RESEARCH PAPER
Clinical characteristics of head and neck cancers at a tertiary care hospital
Sajid Durrani 1  
,   Saleh Al-Dhahari 2  
,   Haneen Sebeih 2  
,   Tariq Wani 3  
,   Khalid Al Qahatani 4  
,   Humariya Heena 3  
 
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1
Comprehensive Cancer Center, King Fahad Medical City, Riyadh, Saudi Arabia
2
Department of Otolaryngology, Head and Neck Surgery, King Fahad Medical City, Riyadh, Saudi Arabia
3
King Fahad Medical City Research Center, Riyadh, Saudi Arabia
4
Department of Head and Neck Surgery, King Saud University, Riyadh, Saudi Arabia
CORRESPONDING AUTHOR
Sajid Durrani   

Comprehensive Cancer Center, King Fahad Medical City, Riyadh, Saudi Arabia
Submission date: 2020-01-10
Acceptance date: 2020-04-04
Publication date: 2020-04-30
 
Popul. Med. 2020;2(April):9
 
KEYWORDS
TOPICS
ABSTRACT
Introduction:
Head and neck cancer (HNC) is common and accounts for thousands of deaths each year. In Saudi Arabia alone hundreds of cases and deaths due to head and neck cancers are reported owing to alarmingly high consumption of tobacco and infections such as Epstein– Barr virus (EBV) and human papillomavirus (HPV) that lead to metastatic or loco-regional or viral-associated HNC. Nasopharyngeal cancer (NPC) is most common among all HNCs in Saudi Arabia, with male predominance in having a poor survival rate. Comprehensive studies documenting extensive variables related to HNC are lacking in Saudi Arabia; hence, it is particularly important to document the clinical characteristics of this cancer, especially in the Saudi population. Therefore, the present study aimed to understand the clinical characteristics of patients with HNC treated at King Fahad Medical City (KFMC).

Methods:
A hospital-based retrospective cohort study included patients diagnosed with HNC from 2009–2018 as per the electronic medical records and treated at KFMC. All patients with histopathologically confirmed cancer at sites including oral cavity, nasopharynx, oropharynx, pharynx, larynx, sinonasal, and salivary glands were included. The endpoints were to assess tumour site of HNC, frequency of HNC based on histology, tumor-node-metastasis (TNM) staging, and etiological factors of HNC. The pattern of treatment failure was also recorded in reference to the site of tumour recurrence as local, general or distant.

Results:
Out of 1349 patients screened, 652 were confirmed with HNC. The most common primary tumor site was the oral cavity (25.9%), followed by nasopharynx (23.8%), and larynx (17.5%). Squamous cell carcinoma was the most common HNC (78.1%). Based on TNM staging, the frequency of HNC varied from stage 0 to 4, with 64.6% of patients in stage 4. Infection with Epstein–Barr virus (EBV) was found in 8.5% of patients. Treatment failures were recorded in 24.3% of patients, and 62.5% of patients reported metastasis.

Conclusions:
High tobacco consumption in the region needs to be monitored and controlled by awareness and education campaigns. Effective management of HNC with early diagnosis and treatment is required by healthcare professionals to improve the overall quality of life of HNC patients.

CONFLICTS OF INTEREST
The authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none was reported.
FUNDING
There was no source of funding for this research.
PROVENANCE AND PEER REVIEW
Not commissioned; externally peer reviewed.
 
REFERENCES (33)
1.
Sharma JD, Baishya N, Kataki AC, Kalita CR, Das AK, Rahman T. Head and neck squamous cell carcinoma in young adults: A hospital-based study. Indian J Med Paediatr Oncol. 2019;40(5):18-22. doi:10.4103/ijmpo.ijmpo_252_17
 
2.
Alsbeih G, Al-Harbi N, Bin Judia S, Al-Qahtani W, Khoja H, El-Sebaie M, Tulbah A. Prevalence of Human Papillomavirus (HPV) Infection and the Association with Survival in Saudi Patients with Head and Neck Squamous Cell Carcinoma. Cancers. 2019;11(6):820. doi:10.3390/cancers11060820
 
3.
Elasbali AM, Ahmed HG. A Review on the Etiology of Oral Cancer in Saudi Arabia. Int J Med Res Health Sci. 2018;7(6):161-170. https://www.ijmrhs.com/medical.... Accessed January 10, 2020.
 
