Why head and neck cancers often go undiagnosed?

Head and neck cancers are often misunderstood as being limited to oral or mouth cancer. Head and neck cancer refers to a group of cancers that develop in the head and neck region, including the oral cavity (mouth), pharynx (throat), larynx (voice box), nasal cavity, sinuses, and salivary glands. These cancers typically originate in the squamous cells that line the moist surfaces of these areas.This group of cancers is far more complex and includes malignancies of the oral cavity, throat, voice box (larynx), nasal cavity, nasal sinuses, thyroid, parotid gland (salivary glands), and even the orbits (eye sockets). All these falls under the umbrella of head and neck cancers. However, when people commonly refer to head and neck cancers, they are typically referring to more prevalent forms such as cancers of the oral cavity (mouth), voice box, and upper airway areas largely associated with tobacco abuse, whether through smoking or chewing. Chewing tobacco is particularly linked to mouth cancers, while smoking is more often associated with throat, laryngeal, and upper airway cancers. One of the major challenges with head and neck cancers is the significant delay in diagnosis. This delay stems from both the patient and physician sides. For instance, symptoms such as persistent mouth ulcers (on the cheek or tongue), changes in voice, or pain while swallowing are often misattributed to non-cancerous causes like bacterial or fungal infections. As a result, many patients receive symptomatic treatment including antibiotics, supportive care, and sometimes steroids without a proper evaluation for cancer. This conservative approach often allows the disease to progress silently.Even among healthcare providers, including dental professionals, there is a tendency to initially manage such symptoms with multiple lines of medication. Only when the lesions fail to respond do they consider the possibility of cancer and refer the patient for further evaluation.It is crucial to recognize that if symptoms like ulcers, white patches, or red lesions do not resolve with first-line treatment, an early referral to an oncologist and a biopsy is necessary. Unfortunately, myths and misconceptions around biopsy procedures add another layer of delay. A common belief among patients is that undergoing a biopsy could cause cancer to spread — a myth that needs to be actively debunked.Furthermore, many patients are in denial when faced with the possibility of cancer. They hope the issue is benign and delay undergoing confirmatory tests like biopsies, which leads to late-stage presentation and poorer outcomes.When it comes to cancers of the throat, tonsils, base of tongue, or larynx, specialized diagnostic procedures such as endoscopy or laryngoscopy are required. These are often available only in tertiary care centers or urban hospitals, making access difficult for patients in Tier II and III cities. As a result, physicians tend to delay these procedures and continue with conservative treatment, especially if the patient shows temporary improvement.Another contributing factor is the long turnaround time (TAT) for biopsy reports. In smaller towns, biopsy samples are often first sent to local labs, which may then forward them to specialized labs in metro cities. This multi-step process adds significant delay, as the sample passes through several hands before a report is finally shared with the treating doctor and patient.Recent advances such as liquid biopsy and robotic surgery are helping address some of these diagnostic and treatment delays.In head and neck cancers, the principle is straightforward: early detection leads to simpler, safer, and more effective treatment. Early-stage cancers that have not invaded the skin, jawbone, or lymph nodes can often be treated with minimally invasive surgery. Such procedures are not only functionally and aesthetically favourable but may also eliminate the need for chemotherapy or radiation therapy.Dr Mandeep Singh Malhotra, Director of Surgical Oncology at CK Birla Hospital (R), Delhi