the majority of upper airway tract (UAT) cancers are triggered by alcohol and tobacco, which together probably account for three-quarters of cases
cigarette smoking is associated with increased risk of all of the more common forms of UAT cancer
the risk among cigarette smokers may be 10 or more times that for non-smokers
pipe or cigar smoking is associated with an even higher excess risk of oral cancer
chewing tobacco – with or without areca (betel) nut – is strongly linked with oral and pharyngeal cancer, as well as to some extent with cancer of the larynx and the thyroid
more intense use of tobacco increases risk, while ceasing to smoke for 10 years or more reduces it to virtually equal to that among nonsmokers
second primaries, i.e. tumours which did not develop from the first one, are more likely with heavier smoking prior to diagnosis
high alcohol consumption and smoking have synergistic or multiplicative effects on the risk of head and neck cancer
for heavy drinkers who are also heavy smokers, the risk of oral cancer is over 35 times that for those who neither smoke nor drink, and a similar pattern is found with cancer of the larynx
alcohol consumption is a particularly important risk factor for cancers of the mouth and pharynx, and to a lesser degree, for cancer of the larynx
consumption of 100g of alcohol or more per day (about 12 units – six pints of beer or 12 measures of wine or spirits) multiplies the risk of developing oral cancer at least six-fold, after adjustment for tobacco use; the more alcohol consumed, the greater the risk
diet also affects the risk of cancers of the oral cavity, pharynx and larynx
frequent consumption of fruit and vegetables is associated with reduced risk
poor diet is often associated with heavy smoking and alcohol use, and malnutrition can exacerbate the risk of cancer
eating Cantonese-style salted fish increases risk – which may account for high levels of particular forms of head and neck cancer found among some Chinese ethnic groups
occupational exposure to asbestos, formaldehyde, nickel, isopropyl alcohol and sulphuric acid mist have been linked with laryngeal cancer
exposure to diesel fumes is also associated with an increased risk of laryngeal cancer
oral cancer has also been linked to exposure to formaldehyde - there is accumulating evidence that this is an independent risk factor for cancers of the mouth and pharynx
viral infection
notably human papillomavirus (HPV) – which is known to cause cervical cancer – is implicated in the development of some cancers of the oral cavity, pharynx and larynx
HPV could be involved in 30-40% of cases of oropharyngeal cancer in Western countries
patients with cancer of the tonsil are particularly likely to show signs of previous HPV infection
HPV-positive tumours have a better prognosis than those associated with smoking and alcohol
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