The stigma that cancer continues to carry is multiplied in some types of tumors, such as those of the head and neck, to the point of turning them into hidden cancers. Breast or prostate cancer is increasingly being talked about with more normality, while silence is imposed on these other tumors. Every year 12,000 people in Spain receive a diagnosis of cancer of the pharynx, larynx, oral cavity, salivary glands or nasal cavity.
They are ignored tumors, according to specialists, for two reasons. The first is that they show that we are capable of acquiring and perpetuating habits that undermine our health until they produce a serious illness. In that sense, they are socially punished, the patient appears to be guilty of what happens to him. “The biggest risk factor is tobacco use, which is enhanced by alcohol. If they were avoided, the incidence of head and neck tumors would be reduced by up to 90% ”, points out Juan Jesús Cruz, head of Oncology at the Hospital Clínico de Salamanca. The second reason is explained by José Luis Cebrián, president-elect of the Society of Oral and Maxillofacial Surgery of the Head and Neck and head of the Maxillofacial service of the Hospital Universitario La Paz: “In the society of the image, where the healthy and the good prevail aspect, we prefer not to see people with a deformity in the face or neck as a result of the treatment. This distinguishes these neoplasms from others such as breast or prostate that do not show external signs. “
In this group of tumors, as in others related to tobacco consumption, there has been a progressive increase in cases affecting women. 25 or 30 years ago, 80% or 85% of cases were in men, while now the percentage has dropped to 75%. The feminization of head and neck cancer is also related to the increasing prevalence of another risk factor, the Human Papilloma Virus (HPV), which affects men and women equally and is related to the spread of oral sex. “In Spain its influence is still small, but in other countries such as Sweden HPV is at the origin of 30% of cases”, says José Luis Cebrián. Although other factors may also play a role, they are not very relevant or are related to very specific tumors.
Only between 20% and 30% of head and neck tumors are detected in the early stages, which determines the prognosis of the disease. Juan Jesús Cruz explains that “early diagnosis is decisive because the neoplasms detected in the initial stages are practically all cured”.
In the last three decades, not only treatments have evolved, more effective and with fewer side effects, as well as life expectancy, but also the quality of life of patients. In many cases they can return to a state similar to the one they enjoyed before surgery. In addition to giving thanks for being alive, they can give thanks for doing it in good condition. Some patients have to remove the jaw, part of the tongue or teeth, which before greatly decreased their quality of life because there were no alternatives. However, advances in maxillofacial surgery have largely resolved that impact. José Luis Cebrián recalls that “now these areas are reconstructed using autotransplant techniques with microvascularized flaps and we rehabilitate the dentition so that patients can eat normally again”.
Juan Jesús Cruz adds two other important advances: “The incorporation of new chemotherapy treatments together with the technical advances of radiotherapy that have made it possible in advanced tumors to preserve organ and function, and also with less toxicity of the surrounding tissues”. But the head of Oncology at the Hospital Clínico de Salamanca points out that what truly represents a turning point in the treatment of head and neck tumors is immunotherapy: “At the moment, it shows very good results in people who have developed metastases, so the median survival has gone from 10 months to 14-15 months with immunotherapy. But the most important thing is that immunotherapy has allowed long survivors to speak with property, patients who see their lives being substantially prolonged. The great hope now is that immunotherapy will give good results not only in patients with metastases, but also in early stages of the disease, ”says Dr. Cruz.
The vision of specialists on advances in treatments is optimistic. The goal is to achieve a higher survival rate for head and neck cancers than the current one, which is around 60% five years after diagnosis.
“In cancer, what we know so far is that everything depends on the sum of risk factors. If a person has an individual predisposition and adds one or more of these factors, the possibility of developing a tumor is much greater ”, says José Luis Cebrián to explain that, apart from advances in therapies, we must influence prevention and also in early diagnosis. And there dental check-ups play a fundamental role. Going to the dentist once a year is not only important because of the cavities it can detect, it is often the first to realize that there is something in the oral cavity that should not be there.
Specialists point out a golden rule: when a person has an ulcer in the mouth that does not heal for two or three weeks, a biopsy must be done. In other tumors, there are no specific symptoms or biological markers that allow a diagnosis, which makes early detection difficult. However, in head and neck tumors there are clear signs, as Juan Jesús Cruz explains: “The signs can be seen and palpated, they are lesions in the mouth, aphonia or lumps in the neck. The problem is that many people do not pay the attention that these symptoms require and do not consult a doctor ”.
Once head and neck cancer has been diagnosed, each patient’s case is evaluated by a vast team of specialists. One of the characteristics in the current approach to this type of tumors is multidisciplinary treatment. Each case is evaluated by a tumor committee made up of surgeons, oncologists, radiotherapists, psychiatrists or pathologists, among other professionals, who decide on a consensual treatment. This is established by the clinical guidelines before intervening and in the follow-up of each patient. The objective, recalls José Luis Cebrián, “is that each patient has access to all the tools available for treatment, whether they are in their hospital or in another center, the patient comes first.”
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