Recent advances in head and neck cancer

Ninety percent cancers in the head and neck area are squamous cell cancers (HNSCC) from mucosal epithelium. But anatomical sub sites and morphological sub varieties have different biology, patterns of spread, and treatment requirements. Temporal trend of incident of HNSCC in India is declining; but tongue and oropharynx cancers show a rise in younger age groups with the types that have been reported to be HPV related in western countries, which raises the issue of vaccines and screening as in cervical cancers. Use of MRI, MR spectroscopy, 3D CT scan with reconstruction, and PET-CT in clinics allow more accurate staging and post therapy monitoring. Molecular biology tools now can divide the conventional HNSCC in two main groups: 1) elderly male, user of tobacco and alcohol, keratinizing SCC, TP53 mutated and/or p53-positive, HPV16-negative, with an aggressive course; and 2) younger men without known risk factors, non-keratinizing SCC, HPV16-positive, p16-positive, and p53-negative, with improved prognosis. While surgical treatment has expanded toward two opposite but complementary directions of minimally invasive to ultra radical excision and reconstruction, radiotherapy has moved to a more biological approach by altering dosage schedule, being more conformal and using chemotherapy concurrently. Neoadjuvant or Induction chemotherapy has been introduced before definitive treatment with surgery or radiation alone or concurrent chemoradiotherapy. Targeted therapy with cetuximab in combination with chemotherapy and radiotherapy has improved results in advanced or recurrent disease. Many other anti growth factor agents like TKIs and anti VEGF monoclonal antibody, bevacizumab are showing promise.