‘Head and neck cancer is uncommon, but quality of life when onset ↓… Stop smoking, drinking alcohol, vaccination is essential’

Oral/pharyngeal/nasal/larynx cancer, salivary gland cancer, etc.
Any cancer that occurs in the head and neck region
Causes of smoking, drinking, and HPV
Robotic surgery without incision makes recovery faster

(From left) National Health Insurance Ilsan Hospital, Department of Otorhinolaryngology, Professor Ji-Hoon Kim, Plastic Surgery Professor Jun-Ho Song, and Oncology and Hematology Professor Ja-Yun Huh

Planning serialization order

① National Health Insurance Ilsan Hospital Cancer Center Introduction
② breast cancer
③ thyroid cancer
④ lung cancer
⑤ Gynecological cancer
⑥ colorectal cancer
⑦ Liver cancer
⑧ Cancer of the pancreas and biliary tract
⑨ Urinary cancer (prostate, bladder, kidney cancer)
⑩ Head and neck cancer

⑪ brain tumor
⑫ stomach cancer
⑬ blood cancer
⑭ Lifelong Cancer Clinic
※ The serial order and contents may change depending on the situation.

[고양신문] Head and neck cancer literally refers to all cancers that arise from the head and neck. Symptoms such as pain, lumps, nasal congestion, bleeding, sores in the mouth, and changes in voice may appear depending on the site of occurrence, such as the face, mouth, and neck. It can affect your nutrition and cause major problems with your interpersonal relationships. As a result, head and neck cancer acts as a factor that significantly lowers the quality of life.

Although it is a relatively new disease compared to other cancers, the incidence of head and neck cancer is gradually increasing as the population ages. Males in their 50s and older account for well over half of head and neck cancer patients, and it can be assumed that tobacco and alcohol, the representative risk factors, have had an effect. In particular, it is known that the prognosis is not very good in the case of head and neck carcinoma whose disease has progressed due to smoking.

Since head and neck cancer is usually diagnosed only following the disease has progressed to a significant level, it is not so easy to restore the very normal activities of breathing, eating, and speaking even if the tumor is removed and treated. We met with Professor Ji-Hoon Kim of the Department of Otorhinolaryngology at National Health Insurance Ilsan Hospital, Professor Jun-Ho Song of Plastic Surgery, and Professor Ja-Yun Huh of Oncology and Hematology to learn more regarding head and neck cancer.

I’m not generally familiar with the head and neck, but please explain the anatomical structure, location, and function of the head and neck in the human body.
Jihoon Kim Head and neck (頭頸部) means ‘head’ and ‘gyeong’ in Chinese characters, and in English it is expressed as head and neck. Anatomically, it covers from the top of the clavicle to the bottom of the brain, but excludes the eyeball. This area is made up of organs essential for respiration, vocalization, and swallowing (the process of taking food through the mouth, chewing it in a state suitable for swallowing, and then passing it through the esophagus to the entrance to the stomach). These include the nasal cavity (sinuses), oral cavity, pharynx (nasopharynx, oropharynx, hypopharynx), larynx, salivary glands, and thyroid gland.

Statistics by type of head and neck cancer and anatomical structure of the head and neck region [이미지 출처 = 분당서울대병원]

The types, symptoms, and diagnosis methods of major cancers occurring in each site are described.
Jihoon Kim According to the nature of cancer, it is classified into cancers of the respiratory system (oral cancer, pharyngeal cancer, nasal cancer, laryngeal cancer) and salivary gland cancer. In the case of thyroid cancer, although the nature of the cancer is somewhat different, it is included in the head and neck region due to its location, but it is generally classified separately from head and neck cancer. The head and neck area has slightly different characteristics for each location, so it is somewhat difficult to identify common symptoms.

In the case of oral cancer, one part of the lips or tongue may continuously break and bleed, white spots may appear on the surface of the tongue, or a hard lump may appear. In the case of pharyngeal cancer, there may be a feeling of foreign body when eating or the feeling that food is not swallowed well. Laryngeal cancer can be suspected when hoarseness persists for a long time. Salivary gland cancer may be suspected when a hard lump in the front or lower part of the ear is felt and is painful or accompanied by facial paralysis.

Because head and neck cancer metastasizes well to the cervical lymph nodes in the neck, if you feel a lump on the neck and it does not subside over time and grows larger, there is a possibility of metastasized lymph nodes, so it is essential to check up.

If head and neck cancer is suspected due to these symptoms, you should visit an otolaryngologist and undergo an endoscopy. Gastric endoscopy and colonoscopy require pretreatment and fasting, but otolaryngology endoscopy can be tested immediately on an outpatient basis without anesthesia. The endoscope is inserted through the nose or mouth, and the entire neck can be viewed in regarding 1 minute. If cancer is suspected, additional CT or ultrasound examinations may be required. Because it most often occurs in the mucous membrane, it can be easily diagnosed through endoscopy.

