Expert Overview of Recurrent/Metastatic HNSCC

Glenn Hanna, MD, a head and neck cancer specialist at Dana-Farber Cancer Institute, provides a comprehensive overview of recurrent HNSCC. The discussion features patient Andrew Dunning, who shares his unique cancer journey beginning with rectal cancer in 2019, followed by the discovery of neck cancer during a full-body PET scan. Dunning's case illustrates the complexity of multiple primary cancers, as his head and neck cancer later metastasized to his ribs and liver despite successful initial treatment.

The clinical presentation of HNSCC varies significantly, with common initial symptoms including persistent sore throat, difficulty swallowing, ear pain, and palpable neck lumps that patients often discover during routine activities such as shaving. Hanna emphasizes that recurrent disease can be asymptomatic and detected only through imaging surveillance, highlighting the importance of regular monitoring protocols. Advanced cases may present with pain in various locations or laboratory abnormalities, while emerging circulating tumor DNA blood tests offer new detection possibilities.

Risk factors for HNSCC encompass 2 distinct disease categories: carcinogen-related cancers from tobacco and alcohol use, and the increasingly prevalent HPV-associated cancers affecting the oropharynx. The rise in HPV-related head and neck cancers particularly affects individuals in their 50s and 60s who lacked access to preventive vaccination during their youth. This epidemiological shift reflects changing risk factor patterns as smoking rates decline in developed countries, making HPV-associated disease more prominent in current clinical practice.