Overview

Head and neck cancer represents a category of cancers that usually start in the squamous cells (skin cells) found in the lining of the mouth, throat, and voice box. Squamous cell cancers of the head and neck are the most common form, but these cancers can also originate in salivary glands, sinuses, muscles, or nerves in the head and neck area. Although these cancers differ, they are often grouped based on similarities in treatment.^1,2

Common causes and risk factors

The main risk factors for developing head and neck cancer include the use of tobacco and alcohol in combination, which significantly heightens risk, especially for cancers of the mouth, throat, and voice box.^3,4 Another major risk factor for oropharyngeal cancers, which targets the tonsil and base of the tongue region, is HPV infection, specifically with HPV-16.^5,6 Other risk factors include, but are not limited to, the use of chewing tobacco like Paan (betel quid), which is strongly linked to cancers of the mouth.^7,8 Occupational exposures to specific substances such as wood dust⁹, asbestos, and synthetic fibres are linked to heightened risk of voice box cancer.¹⁰ Radiation exposure to the head and neck induces salivary gland cancer risk.¹¹ Epstein-Barr virus (EBV) infection, a common human infection strongly associated with a rare form of head and neck cancer called nasopharyngeal cancer, as well as malignancies of the salivary gland.¹² There are also genetic and ancestral risk factors for specific ethnic ancestries, such as Asian ancestry (especially Chinese)¹³, and certain genetic disorders (e.g. Fanconi anaemia), increase the risk for neoplasia.¹⁴

Importance of weight management in cancer patients

Cancer patients must have a healthy weight status, as both losing weight and gaining weight can impact the effectiveness of their treatment. Severe and unintentional weight loss can contribute to muscle wasting (cachexia), impaired immune functioning and poor treatment tolerability.¹⁵ Proper nutrition can help maintain strength, facilitate repair and healing, and enhance overall survival.¹⁶ Managing weight through well-balanced nutrition, high-protein diets, and medical supervision has been proven to support recovery and increase quality of life.¹⁷

Symptoms

Symptoms of head and neck cancer include:

• Unexplained persistent pain
• Swelling
• Hoarseness
• Chronic sore throat
• Persistent cough 
• Difficulty swallowing
• Bad breath 
• Unexplained, unintended weight loss

These signs may mean you have head and neck cancer or other medical issues. You should schedule an appointment with your healthcare provider if you suffer from these symptoms. If caught early, treatments for this cancer will yield better results.¹⁸

Diagnosis methods

Diagnosis involves a complete physical examination of the site, followed by nasendoscopy (examination of the nasal passage), micro-laryngoscopy (examination of the voice box), and biopsy, which examines the site and checks for cancer cells. Imaging, including X-rays, CT scans, MRIs, PET-CT scans, and ultrasound systems, assesses the location and spread of tumours.¹⁸

The impact of cancer on weight

Cancer can have a major effect on weight, resulting in unintentional weight loss or weight gain, depending on the type of cancer, treatment, and metabolically altered state of the patient. Unintentional weight loss has been associated with cachexia, which is characterised by muscle wasting, decreased appetite, and metabolic changes.¹⁵ Treatments for cancer, including chemotherapy, radiation, and immunotherapy, can result in nausea, altered taste perception, and swallowing difficulties, which can contribute to inadequate food intake and weight loss.¹⁶ In contrast, some patients significantly gain weight through hormonal therapy, steroid use, or reduced activity levels.¹⁷ Nutritional support and weight management are essential to improve outcomes and quality of life.

The role of nutrition in cancer care

Nutrition is crucial in the care of patients with cancer because it supports tolerance to treatment, immune function, and quality of life. Proper nutrition helps preserve muscle mass, improves energy levels, and maintains organ function while decreasing the risk of malnutrition and cachexia.¹⁹ Cancer treatments (e.g., chemotherapy, radiation, surgery) may have side effects (e.g., nausea, loss of appetite, and injury while swallowing) that necessitate proper dietary support.²⁰ A balanced diet with adequate protein, healthy fats, vitamins, and minerals will help improve recovery and treatment outcomes.²¹ Nutritional intervention, whether through dietary counselling, enteral nutrition (tube feeding), or nutrition support, is often recommended when an initial assessment is made to assess nutritional status.²²

Managing weight during treatment

Maintaining a healthy weight throughout cancer treatment is important to enhance tolerance of therapy, improve recovery, and promote well-being. Weight loss as a result of decreased appetite, nausea, taste changes, and swallowing difficulties can contribute to malnutrition and can negatively impact the efficacy of the treatment.¹⁹ Patients are encouraged to eat foods rich in nutrients, consume small and frequent meals, and consider nutritional supplements if needed.²⁰ On the other hand, well-planned restriction plus regular physical activity can mitigate unintentional weight gain from medications.²¹ Individualised nutritional plans and working with a dietitian can help manage weight during treatment.²²

Recovery and long-term weight management

After cancer treatment, managing your weight is important for recovery and an overall healthy lifestyle, as well as minimising the risk of recurrence or other health complications.²³ Many survivors continue to experience a loss of weight attributed to ongoing side effects from treatment or gain weight as a result of metabolic changes, hormonal therapy, or acceptable activity levels. A healthy diet consisting of lean protein, whole grains, fruits, and vegetables, combined with regular physical activity, can help maintain a healthy weight after cancer treatment.¹⁹ It will also be important for survivors to monitor their intake of nutrition, hydration, and physical fitness to minimise complications associated with malnutrition or obesity. ²⁴ Survivors can work with Registered Dietitians and other healthcare providers for a personalised approach to long-term weight management and well-being.²⁵

Summary 

Head and neck cancers predominantly occur on the mucosal surfaces of the mouth, throat, and larynx, with major risk factors of tobacco, alcohol, and HPV-16. Other factors contributing to head and neck cancer are the use of betel quid, exposure to occupational hazards, radiation exposure, having had EBV infection, and genetic susceptibility. A healthy weight is important, as those with cancer are at risk for both weight loss (cachexia) and/or weight gain because of cancer and cancer therapy. Optimal nutrition can help maintain strength, promote immunity, and increase tolerance to treatment. Symptoms such as persistent pain, swelling, persistent hoarseness, and difficulty swallowing require timely and thorough evaluation and physical examination to confirm or exclude head and neck cancer.

Cancer treatments may affect metabolism, appetite, or digestion; good nutrition is therefore an important support adjunct during treatment. If your weight is stable, endeavours to maintain it during treatment are useful; if the weight can be lost and regained, you can help your body recover from treatment, improve overall health, decrease the risk of recurrence, and improve quality of life. The best way to do this is by maintaining a balanced diet of a variety of foods, eating regularly and frequently, and being active when possible.