therapy. They are used in studies that our center conducts in collaboration with other reference centers in Europe and the United States.
For any further information, or if you would like to make an appointment, please contact the Oncology Care Coordinator at + 32 2 764 12 73.