Head & Neck Cancer

Head and neck cancers are a group of cancers arising from the mucosal lining of the upper aerodigestive tract — the surfaces of the mouth (oral cavity), nose (nasal cavity), sinuses, throat (pharynx: nasopharynx, oropharynx, hypopharynx), and voice box (larynx). The vast majority are squamous cell carcinomas. Salivary gland tumours and nasopharyngeal carcinoma have distinct biology and risk factors. Head and neck cancers are collectively the 6th most common cancer globally. In Ethiopia and East Africa, oral cavity and laryngeal cancers predominate, strongly associated with tobacco and khat (qat) chewing habits.

Do not ignore these symptoms — they require prompt medical evaluation:

Clinical examination: careful inspection of the mouth, throat, and neck; laryngoscopy (looking at the voice box). Nasopharyngoscopy or flexible fibreoptic laryngoscopy: visualises the nasopharynx, oropharynx, and larynx. Biopsy of the primary tumour: the definitive diagnostic test — tissue is sent for histopathology and HPV/p16 immunohistochemistry for oropharyngeal tumours. CT and/or MRI of the head, neck, and chest: essential for staging, showing invasion of adjacent structures and lymph node involvement. PET-CT: detects nodal disease and distant metastases. HPV status (p16 IHC) guides prognosis for oropharyngeal cancer — HPV-positive tumours have better outcomes.

Head and neck cancers are staged using the TNM system (tumour size, node involvement, metastases). Stage I–II: Small tumour confined to the primary site; no lymph node involvement — high cure rates with single modality treatment. Stage III: Larger tumour and/or involvement of regional lymph nodes — combined modality treatment needed. Stage IVA: Moderately advanced local or regional disease — still potentially curable with aggressive multimodal treatment. Stage IVB: Very advanced local disease (invading carotid artery, skull base). Stage IVC: Distant metastases — palliative intent. Nasopharyngeal cancer staging follows a separate classification.

Treatment depends on the site, stage, and HPV status. NCCN Guidelines recommend:

Tobacco cessation is the single most impactful preventive measure — stopping at any age reduces risk. Avoid all forms of tobacco: cigarettes, hookah (shisha), smokeless tobacco, and khat chewing. Limit alcohol consumption — alcohol acts synergistically with tobacco to greatly increase risk. HPV vaccination in adolescents also prevents HPV-associated oropharyngeal cancer. Regular dental check-ups allow early identification of suspicious oral lesions. White or red patches in the mouth (leukoplakia or erythroplakia) are pre-cancerous; biopsy these lesions to exclude early cancer. Community health workers in Ethiopia should be trained to recognise oral lesions during routine visits.