World Head and Neck Cancer Day is on July 27. We spoke to the experts about how important dentists can be to support their patients going though diagnosis and treatment.
Chairman and Founder of the Western Australian Head and Neck Cancer Support Foundation, Stephen McPherson, says head and neck cancer is on the rise, from 630 West Australians in 2021 to 752 people in 2022.
“In 2022, 3.2% of all cancers diagnosed in Australia were Head and Neck related with approximately 17,374 people living with head and neck cancer in Australia,” he says. “The plus side is the five-year survival rate has increased from 63% in 2018 to 72% in 2022. Why is this important to you as dentists? Great question and the answer is, because you are likely to be the person to spot an abnormality first. Any abnormality should be checked out immediately. There have been numerous people who have been saved by their dentist spotting and doing something on what has turned out to be head and neck cancer.”
Oral and maxillofacial surgeon and maxillofacial head and neck oncology and reconstructive surgeon, Dr Ken Wan, says dentists are the best-trained clinicians in detecting oral cancer and are the first line of defence against the disease. “Every time a dentist sees a patient, a physical examination is performed to scan for abnormal oral lesions,” he explains.
“Early-stage cancers of the head and neck may initially be asymptomatic and often manifest as subtle oral mucosal changes, or painless lymphadenopathy,” adds Oral Medicine Specialist, Dr Lalima Tiwari. “The best way to currently detect these is through conventional oral and tactile examination of the oral cavity, as well as lymph node examination of the head and neck. Routine dental examinations serve as an excellent opportunity for dentists to provide a head and neck cancer assessment for patients and aid in the early detection of cancer and improving the clinical outcomes for cancer patients.”
She says some red flags for dentists to look for that should raise suspicion of malignancy include:
Ken says when cancer is detected at an early stage, treatment is less invasive, and radiotherapy/chemotherapy may not be required. “The patient’s probability
of disease-free survival increases, and the risk of locoregional recurrence decreases,” he explains.
Lalima says survival outcomes for head and neck cancer are significantly correlated to the TNM classification and staging at diagnosis. “When detected and treated at an early stage, five-year survival rates can reach up to 80%,” she says. “When diagnosed at an advanced stage, five-year survival rate is 50%. That is why early detection is one of the most effective ways to reduce the high mortality and morbidity associated with head and neck cancer. If a lesion is suspected of malignancy, a prompt referral should be arranged to an appropriate specialist centre for a surgical biopsy to confirm diagnosis.”
Ken says dentists are critically important in the multidisciplinary management of head and neck cancer patients. “Often times, patients are required to be made dentally fit prior to their ablative surgery or radiotherapy/chemotherapy,” he explains. “Sequelae of their treatment, e.g. xerostomia from radiotherapy, will render them with a much higher oral disease risk.”
Lalima says dentists play a key part in the entire journey of the head and neck cancer patient, which extends to after their cancer treatment is complete. “Dentists should be closely involved in risk factor modification including smoking cessation and counselling patients in reducing alcohol intake, provide oral supportive care throughout the patient’s treatment phase, and remain vigilant for recurrence after treatment during routine examination, as part of the patient’s cancer surveillance,” she says.
“Prevention of dental disease is also key,’ she adds. “During cancer treatment phase, dentists may need to perform a pre-radiation therapy dental assessment before patients commence radiation or chemotherapy as part of their overall cancer management, to reduce the risk of dental problems mid-treatment and after treatment. After completion of treatment, dentists should provide oral hygiene support and regular follow up care to reduce the risk of tooth loss, especially post radiation treatment.”
“Every dentist will see and diagnose at least one or two oral cancers during their career. The key is early diagnosis and to detect suspicious premalignant lesions before they become frank cancers.”
Dr Ken Wan
If you would like to increase your education about head and neck cancer, have a look at the following resources:
Head and Neck Cancer Australia, headandneckcancer.org.au
Head and Neck Cancer Australia has recently launched resource called “The changing face of Head & Neck Cancer” for dentists to improve knowledge in identifying signs and symptoms of head and neck cancer.
The American Head and Neck Society Journal Club
ahns.info/resources/ahns-journal-club/
The Western Australian Head and Neck Cancer Support Foundation
WA’s only dedicated Head and Neck Cancer Support Foundation that provides support to Head and Neck Cancer patients, waheadandneckcancer.org.au
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