An ongoing concern

04 February 2021
3 min read

Ellen Cummings talks to Michelle Vickers about cancer diagnoses and the impact of Covid-19.

Head and neck cancer is the eighth most common cancer in the UK, with 34 new cases diagnosed every day on average. Despite these numbers it is not as well-known as other types of cancer, and so diagnoses often come at a later stage; around 60 per cent of patients are diagnosed at stage three or four, leading to more invasive treatment and poorer outcomes.

The Head and Neck Cancer Foundation (HNCF) was established in 2014 with the objectives of raising awareness of head and neck cancer, developing new technology to make head and neck cancer treatment less invasive and training cancer teams to utilise this technology.

Training and technology
Traditional surgical treatment for head and neck cancer may be lifesaving, but it is also life-changing. Patients are left with facial scars, and surgery can also have lasting impacts on breathing, swallowing, speech, sight, hearing, taste and smell.

Michelle Vickers, CEO of the HNCF, comments, “Currently, wherever you may get cancer in your oral cavity – whether it be in the bone or in the soft tissue – you will be told that you have to have a full neck dissection, which is an ear-toear dissection, so that the surgeon can find where the cancer is.”

One of the technologies that the HNCF has developed as an alternative to this traumatic surgery is the sentinel node biopsy (SNB). Pioneered by the charity’s co-founder Professor Mark McGurk, an oral and maxillofacial head and neck cancer surgeon and consultant, SNB works by fluorescing a lymph node which may be showing signs of cancer. Removing the cancerous nodes is a far less invasive surgery, and it saves over 70 per cent of patients who are diagnosed with the early stages of the disease from having the major surgery of a neck dissection.

Although SNB is NICE approved and recommended by the NHS, it isn’t yet standard practice and not all surgeons are trained to carry it out. This is another obstacle which the HNCF is tackling, as Michelle explains, “We provide training for entire cancer teams – including surgeons, radiologists, pathologists and theatre nurses. Once they’ve done the training, we provide them with the actual technology for a year in the hope that after that year they can show their hospital its efficacy and the hospital will then invest in the technology. We’ve trained 43 UK cancer units in the UK and 21 overseas.”

Another way of minimising the impact of head and neck cancer is early diagnosis, which can increase survival rates by 90 per cent. To promote early diagnosis the HNCF raises awareness amongst the public of head and neck cancer’s existence and how they can check for its symptoms.

The HNCF website says, “When it comes to breast or testicular cancer, the message is clear: self-examination is one of the best ways to detect potential signs of the disease. Knowing our bodies and what is normal for us as individuals is crucial in helping us to recognise potential symptoms that may need to be discussed with a GP.”

The potential signs of head and neck cancer to look out for when carrying out a self-check are:

  • Mouth ulcers which don’t heal within three weeks
  • Red and white patches inside the mouth
  • Unusual lumps or swellings in the mouth or on the face and neck
  • Difficulty in swallowing or chewing
  • Numbness of the tongue or lips
  • Changes in the texture of the lips or oral cavity
  • Hoarseness in the voice lasting longer than six weeks

The impact of Covid-19
Unsurprisingly, the limited access to dentists during the pandemic is a cause for concern. Michelle explains, “The number of patients being diagnosed with mouth cancer has dramatically reduced in recent months due to the pandemic, but before the pandemic the number of newly diagnosed mouth cancer cases was on the rise. This is the same with all cancers, but with dentists in particular it’s a big problem because cases of oral cancer are quite often diagnosed by dentists. People haven’t been having their regular check-up and that’s going to have a knock-on effect when the pandemic eases off – people will have oral cancers which are in later stages because they weren’t able to be diagnosed by their dentist.”

Michelle believes that outreach work is key to preventing this from happening. She says, “I think the role of the dentist during this time is to still be part of the whole diagnostic pathway by doing outreach work and sharing information about oral cancer. Encourage people to do a self-check, and when we do return to some sort of normality and people are able to see dentists then I would really like to see dentists explaining to their patients when they’re doing a check for symptoms of oral cancer in order to raise awareness.”

Dentists play an important role in the diagnostic pathway for head and neck cancers, as well as in raising awareness of the cancers’ existence. Although their access to patients is not currently what it should be, they can still make a difference in preventing the severity of head and neck cancer cases. There are a number of resources available to help dentists on the HNCF’s website including advice on self-checking, information about the pioneering technologies they’re developing, and the opportunity to donate and support their life-saving work.

References available on request.