However, the annual incidence of head and neck cancer is very rare, regarding 2-3%. It is known that regarding 5,000 cases occur annually in Korea. The general public is often unaware that cancer develops in this area, and since it is a cancer that is not easily accessible even in primary care institutions, early diagnosis is often difficult, so it is very regrettable as a specialist. According to the 2018 National Cancer Registry Annual Report, the annual incidence of head and neck cancer is regarding 2.2%, which is a very rare cancer. Among them, oral cancer 0.68%, pharyngeal cancer 0.64%, laryngeal cancer 0.46%, salivary gland cancer 0.23%, nasal sinus cancer 0.16%, thyroid cancer 11.75%, etc.

Smoking, alcohol, and human papilloma virus (HPV) are mentioned as major risk factors for head and neck cancer.
Heo Ja-yoon Head and neck cancer occurs when carcinogens such as alcohol and tobacco continuously irritate the mucous membranes of the mouth and respiratory tract, damage and degeneration of the mucous membranes, resulting in gene denaturation. Head and neck cancer is a squamous cell carcinoma that occurs in more than 90% of the mucous membrane. Alcohol and smoking are typical environmental factors. Recently, human papilloma virus (HPV) infection has been reported as an important risk factor.

Professor Jihoon Kim of the Department of Otolaryngology

Jihoon Kim The incidence of head and neck cancer increases in people over the age of 60 who have been exposed to smoking and drinking for a long time. Smokers are 15 times more likely to develop head and neck cancer than nonsmokers. It is known that smoking and drinking alcohol at the same time increases the risk of head and neck cancer by 30 times. Head and neck cancer is also related to oral hygiene and prosthetics. If oral hygiene is poor, dentures or prostheses irritate the tongue or oral mucosa, causing repeated inflammation or continuous physical stimulation, leading to cancer.

The pharynx refers to the back of the neck, the back of the nose is called the nasopharynx, the back of the oral cavity is called the oropharynx, and the entrance to the esophagus is called the hypopharynx. The area around the tonsils on either side of the uvula corresponds to the oropharyngeal region. It is reported that more than 70% of oropharyngeal cancers occurring in this area are caused by the human papillomavirus (HPV). HPV is a virus that causes cervical cancer. Like cervical cancer, HPV types 16 and 18 are mainly associated with cancer. In 2021, the Korean Society of Gynecological Oncology also recommends that women between the ages of 9 and 45 and men between the ages of 9 and 26 receive the cervical cancer vaccine.

Since HPV-positive oropharyngeal cancer and HPV-negative oropharyngeal cancer have very different characteristics, from the end of 2016, the staging of HPV-positive oropharyngeal cancer and HPV-negative oropharyngeal cancer was divided according to the presence of HPV infection. HPV-positive oropharyngeal cancer occurs most often in people in their 40s to 60s, and the male to female ratio is 3:1. It is known that there is a higher correlation with sexual history than smoking or drinking. Although the primary cancer is small, the lymph nodes are large and metastases are high. Although lymph node metastasis is commonly found, the 5-year survival rate is as high as 80 to 90% because it responds well to chemotherapy. In the case of HPV-negative oropharyngeal cancer, the majority are over the age of 60, the male to female ratio is 3:2, and the 5-year survival rate is 40-60%.

Professor Heo Ja-yoon, Department of Oncology and Hematology

The anti-smoking campaign through the Ministry of Health and Welfare’s ‘No Dam’ advertisement seems to have a significant effect.
Heo Ja-yoon It is difficult to immediately feel the effect of such a smoking cessation campaign in the medical field. In particular, in the case of head and neck cancer patients, there are many people who have already smoked for more than 20 years. Quitting smoking is not an easy task to the extent that there are people who smoke even while receiving chemotherapy, so I think it is a good way to start an active campaign to prevent young people from starting smoking at all.

Jihoon Kim According to a recent study in the United States, it was estimated that cigarette pack warning pictures might prevent the initiation of smoking and prevent 270,000 smoking-related deaths by 2100. I know there were opinions for and once morest introducing warning pictures, but personally, I think more active introduction and publicity are needed.

Alcohol and smoking are clearly known carcinogens. There are many people who do not know how hard it is to suffer from head and neck cancer surgery, losing a tongue, being unable to speak, and not being able to eat. It is known that the earlier you quit smoking, the lower your risk of cancer. According to the Korea Centers for Disease Control and Prevention (KCDC) data released this year, if you have smoked for less than 10 years, your cancer risk decreases by 74% when you quit smoking, but if you quit smoking for more than 40 years, your cancer risk decreases by only 9%.

