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Frontiers of Medicine

ISSN 2095-0217

ISSN 2095-0225(Online)

CN 11-5983/R

Postal Subscription Code 80-967

2018 Impact Factor: 1.847

Front Med    2012, Vol. 6 Issue (4) : 339-353     DOI: 10.1007/s11684-012-0213-7
Basic consideration of research strategies for head and neck cancer
Jin Gao1(), Ben Panizza2, Newell W. Johnson3, Scott Coman2, Alan R. Clough1
1. Schools of Medicine and Dentistry, and Public Health, Tropical Medicine and Rehabilitation Sciences, James Cook University, Cairns, QLD 4878, Australia; 2. School of Medicine, the University of Queensland, and Head & Neck Surgery Unit, Princess Alexandra Hospital, Brisbane, QLD 4151, Australia; 3. Griffith Health Institute, Griffith University, Gold Coast, QLD 4015, Australia
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Head and neck cancer (HNC) consists of a group of malignancies affecting closely related anatomical regions of the upper aerodigestive tract (UADT), including the oral cavity, salivary glands, upper and lower jaw bones and facial skin; the nasal cavity, paranasal sinuses, pharynx, larynx and thyroid gland (although the latter is often excluded and considered as part of endocrine neoplasms). Of these, 90% of HNCs are histologically squamous cell carcinomas originating from the mucosal lining. These malignancies are strongly associated with certain environmental and life-style risk factors, principally tobacco in both smoked and smokeless forms, excessive alcohol consumption, diets poor in antioxidants and essential micronutrients, UV light, chemicals used in certain workplaces, and viruses, principally certain strains of human papillomavirus (HPV) and Epstein-Barr virus (EBV). These cancers are frequently aggressive in their biological behaviour with local invasion and metastasis to lymph nodes in the neck. Since most patients are already at late stages of disease at the time of diagnosis, the desirable practice of early diagnosis (first sign of the malignant lesion at an initial stage ) and early treatment, a critical priority to save lives and retain quality of life, is difficult to implement. Thus, primary prevention has been set as a key goal. This article aims to reinforce the basic knowledge of aetiology, key risk factors related to the development of head and neck cancer, basic features of clinical appearance of this group of cancers, and strategies for prevention and early detection. We also suggest basic research strategies on the basis of current knowledge, which should ultimately lead to the improvement of clinical management.

Keywords clinical management      head and neck cancer      prevention and early detection      research strategies      risk factors     
Corresponding Authors: Gao Jin,   
Issue Date: 05 December 2012
URL:     OR
Fig.1  Head and neck region. This anatomical schema briefly shows the locations of each oral and laryngopharyngeal junctions in the head and neck region.
Fig.2  OSCC in patients. Cancers present in posterior tongue (A), lower lip (B), floor of mouth (C), and upper gingiva (D).
SiteSubsitesClinical pathologySigns and symptomsPotential aetiology
Oral cavityLip, buccal, tongue, gingivae, palate, floor of mouthSCC, can be well to poorly differentiatedWhite, red or dark patches, lump in the lip, gums, mouth, sore tongue, ulcerTobacco and alcohol, poor diet
Naso-pharynxThe nasal cavities and the Eustachian tubes connect with the upper part of the throat.SCC, often seen “poorly differentiated” bad breathMass in the neck, neck pain, bleeding from the mouth and sinus congestionEBV infection with HPV-16, -18
Oro-pharynxThe middle part- throat including the soft palate, tongue base and the tonsilsSCC, tends to metastasize early due to the extensive lymphatic network around the larynxAs above, difficulty in swallowingAs above, except for smoke and alcohol
Hypo-pharynxThe pyriform sinuses, the posterior pharyngeal wall, and the post-cricoid area95% of HPC are SCC and have lymphatic metastasisSore throat and/or hoarse voice, numbness or paralysis of the face muscles.As above
LarynxThe larynx or “voice box.” On the vocal folds themselves (glottis cancer), or on tissues above/below the true cords (“supraglottic,” “subglottic” cancers)Mostly SCC, and 75% of the cancer are well-differentiatedPainless hoarseness, speaking may become difficult. There may be a persistent earacheUnknown
Salivary gland Intra-oral cavity. Major and minor glands or face under the earsAdenoid cystic carcinoma, mucoepidermoid carcinoma, malignant mixed tumourLump around glands in intra-oral cavity or face under the ears, pain or painlessUnclear, but may be related to genetic or radiation exposure
ThyroidFront neckMost types are papillary or follicular carcinomasAsymptomatic, solitary nodules, difficulty in swallowing,Unknown
Other rare cancers including in tracheaAdenocarcinomas, teratomas, intro-oral melanoma, dermatofibrosarcoma, lymphoma, Hodgkin’s lymphoma. argangglioma, skin cancers, metastatic tumour of jawsMultiple categories of pathological changes depending on the type of cancerVarious clinical appearance including airway blockage in addition to the description as aboveUnknown
Tab.1  Clinical symptoms of head and neck cancer
Fig.3  Global incidence rates and mortality for oral cancers. This shows, by country and/or region from highest quintile (red) to lowest (green), incidence rates (A,B), male (A,C), female (B,D). (source: www.globocan, which are referenced by Ferlay J, Shin HR, Bray F, Forman D, Mathers C and Parkin DM. GLOBOCAN 2008 v1.2, Cancer Incidence and Mortality Worldwide: IARC Cancer Base No. 10 [Internet]. Lyon, France: IARC 2010:, accessed on 05 January 2012; and by Bray F, Ren JS, Masuyer E, Ferlay J. Estimates of global cancer prevalence in 2008 for 27 sites in the adult population.)
Fig.4  Betel nuts and oral cancer. Panel I: L. Palm (A), betel leaves ( L.) (B), areca nuts unripe (C), areca nut raw (D). Panel II: preparation of betel quid (A-C), chewing betel quid (D); betel chewer’s mucosa shows brownish flakes and homogeneous leukoplakia of the right cheek (E), initial and submucous fibrosis (white bands and plaques in the buccal mucosa: F). (Source: www.globocan, which are provided by Peter Rechart and Nargis Dutt Memorial Cancer Hospital, Barshi, Solapur District, Maharashtra, India, and are referenced by Ferlay J, Shin HR, Bray F, Forman D, Mathers C and Parkin DM. GLOBOCAN 2008 v1.2, Cancer Incidence and Mortality Worldwide: IARC Cancer Base No. 10 [Internet]. Lyon, France: IARC 2010:, accessed on 20 April/2012; and by Bray F, Ren JS, Masuyer E, Ferlay J. Estimates of global cancer prevalence in 2008 for 27 sites in the adult population.)
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