4.
Kobayashi K, Hisamatsu K, Suzui N, Hara A, Tomita H, Miyazaki T. A Review of HPV-Related Head and Neck Cancer. J Clin Med. 2018;7(9):241. doi:10.3390/jcm7090241
 
5.
Alhazzazi TY, Alghamdi FT. Head and Neck Cancer in Saudi Arabia: a Systematic Review. Asian Pac J Cancer Prev. 2016;17(8):4043-4048. PMID:27644659.
 
6.
Al-Wassia R, Abusanad A, Awad N, Marzouki H, Alkhayyat S, Al-Khatib T, Constantinescu C. Outcomes of Saudi Arabian patients with nasopharyngeal cancer treated with primarily neoadjuvant chemotherapy followed by concurrent chemoradiotherapy. J Glob Oncol. 2016;2(3):123-128. doi:10.1200/jgo.2015.001743
 
7.
Tandon P, Pathak VP, Zaheer A, Chatterjee A, Walford N. Cancer in the Gizan Province of Saudi Arabia: an eleven year study. Ann Saudi Med. 2015;15(1):14-20. doi:10.5144/0256-4947.1995.14
 
8.
Cohen EE, LaMonte SJ, Erb NL, Beckman KL, Sadeghi N, Hutcheson KA, Pratt-Chapman ML. American Cancer Society Head and Neck Cancer Survivorship Care Guideline. CA Cancer J Clin. 2016;66(3):203-239. doi:10.3322/caac.21343
 
9.
Kim DH, Kim WT, Lee JH, Ki YK, Nam JH, Lee BJ, Kim DW. Analysis of the Prognostic Factors for Distant Metastasis after Induction Chemotherapy Followed by Concurrent Chemoradiotherapy for Head and Neck Cancer. Cancer Res Treat. 2015;47(1):46-54. doi:10.4143/crt.2013.212
 
10.
Pulte D, Brenner H. Changes in survival in head and neck cancers in the late 20th and early 21st century: a period analysis. Oncologist. 2010;15(9):994-1001. doi:10.1634/theoncologist.2009-0289
 
11.
El Awa F. Tobacco control in the Eastern Mediterranean Region: overview and way forward. East Mediterr Health J. 2008;14(Suppl):S123-S131. PMID:19205612.
 
12.
Lydiatt WM, Patel SG, O'Sullivan B, Brandwein MS, Ridge JA, Migliacci JC, Shah JP. Head and neck cancers-major changes in the American Joint Committee on cancer eighth edition cancer staging manual. CA Cancer J Clin. 2017;67(2):122-137. doi:10.3322/caac.21389
 
13.
Reichart PA, Way TH. Oral cancer and pre‐cancer in Myanmar: a short review. J Oral Pathol Med. 2006;35(4):193-196. doi:10.1111/j.1600-0714.2006.00390.x
 
14.
Al-Zahrani O, Eldali A, Al-Shahri MZ. Prevalence and severity of pain in cancer patients in an outpatient palliative care setting in Saudi Arabia. Qatar Med J. 2014;2014(1):38-45. doi:10.5339/qmj.2014.6
 
15.
Farrag A, Shaukat A, Ali M, Kandil M. Clinico-Pathological Features and Outcome of Treatment of Saudi Patients with Oral Cavity Cancer. Head Neck Cancer Res. 2018;3(1). doi:10.21767/2572-2107.100022
 
16.
Cruz-Gregorio A, Martínez-Ramírez I, Pedraza-Chaverri J, Lizano M. Reprogramming of energy metabolism in response to radiotherapy in head and neck squamous cell carcinoma. Cancers. 2019;11(2):182. doi:10.3390/cancers11020182
 
17.
Chang ET, Adami HO. The enigmatic epidemiology of nasopharyngeal carcinoma. Cancer Epidemiol Biomarkers Prev. 2006;15(10):1765-1777. doi:10.1158/1055-9965.EPI-06-0353
 
