Dental management of the head and neck cancer patient

The number of people being diagnosed with head and neck cancer is rising. In 2011, it is estimated that 7 354 people in England and Wales developed head and neck cancer (Health and Social Care Information Centre, 2012). The anatomical sites included in head and neck cancer are seen in Table 1. Over 90% of head and neck cancers are found to be squamous cell carcinoma (see Figure 1), which is derived from the epithelial lining of the structures (Health and Social Care Information Centre, 2012).

Sites of head and neck cancer

Figure 1.Squamous cell carcinoma of palate

Head and neck cancers are heavily linked to certain environmental or lifestyle factors, including tobacco smoking or chewing, alcohol consumption (especially spirits) and chronic trauma due to gastro-oesophageal reflux disease. The combination of alcohol and tobacco greatly increases the risk of head and neck cancer, with those who have smoked and drank heavily for many years being at high risk (Macmillan Cancer Support, 2012). Pre-existing soft tissue lesions, such as leukoplakia (white patches) or erythroplakia (red patches), also increase the patients’ risk of developing cancer. Increasingly, Human Papilloma Viruses (HPV) are being linked to head and neck cancers, with up to 50% of tumours being found positive for HPV (Health and Social Care Information Centre, 2012). Certain chemicals have been linked to head and neck cancer and exposure to sunlight is a risk factor for lip cancers (Macmillan Cancer Support, 2012).