TV CF for ‘Keep your distance from cigarettes’ that conveys the dangers of smoking from a child’s point of view [이미지 출처 = 보건복지부 국가금연지원센터]

If you explain the main treatments such as robot surgery, head and neck cancer surgery method, chemotherapy, and radiation therapy.
Heo Ja-yoon If it is detected at an early stage (stage 1 or 2), the cancer is often removed only by surgery. can. Anticancer drugs, like other chemotherapy, often use toxic chemotherapy, and usually take liquid food and fluids for regarding 6 weeks.

Jihoon Kim Since cervical lymph node metastasis is common in head and neck cancer, cervical lymph node dissection is usually performed together with primary site resection. When the cancer is excised, regarding 1 cm more is excised from the border of the visible cancer mass. It is intended to remove even microscopic cancers that are invisible to the naked eye. In the case of advanced tongue cancer, more than half of the tongue is resected. After surgery, it becomes difficult to speak or swallow food.

Song Jun-ho Therefore, it is necessary to maintain the function of the tongue as much as possible by making an artificial tongue that reconstructs its own tissues as much as the resected part. This process is called reconstructive surgery. A reconstructed tongue is made using autologous tissue, mainly using the patient’s inner arm muscles or thigh muscles. Also, if tongue cancer has advanced and invades the jawbone, part of the jawbone is cut and the defect is reconstructed using an implant or leg bone.

Jihoon Kim Because otolaryngology surgery is cancer that occurs inside the throat, it is difficult to access, so it is often necessary to cut the chin or make a large incision in the neck to expose the inside. Recently, with the development of robotic surgery techniques, a long robotic arm is inserted through the oral cavity to remove the internal cancer without an external incision. Even in a narrow space, precision surgery that protects nerves and blood vessels is possible through 3D magnified images. Because there is no external incision, the recovery period and recovery to daily life are fast.

Professor Junho Song of Plastic Surgery

It seems a bit surprising to see plastic surgeons participating.
Song Jun-ho When people think of plastic surgery, they usually think of plastic surgery for the eyes, nose, and chin, but an important area of ​​plastic surgery is reconstructive surgery. Plastic surgery is also responsible for reconstructing facial defects caused by trauma. Reconstruction, such as extensive resection for skin cancer or skin recovery from burns, is a big part of plastic surgery.

If there is any differentiation and characteristics of Ilsan Hospital in the treatment of head and neck cancer.
Jihoon Kim Just as a car can speed up when all four wheels move well, the best treatment for head and neck cancer can only be provided when specialists in each field, such as otolaryngology, head and neck surgery, hematology oncology, plastic surgery, and radiation oncology, work together to provide the best treatment. Although there are standardized treatment guidelines, it is essential to provide customized treatment for each patient because the characteristics of cancer are different for each patient.

Song Jun-ho The head and neck cancer treatment team at Ilsan Hospital is made up of young professors, so communication between medical staff is smooth. Therefore, I think the biggest advantage is that we can schedule the surgery without much difficulty through consultation with each other and continue surgery and treatment under the best conditions.

Robot surgery scene at National Health Insurance Ilsan Hospital. Robotic surgery is performed while viewing the surgical site magnified 10 times on a three-dimensional image, and the robot arm can be moved like a doctor’s hand in a narrow space, making it a safe and accurate operation.

If there is one last thing you want to say.
Jihoon Kim Head and neck cancer is a cancer where early diagnosis and prevention are of the utmost importance. When cancer develops, it is difficult to speak, it is difficult to swallow food, and surgery can cause facial deformities and a large scar on the neck, which greatly reduces the quality of life. Even following surgery, the sense of loss of ordinary life is greater compared to other cancers. Although head and neck cancer is not a common cancer, it is a cancer that cannot be overlooked because Korea has a well-developed drinking culture and is relatively tolerant of binge drinking. Furthermore, head and neck cancer screening is not an item of the national cancer screening project, so the role of the patient is huge.

Song Jun-ho Although the incidence of head and neck cancer is not high, once it develops, it becomes difficult to eat and speak, which significantly reduces the quality of life. I would like to ask you not to take it lightly because communication is not smooth and it greatly interferes with interpersonal relationships. If you have any suspicious symptoms, we recommend that you do not delay and visit a hospital for examination. In particular, in the case of middle-aged people over the age of 50, it is necessary to reduce alcohol and tobacco and thoroughly manage oral hygiene. Continuous care is also required when using dentures or prostheses.

Heo Ja-yoon Compared to other cancers, the majority of head and neck cancer patients are single-person households. This seems to be because in many cases the body as well as the home were destroyed by excessive alcohol and tobacco. When I contacted my family, I’ve even seen them say, ‘Please call me following I die’. I would like to urge you to stop smoking and drinking alcohol for the sake of protecting yourself and the happiness of your family.