18.
Hesham A, Syed KB, Jamal BT, et al. Incidence, clinical presentation, and demographic factors associated with oral cancer patients in the southern region of Saudi Arabia: A 10-year retrospective study. Journal of International Oral Health. 2019;9(3):105-109. doi:10.4103/jioh.jioh_58_17
 
19.
Raab-Traub N. Epstein–Barr virus in the pathogenesis of NPC. Semin Cancer Biol. 2002;12(6):431-441. doi:10.1016/s1044579x0200086x
 
20.
Young LS, Dawson CW. Epstein-Barr virus and nasopharyngeal carcinoma. Chin J Cancer. 2014;33(12):581-590. doi:10.5732/cjc.014.10197
 
21.
Nasrin N, Taiba K, Hannan N, Hannan M, al-Sedairy S. A molecular study of EBV DNA and p53 mutations in nasopharyngeal carcinoma of Saudi Arab patients. Cancer Lett. 1994;82(2):189-198. doi:10.1016/0304-3835(94)90011-6
 
22.
Boscolo-Rizzo P, Del Mistro A, Bussu F, Lupato V, Baboci L, Almadori G, DA Mosto MC, Paludetti G. New insights into human papillomavirus-associated head and neck squamous cell carcinoma. Acta Otorhinolaryngol Ital. 2013;33(2):77-87. PMID:23853396.
 
23.
Gillison ML, Chaturvedi AK, Anderson WF, Fakhry C. Epidemiology of Human Papillomavirus-Positive Head and Neck Squamous Cell Carcinoma. J Clin Oncol. 2015;33(29):3235-42. doi:10.1200/JCO.2015.61.6995
 
24.
Azimi S, Mortazavi H, Tennant M, Kruger E, Rezaei B, Taheri JB, Tarahhomi MR. Pattern of the head and the neck cancer in two geographically and socioeconomically different countries. J Orofac Sci. 2017;9(1):43-47. doi:10.4103/0975-8844.207943
 
25.
Kreimer AR, Clifford GM, Boyle P, Franceschi S. Human papillomavirus types in head and neck squamous cell carcinomas worldwide: a systematic review. Cancer Epidemiol Biomarkers Prev. 2005;14(2):467-475. doi:10.1158/1055-9965.EPI-04-0551
 
26.
Worsham MJ. Identifying the risk factors for late-stage head and neck cancer. Expert Review of Anticancer Therapy. 2011;11(9):1321-1325. doi:10.1586/era.11.135
 
27.
Gil Z, Fliss DM. Contemporary management of head and neck cancers. Isr Med Assoc J. 2009;11(5):296-300. PMID:19637508.
 
28.
Cognetti DM, Weber RS, Lai SY. Head and neck cancer: an evolving treatment paradigm. Cancer. 2008;113(7 Suppl):1911-1932. doi:10.1002/cncr.23654
 
29.
Maklad AM, Bayoumi Y, Senosy Hassan MA, et al. Patterns of failure and survival in patients with nasopharyngeal carcinoma treated with intensity-modulated radiation therapy in Saudi Arabia. Onco Targets Ther. 2016;9:6561-6567. doi:10.2147/OTT.S95457
 
30.
Al-Herabi AZ. Head and neck oncology experience in Makkah, Saudi Arabia. Saudi Med J. 2009;30(10):1316-1322. PMID:19838441.
 
31.
Gilyoma JM, Rambau PF, Masalu N, Kayange NM, Chalya PL. Head and neck cancers: a clinico-pathological profile and management challenges in a resource-limited setting. BMC Res Notes. 2015;8:772. doi:10.1186/s13104-015-1773-9
 
32.
Sanderson R, Wei WI, Ironside J. Clinical reviewSquamous cell carcinomas of the head and neck Commentary: Head and neck carcinomas in the developing world. BMJ. 2002;325(7368):822-827.
 
33.
Leeman JE, Lee N, Riaz N. Patterns of failure in head and neck cancer patients treated with intensity modulated radiation therapy: editorial response. Translational Cancer Research. 2017;6(S7):S1299-S1300. doi:10.21037/tcr.2017.10.04
 
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