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.