A PHARMACOLOGICAL REVIEW ON HEAD AND NECK CANCER
Dr. Tarra Rushi Naidu1, Kontheti Mahesh
Pavan*2, Vamaraju Upajna2, Burreddy
Navya Deepika2
1 Associate professor in Avanthi Institute of Pharmaceutical Sciences,
cherukupally, Vizianagaram.
2 Student of Avanthi Institute of Pharmaceutical Sciences, Cherukupally,
Vizianagaram.
*Corresponding author:
Kontheti Mahesh Pavan,
Contact: 9494579837;
E-mail: maheshpavankontheti@gmail.com
Andhra Pradesh, India
ABSTRACT: Head and neck cancer are a group of cancers of the mouth,
sinuses, nose or throat, where smoking is considered a major risk
factor. Symptoms may appear in mouth, sinuses, nose or throat and
include a sore or lump that doesn’t heal, a persistent sore throat,
trouble swallowing and changes in the voice. Prognosis in this type of
cancer generally depends on the size of tumor, primary site, causative
factor, and presence of local or distant metastases. In general, the
prognosis is favourable if diagnosis is early and treatment is timely
and appropriate. Treatment includes surgery, radiation therapy or
chemotherapy. Staging of tumor can be done using TNM classification and
the can be evaluated through RECIST guidelines. Removing risk factors is
very much important in preventing this type of cancer, and patients
should stop the usage of tobacco and limit alcohol consumption.
KEY WORDS: head and neck cancer, squamous cell carcinoma, tobacco use,
lesion, chemotherapy.
INTRODUCTION:
Cancers of the upper nasopharyngeal tract which are collectively known
as head and neck cancers, arise from many of sites. These tumours cause
major problems in management, and skilled healthcare team is necessary
to achieve the highest level of service and research. Previously,
surgery and radiotherapy have been widely used in the treatment while,
chemotherapy is now increasingly employed but not yet fully established.
Current research efforts majorly concentrate on defining the importance
of chemotherapy and determining the advantage of unconventional
radiation approaches1. These malignancies develop in
areas responsible for eating, talking, and breathing and are associated
with substantial morbidity and mortality despite advances in treatment.
We need to understand the advances in head and neck cancer (HNC)
management to study the patients across the cancer care continuum.
Additionally, the recent Coronavirus Disease 2019 (COVID-19) pandemic
has necessitated adaptations to HNC care to accommodate mitigation of
COVID-19 risk and ensure timely treatment2. Smoking
and alcohol abuse are major risk factors for the development of this
disease. Majority of the cases are squamous cell carcinomas, and it
arises in the oropharynx, oral cavity, hypopharynx, or larynx. HNSCC
develops as a result of the both environmental factors and genetic
inheritance, and is thus called multifactorial. Human papillomavirus
(HPV) is also considered risk factor in about 25% of the disease. Now,
there are many surgical procedures, which include robotic surgery, that
decreases the tracheotomy rate, and allows a faster oral swallowing
recovery and shorter hospital stay3.
EPIDEMIOLOGY:
Head and neck squamous cell carcinoma (HNSCC) include mucosal squamous
cell carcinomas of the upper aerodigestive region and represents more
than 65,000 new cancer cases and 14000 plus cancer-related deaths in the
United States annually. Head and neck cancer is mainly associated with
smoking and alcohol consumption and have been decreasing in incidence in
recent years. In contrast, the primary cause for oropharyngeal SCC is
now HPV. The incidence of HPV-associated OPSCC has been exponentially
rising, with an annual increase of 3.8% in Caucasian men between for
about two and half decades since 1992. The incidence of HPV-positive
OPSCC has become more common than HPV-related cervical
cancer4. A majority of patients can be cured with
surgery or radiation with early-stage SCCHN, and those with aggressive
disease and those with locally advanced stages, there are mor chances
for the cancer to recur5. There are about 350,000
deaths yearly which are associated with SCCHN worldwide. In the United
States, head and neck cancer cases
accounted for more than 40.000 new cancer cases in 2007, corresponding
to 3% of all
new cancer diagnoses in the country. Although there are several advances
in treating this cancer, approximately 11,210 head and neck cancer
related deaths have been noted during 2007 in the United
States6.
ETIOLOGY & PATHOGENESIS:
Tobacco smoking is considered as a major risk factor for HNSCC, and this
is associated with the intensity and duration of smoking habit. The
cigarette contains nitrosamines and polycyclic hydrocarbons carcinogens
elements that cause toxic effects to genes and therefore may increase
the risk of occurrence of disease. These factors are responsible for the
alterations in the molecular profile of the individual and cause gene
mutations. Alcohol acts as a medium to enhance exposure of the mucosa to
carcinogens, thereby increasing cellular uptake of these cancer-causing
compounds. The acetaldehyde, can form DNA adducts, which interfere with
DNA synthesis and repair. According Marur & Forastiere, tobacco intake
along with alcohol consumption increases the HNSCC the risk to 40
times7. Figure 1 represents the sites of occurrence of
head and neck cancer.