Nearly 80 per cent of head and neck cancers are caused by consumption of tobacco, areca nuts and alcohol. Especially with the advent of chewable forms of tobacco, there has been an alarming rise in the number of oral cancer patients. Unfortunately, these causative agents are freely available in the market

Since the last few years, July 27 has been observed every year as World Head and Neck Cancer Day. The ongoing pandemic has taken center stage of the country's health system as in all countries, and even cancer care has taken a back seat in Nepal. We started observing this day a few years back with the aim of increasing awareness about this very common preventable cancer in Nepali society. Interaction with head and neck cancer survivors, formation of head and neck cancer support groups and increasing awareness through the media are common activities carried out on this day.

Head and neck cancer is a conglomerate of cancers of various subsets involving the body part from the lowermost neck up to the skull base (bone separating the sinus from the brain).

It includes the mouth, larynx (voice box), throat, nose and sinus, ear, skin cancer of the face, thyroid, salivary gland and lymph node of the neck. It's three times more common in males than females. Although no age group is immune to it, it's more common in the above 40 years age group In other parts of the world, it is considered to be the fifth most common malignant cancer. In Nepal and other SAARC countries, it is considered to be one of the most common cancers in the male and the third most common cancer (after cervical and breast) in the female.

Although we don't have concrete data due to lack of a national cancer data base, but based on available data, we can assume that 3,500-5,000 Nepalis lose their lives annually due to head and neck cancer.

More than 12,000- 14,000 new cases are detected every year, of them70-80 percent present them at the referral centrein the advanced stage.

About 70 percent of the head and neck cancer patients belong to the lower socio-economic group.

Nearly 80 per cent of head and neck cancers are caused by consumption of tobacco, areca nuts and alcohol.

Especially with the advent of chewable forms of tobacco (khaini, guthkha and paan), there has been an alarming rise in the number of oral cancer patients in society. Unfortunately, these causative agents are freely available either due to a weak tobacco control policy or its implementation.

Addiction to these forms of tobacco at a very young stage of life has increased its prevalence in the younger age group as compared to the Western population, which puts a heavy burden on families for its treatment.

People who smoke and drink simultaneously have a higher chance of acquiring head and neck cancer than those who smoke or drink only. Poor oral hygiene, ill-fitting denture and sharp teeth are other less common causes of mouth cancer.

Detecting the disease at a nearly stage is key to managing head and neck cancer.

Patients present themselves with various site-specific symptoms like non-healing ulcers in the mouth, difficulty in swallowing, voice change, swelling in the neck, loose tooth, non-healing of the wound post tooth extraction, ill-fitting dentures, one-sided facial swelling, increase in mole size, previous or new skin lesion with ulceration.

Diagnosis is established after performing clinical examination, biopsy from an ulcer and FNAC (Fine needle aspiration cytology) from a palpable lump in the neck. Further assessment and staging after tissue diagnosis involve performing an endoscopy and imaging, which consists of a CT scan, ultrasonography, MRI scan and sometimes PET scan, which are now available in Nepal.

After the final staging, a multimodality team, which consists of head and neck and reconstructive surgeons, and radiation and medical oncologists, decides upon the treatment modality. The treatment modality mainly consists of surgery, radiation and chemotherapy.

In the early stage (stages 1and2) of the disease, a single modality is chosen, which mostly consists of surgery and sometimes radiation.

In the advanced stage (stages 3 and 4), more than one modality is applied.

An early stage disease has a favourable prognosis while an advanced stage disease has a dismal prognosis. When the disease cannot be treated with curative intent, it is considered for palliative and supportive care.

In Nepal, we, as caregivers, face a lot of challenges while treating head and neck cancer patients, mostly due to their financial constraints, presentation at the cancer centre at an advanced stage, social stigmata of having the disease and spending valuable time going to a faith healer for treatment, refusal to undergo surgery due to cosmetic and functional issues, and poor follow-up.

In Nepal, there are only a few comprehensive cancer centres, which are always overburdened with head and neck cancer patients.

Also there is a shortage of trained manpower capable of treating head and neck cancer patients.

But the scenario will change in the near future as quite a few cancer centres are coming up at both the private and government level, while at the same time, more health personnel are being trained in the head and neck cancer specialty.

Prevention is key to reducing the burden of this disease. Increasing awareness in the public about tobacco being the main cause of head and neck cancer will be the single most bold step.

The government must introduce stringent laws onthe sale of tobacco while the people must adopt a healthy lifestyle. Regular checkups, especially by patients who are chronic abusers of tobacco and its products and an early referral system are a few other steps which will help to reduce the burden of this disease.

All modalities of treatment with the latest technology and expertise are now available in Nepal, and results are comparable to any hospital abroad.

So going abroad for treatment at costs many times higher is not necessary as this disease requires regular follow-up as well as social and emotional support.

Dr Thakur is director, head and neck oncology programme, Nepal Cancer Hospital and Research Centre, Harisidhhi, Lalitpur

A version of this article appears in the print on July 28 2021, of The Himalayan Times.