What to Expect: From Diagnosis to Treatment for Head and Neck Cancer
Despite being diagnosed with head and neck cancer, this happy elderly patient enjoys an hour of yoga in his backyard.
By Leonard A. Farber, MD
“Head and neck cancer” is a term used to describe many types of cancer that develop in or around several anatomical areas, including the larynx (voice box), throat, mouth, nose, and sinuses. These cancers begin when healthy cells in these areas change and grow out of control, forming a solid mass called a tumor. About 90 percent of head and neck cancers are squamous cell carcinomas, meaning they start in flat squamous cells that form the surface layer of tissue inside the mouth, nose, and throat.
There are five main types of head and neck cancer, each named after the part of the body where it first develops:
1)Laryngeal and hypopharyngeal cancers begin in or behind the larynx, which is situated in the throat.
2)Oral and oropharyngeal cancers start in the mouth, tongue, or mid-throat.
3)Nasal cavity and paranasal sinus cancer develops in the air-filled area behind the nose where air passes on its way to the throat or in the spaces surrounding the nasal cavity.
4)Nasopharyngeal cancer begins in the nasopharynx, situated behind the nose in the air passageway at the upper part of the throat.
5)Salivary gland cancer starts in a salivary gland.
Cancers of the brain, esophagus, eye, parathyroid, and thyroid can also start in the area of the head and neck, but they are not classified as “head and neck cancers” and their symptoms, diagnoses, and treatments are very different.
Head and Neck Cancer Symptoms
Head and neck cancer symptoms differ depending on the site of the cancer. In the mouth, for example, cancer can cause a white or red sore that does not heal, while in the sinuses and nasal cavity, cancer can, among other symptoms, cause sinus infections that do not respond to treatment with antibiotics or blocked sinuses that do not clear. In the larynx, cancer can cause ear pain or pain when swallowing. In the back of the throat, it can cause, in addition to a slew of other symptoms, an ongoing feeling of needing to clear the throat or trouble breathing or speaking.
Just because a person has a symptom (or two or more!) associated with head and neck cancer, it doesn’t mean they have the disease. This is because many head and neck cancer symptoms overlap with benign (non-cancerous) conditions. For example, while a sore throat is a symptom typical of some types of head and neck cancer, it can also be symptomatic of a viral infection.
Because symptoms are so varied and because head and neck cancer must be diagnosed in a clinic or hospital, it’s important to take charge of your own health by speaking with a doctor about any changes or pain you might be experiencing.
Screening for Head and Neck Cancer
Head and neck cancer can metastasize (spread) to other parts of the body, such as to lymph nodes or other organs such as the lungs. Therefore, the sooner a patient’s head and neck cancer is diagnosed, the better the prognosis.
A doctor must diagnose head and neck cancer, but patients can easily access a very important tool to help battle the disease: a screening for head and neck cancer.
Getting a screening is simple – it simply involves making an appointment with your doctor or taking advantage of free, local screenings when they are offered in your area.
Also, similar to self-exams for breast cancer, people can perform a monthly self-exam for head and neck cancer. Check out this self-exam guide from the Head and Neck Cancer Alliance to learn how.
Survival and Impact on Quality of Life
Similar to symptoms, survival data differs depending on the type of head and neck cancer and the stage of the disease, which tells you how advanced the cancer is.
Yet as I always tell my patients: data is just data. The statistics on survival rates are estimates that are measured every five years. This information provides a baseline for validating various treatment regimens, but each of my patients is more than just a number. This means that most survival outcomes don’t happen at the average number of an estimate, but rather they fall on a wide spectrum.
A patient’s quality of life is just as important as their survival, and it is dependent on two factors: the cancer itself and side effects from treatment. For example, with regard to the first factor, if a patient has an advanced disease that leaves them unable to swallow, they may experience a lot of weight loss, contributing to low energy levels and decreased ability to do their daily activities and enjoy life. An example of the second quality of life factor may be pain. Some patients experience side effects from chemotherapy such as mouth sores or neuropathy (weakness, numbness, or pain due to damage to nerves), or they can’t swallow or get uncomfortable skin lesions caused by radiotherapy.
Patients may feel initially worse during treatment for head and neck cancer. But if they do, it is really important to keep an open dialogue with their physician because many of their symptoms can be managed, contributing to a better overall quality of life.
Who Gets Head and Neck Cancer?
Anyone at any age can get head and neck cancers, but they are most common in people over the age of 50 and are more than twice as common among men.
The majority (70 percent to 80 percent) of head and neck cancers are linked to tobacco use. Drinking alcohol also raises an individual’s risk. Other factors include, but are not limited to, infection with a common sexually transmitted infection called human papillomavirus (HPV), too much sun exposure, genetic factors, the Epstein-Barr virus (EBV), and poor dental and oral hygiene. Some risk factors are largely limited to region – for example, betel nut chewing, a common practice in Asia, is a factor that, when combined with tobacco use, may be even more carcinogenic (cancer-causing).
Does Everyone Have Access to Clinical Trials?
Investigators in clinical trials specify inclusion and exclusion criteria for the participation of patients in a study. These criteria may include gender, race, ethnicity, age, type of disease, the stage of disease, and others. These criteria help investigators select populations of patients most likely to respond to treatment in order to accomplish the purpose of the study. But this means that other populations of individuals, including those who are very young, pregnant, frail, or elderly, are often excluded from clinical trials. This causes these groups of people to have their treatment needs unmet, as the majority of drugs and therapeutic modalities treat various groups of patients, but do not treat all patients.
A New Path Forward
While there is a cancer care gap caused by the way cancer drugs and therapeutics are designed as well as geographic factors, Nanobiotix is working to change the paradigm of care by designing NBTXR3, a potential first-in-class radioenhancer.
We designed NBTXR3 based not on the moving targets of biology or chemistry, but on the physical principles within cells. What this means is that rather than developing a therapeutic that works only on certain groups of individuals, NBTXR3 may impact treatment outcomes for many more millions of patients – even those patients who are frail, elderly, or have limited treatment options – because, theoretically, it works on any solid tumor in the body. NBTXR3 does not impact on the flow of radiation therapy, as it is injected only one time into the tumor prior to radiotherapy, at which time it is only activated by the radiation therapy.
NANORAY-312 is a global phase III study evaluating radiotherapy-activated NBTXR3 for elderly patients with locally advanced head and neck cancer who are ineligible for platinum-based chemotherapy.
NANORAY-312 builds on Nanobiotix Study 102, a phase I trial evaluating safety and early signs of efficacy for radiotherapy-activated NBTXR3 in high-risk elderly patients with head and neck cancer who are chemotherapy-ineligible and intolerant to cetuximab (an anti-cancer drug classified as a “monoclonal antibody”). Preliminary data presented at the 2021 Annual Meeting of the American Society for Radiation Oncology (ASTRO) showed that the treatment was feasible and well tolerated at all dose levels, response rates were high, and survival rates increased, suggesting that NBTXR3 may improve outcomes for elderly patients.
ILLUSTRATION OF TUMOR SHRINKAGE
Addressing the unmet need for these patients is our number one priority, and we will remain tireless in our efforts to bring the potential benefits of NBTXR3 to patients around the world.