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Head and neck cancer and the role of the pathologist

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27th September, 2022

The treatment of head and neck cancers can have devastating effects on the way a person eats, speaks, swallows or the way they see and hear. So, what causes them and what role does the pathologist have in the treatment process?

The news that one of Australia’s most beloved per­form­ers, John Farn­ham, had under­gone surgery in August 2022 to remove a can­cer­ous tumour in his mouth brought head and neck can­cers into the pub­lic spot­light like nev­er before.

Pro­fes­sor Ruta Gup­ta sat down with RCPA Pres­i­dent Dr Lawrie Bott to dis­cuss the role of the pathol­o­gist in head and neck can­cers for an episode of the College’s pod­cast series, “The Pathol­o­gists Cut”.

Prof Gup­ta holds many posi­tions, includ­ing as senior staff spe­cial­ist at NSW Health Pathology’s Roy­al Prince Alfred Hos­pi­tal Lab­o­ra­to­ry, and as lead pathol­o­gist with the Head and Neck Oncol­o­gy and Thy­roid Mul­ti­dis­ci­pli­nary team at Chris O’Brien Life­house Can­cer Centre.

“Because of the area of the body that head and neck can­cers affect, they can have very sig­nif­i­cant effects on the way a per­son eats or speaks, the way they swal­low or the way they see and hear. Head and neck can­cers are a very diverse range of can­cers caused by a vari­ety of rea­sons and risk fac­tors, which are all grouped togeth­er because of their loca­tion on the body,” she said.

“Tra­di­tion­al­ly, the most fre­quent cause of head and neck can­cer is smok­ing and drink­ing alco­hol. How­ev­er, in Aus­tralia, the rate of smok­ing is going down which means that we are see­ing a decline in smok­ing asso­ci­at­ed head and neck cancers.

“Cur­rent­ly, we are see­ing an increase in head and neck can­cers caused by virus­es such as human papil­lo­mavirus (HPV), which caus­es can­cer of the orophar­ynx, or Epstein Barr Virus (EBV), which caus­es nasopha­ryn­geal cancer.

“Head and neck can­cers asso­ci­at­ed with smok­ing or alco­hol are gen­er­al­ly seen in old­er peo­ple and are much more com­mon in men who have had a life­time habit with alco­hol or smoking.

“On the oth­er hand, head and neck can­cers caused by virus­es tend to occur in much younger people.

“These patients tend to be in their ear­ly 40s to mid 50s and gen­er­al­ly do not have life­time expo­sure to tobac­co. More recent­ly, we are also see­ing mouth can­cers in young women, the rea­sons for which we don’t know cur­rent­ly,” said Prof Gupta.

HPV is a com­mon virus that affects both males and females and there are more than 100 strains of HPV.

Most types of HPV are harm­less, do not cause any symp­toms, and go away on their own.

A small pro­por­tion of peo­ple, both men and women, will not clear HPV from their sys­tems – these peo­ple are at high­er risk of devel­op­ing can­cers, either of the head and neck, or in the case of women, can­cer of the cervix.

“Because head and neck can­cers that arise from HPV are gen­er­al­ly hid­den in the fold of the ton­sils or right at the back of the throat, they can be very dif­fi­cult to see. Sur­geons will use an endo­scope to look and take biop­sies from the ton­sils or the back of the tongue. These biop­sies are then sent to the pathol­o­gist who will look under the micro­scope and make a can­cer diag­no­sis. If can­cer is present, there are cer­tain tests we can do to see if it is relat­ed to HPV,” said Prof Gupta.

“Once a diag­no­sis of can­cer is made, the patient then under­goes surgery. For head and neck can­cer this is not just the removal of tis­sue with can­cer. It is not just tak­ing out the tongue, the jaw, or the ton­sils, we also need to take out lymph glands from the patient’s neck.

“These are big sur­gi­cal pro­ce­dures and can require ICU care and long hos­pi­tal admis­sions whilst the patient recov­ers. The diag­no­sis of head and neck can­cer is a crit­i­cal step to start the patient’s can­cer journey.

“The pathol­o­gists exam­ine the tis­sues removed dur­ing surgery to deter­mine whether all of the can­cer was removed or whether micro­scop­ic amounts is left behind or whether the can­cer has invad­ed blood ves­sels and nerves. If this has hap­pened addi­tion­al treat­ment with radio­ther­a­py or chemother­a­py may be need­ed. Thus, it is the pathol­o­gist that informs every step of a patient’s can­cer man­age­ment,” said Prof Gupta.

You can lis­ten to Prof Gupta’s pod­cast episode here: https://www.rcpa.edu.au/Library/Publications/The-Pathologists-Cut-Podcast


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