By World Healthcare Journal-
Although it is the 6th most common type of cancer, head and neck cancer falls behind others in both awareness and research funding.
Head and neck cancer is the cause of 380,000 deaths a year, worldwide. Incidence varies from country to country – for example, head and neck cancer accounts for 7-8 per cent of all cancers in the UK whereas in Asia the burden is even more significant with around 30-40 per cent of cancers occurring in the head and neck.
As well as impacting individuals and their families, head and neck cancer also has a negative impact on a country’s economy. In 2010, across India, Pakistan and Bangladesh, economic welfare losses due to head and neck cancer were estimated at US $16·9bn (2010 USD, PPP), equivalent to 0.26 per cent of their combined gross domestic product (GDP).
A report recently released by The Institute of Cancer Research which analysed access to innovative cancer drugs found that whilst 19 new drugs were authorised for lung cancer by the European Medicines Association between 2009-2016, none were authorised for head and neck cancer. Despite needing more attention in comparison to other cancers, ongoing research in head and neck cancer has bought about life-changing advancements in treatments for patients. Oracle Cancer Trust is the UK’s leading national charity at the forefront of funding vital early-stage research in the UK into head and neck cancer.
Cancer can develop in more than 30 areas within the head and neck, including the lips and mouth, throat (pharynx), voice box (larynx), salivary glands, nose and sinuses and back of the nose and mouth (nasopharynx). Established risk factors of head and neck cancer include tobacco, alcohol and the Human Papilloma Virus (HPV). Whilst more commonly known as a cause of cervical cancer, HPV associated head and neck cancer is on the rise, in particular, HPV-positive tonsillar cancer in younger patients.
Early detection can greatly improve outcome for patients, therefore, awareness is key in the fight against head and neck cancer but with symptoms differing across the many types, it can be difficult to spot. Standard treatments including chemotherapy, radiotherapy and surgery on such a complex area of the body can really leave their mark on patients.
Research into new ways of improving treatment for head and neck cancers has gone a long way into tackling some of these issues, for example, breakthroughs in immunotherapy, treatments which trigger the bodies own immune system to kill cancer cells, avoiding damage to healthy tissue caused by chemotherapy and radiotherapy. Currently licensed for patients with advanced head and neck cancer, the immunotherapy pembrolizumab was shown to increase survival in some patients by as much as three years.
We have also seen advancements in surgical techniques including the development of robotic surgery to perform minimally invasive and precise produces inside the mouth. Transoral robotic surgery enables surgeons to access tumours that would normally be difficult, if not impossible to reach. The use of this robot avoids large incisions to the neck and jaw, making it less traumatic for patients and decreasing recovery times. A project currently funded by Oracle Cancer Trust is using this new technique to remove hard to reach tissue from the base of the tongue for testing to help increase detection of tumours in head and neck cancer.
“Despite needing more attention in comparison to other cancers, ongoing research in head and neck cancer has bought about lifechanging advancements in treatments for patients”
Radiotherapy is also becoming more refined; in 2004, Oracle Cancer Trust funded a clinical research fellow to work under the supervision of Professor Chris Nutting, to design a treatment protocol to test the effect of reducing the dose of radiotherapy delivered to the salivary glands during head and neck cancer treatment. The technique used is known as intensity-modulated radiotherapy (IMRT).
It was hoped that by doing this, fewer patients would develop the side-effect of permanent dry mouth caused by damage to the salivary glands. This work laid the foundations for a UK-wide clinical trial. The results were stunning. By adapting treatment, after 24 months only 29 per cent of patients reported they were suffering with dry mouth following treatment compared to 83 per cent who received conventional radiotherapy. That means dry mouth was avoided in over half of patients undergoing treatment.
Professor Nutting and his team of researchers have also studied the use of IMRT to reduce damage to swallowing, currently being evaluated in the follow-up stage of a phase III clinical trial. As well as dry mouth and swallowing dfficulties, change or loss of taste is another common complaint of patients following radiotherapy. Professor Nutting is overseeing a 2-year research project that began in 2018, funded by Oracle Cancer Trust, to determine how damage to taste is caused and importantly for patients, how it can be reduced.
Another exciting advancement in the field or radiotherapy, a technology known as Magnetic Resonance Linear Accelerator (MR Linac) was used to treat a patient with prostate cancer for the first time ever in the UK at The Royal Marsden Hospital in 2018. This treatment allows more accurate delivery of radiotherapy by tracking tumours in real time, accounting for changes over the course of treatment. This helps target radiotherapy to the tumour and avoid damage to healthy tissue.
Researchers funded by Oracle Cancer Trust are now looking into how MR Linac could be used to treat head and neck cancer to help physicians plan and deliver radiotherapy.
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