Figure 1.

Environmental factors support metastasis of head and neck cancer. Metastasis is a complex and multi-step process that is orchestrated by tumor biology and supported by external environmental factors, such as tobacco and alcohol consumption, human papillomavirus (HPV) infection, the microbiome, and diet, which are involved in tumor cell invasion, intravasation, circulation, extravasation, and metastatic colonization. A precision-based model of metastasis prevention centered around modifiable risk factors involves smoking and alcohol cessation, HPV vaccination, and a diet that is high in fruits and vegetables and low in processed and red meats.