• 3/31/2006
  • London, England
  • Dr. Thomas Stuttaford
  • The Times Online (www.timesonline.co.uk)

Less than two years before his death in March 2001, John Diamond’s book “C: Because Cowards Get Cancer Too” was published. The book, his column in The Times and a BBC TV series chronicled Diamond’s final illness. This media coverage introduced the subject of head and neck cancers to the general public.

These cancers are becoming more common. John Diamond’s cancer had started in his tongue but had spread to the neck and beyond before it was diagnosed. His column and book were written with absolute honesty and wry humour. Nobody knows if John greeted St Peter with a quip, but he certainly joked to his surgeon when he went into the operating theatre only a day or two before he died. He was bleeding from a tumour site and the surgeon told him that it was necessary to tie off the “bleeding point” — the technical term for a bleeding blood vessel. John looked at his surgeon, nodded his agreement, smiled, produced his notepad and wrote: “What is the bleeding point?”

Last week a number of experts, including Peter Rhys-Evans, of the Royal Marsden, who looked after John, talked in Amsterdam about Erbitux (cetuximab) in the treatment of head and neck cancers. Erbitux, made by Merck, is one of the new monoclonal antibody chemotheraputic agents that targets cancer cells while largely sparing healthy tissue. It has already proved its worth against colo-rectal cancer, and there are encouraging reports of its use with non-small-cell cancer of the lung.

Malignant tumours of the head and neck are classified as head and neck cancers unless they arise in the eyes, brain, ears, thyroid or oesophagus (gullet). They originate mainly in the lips, tongue, mouth, throat, post-nasal spaces and in or around the larynx. They are responsible for 10 per cent of male cancers in the EU and used to be six or seven times more common in men than women. Now, however, these cancers are only about twice as common among men. They are also being seen more frequently in young people, although most still occur in the over-fifties.

They are difficult to diagnose and treat and hard for the patient to bear. They affect parts of the body that can’t be hidden, and impair key activities: after treatment the patient may be disfigured, have impaired speech, and can sometimes eat and drink only with difficulty.

Head and neck cancers may be triggered by smoking, especially when combined with excessive alcohol, which enhances the effect of the tobacco and is described as a co-factor. The probable reason for the change in the proportion of men to women who develop cancer of the head and neck is that younger women are smoking and drinking more whereas fewer men smoke.

A year or two ago an even more disturbing co-factor than alcohol, and possibly also cannabis, was suggested. It was proposed that the increase in oral sex over the last generation might be a relevant factor. Mr Rhys-Evans, who is not only a consultant surgeon at the Royal Marsden but the executive chairman of the Head and Neck Cancer Research Trust, confirmed that HPV, the wart virus responsible for cervical and some other genital cancers, was also found from time to time in tonsils removed because of malignancy.

He suggested that there were many other co-factors, and that even the current rejection of tonsillectomies in childhood has had some influence on the incidence of head and neck tumours.

Unhealed mouth sores, or unexplained lumps in or around the mouth or on the lips, mouth or throat, if they persist for more than a couple of weeks or if people have difficulty or pain when chewing or swallowing, need investigation, as does a persistently but inexplicably blocked or bleeding nose. Investigation will usually show that it is benign, but occasionally the need for radical surgery will be avoided by quick action.