Neck and head cancers on increase in Uganda

By Flavia Nassaka

Early sex, oral sex, and HPV which also causes cervical cancer blamed

At the Uganda Cancer Institute in Kampala, July 28 has been dedicated to treating sufferers of cancers that affect the neck and head. Experts exclusively handle patients with problems of the oral cavity (gum, tongue, floor of the mouth, hard palate and the lips), nasal cavity, Pharynx (a hollow tube that starts behind the nose and leads to the esophagus), the voice box (larynx) and the lymph nodes.

Dr. Jeffery Otiti, a Head and Neck surgeon at the Institute says people with cancers of the head and neck have been on an increase with between 10 and 15 cases recorded per week. Before, less than 300 would be recorded annually. He said these cancers are likely to become a major burden in the near future.

While smoking and alcohol consumption have been the most dominant risk factors for cancers of the head and neck over the years, recently a new risk factor has been identified – the Human Papillomavirus (HPV), the same virus that causes cancer of the cervix.

“70% of cancers that affect this area are being caused by the papilloma and increasingly people in their 30s and 40s are presenting with the disease yet it was a disease common among people in their 60s and 70s. Most of these patients are male,” he said.

People at the highest risk of HPV associated neck and head cancer according to Dr.Otiti include people with multiple partners, those who start having sex at an early stage, and those who engage in oral anal contact since the virus can be spread through sexual intercourse with the person who has it.

With HPV associated cancers, usually the tumors develop at the back of the tongue, in the throat area, and also in the tonsils.

Dr. Abubakar Bugembe, an Ear, Nose and Throat (ENT) surgeon explains that there are many types of HPV but they have not yet done a comprehensive study to figure out the exact type that causes throat cancer though it is confirmed to be a strain of HPV.

He says like other cancers, there are those that get deep into the tissues (sarcomas) and those that affect the surface (carcinomas) but the commonest are the carcinomas that affect the voice box where vocal cords for speech are found. This cancer is referred to as laryngeal cancer.  This is followed by ones that affect the nose and its extensions (nasopharyngeal carcinomas).

He says the symptoms of head and neck cancers differ with the area affected. For instance, when it is cancer of the nose, one will get nasal bleeding, blockage, swellings in the nose, and others may get sinuses. Some will develop painless swellings in the neck, a condition technically referred to as a bull neck. Cancers that affect the food passage present prolonged difficulty in swallowing and most of these are progressive until when one is completely unable to swallow. When the cancer forms in the voice box, one initially develops a horse voice until when they can no longer speak.

While the exact causes of cancers remain unknown, the doctors say there are a number of other factors that predispose the body to these cancers:

Heavy smoking and drinking is particularly risky especially with people who combine the two. Dr. Bugembe says alcohol makes cancer causing chemicals easily penetrate the skin. These substances damage the cells and begin growing without control leading tumors. People who smoke have 5 to 25% increased risk compared to non smokers because of the nicotine and polycyclic hydrocarbons in the tobacco.

HIV lowers one’s immunity as the body fails to mop out unnecessary cells out of the body. When these cells pile up, tumors are formed in the body.

Diets with carcinogens like in smoked fish, salted fish and some soft drinks can also predispose one to cancers since carcinogens alter cellular metabolism.

Occupational exposures; for instance people who work in leather tanning and hard wood industries are particularly at risk when they inhale the dust from these materials.

Chronic irritation of tissue for instance untreated acid reflux can cause esophageal cancer.

Neck and head cancers can be severe and treatment options include radiotherapy, chemotherapy, and surgery. If one reports the disease early enough, there are 90% chances of cure.  Dr. Bugembe says unfortunately people only report to hospital when the disease is in advanced stages partly because during initial stages, tumours tend to be painless.  At such a time, the chances of survival are minimal and survivors are left with permanent deformity.

Dr. Otiti says people who are cured of head and neck cancer are still at very high risk for a second cancer in their mouth or throat, and, unfortunately, these second cancers are commonly fatal. For him, it’s important for people to seek to prevent the disease since most of the risk factors such promiscuity, alcohol, poor diet, and tobacco use can be avoided.

Globally, the incidence of head and neck cancer is 550,000 to 650,000 cases per year whereby two thirds are found in developing countries. Global survival rate in developed countries is 40% and is much lower in low developing countries like Uganda. Currently the annual burden of all cancers in Africa stands at 650,000 people.