11 Things a Head and Neck Cancer Doctor Wants You to Know
Head and neck cancers make up only 4 percent of all cancers in the United States, but they are just as challenging for patients as other cancers that may get more headlines. To get the facts about these cancers, HealthCentral spoke to Michael G. Moore, M.D., associate professor in the department of otolaryngology at UC Davis Comprehensive Cancer Center and board member at the Head and Neck Cancer Alliance (HNCA). Here are 11 things Dr. Moore wants you to know about this group of cancers.
1. You need to understand your risk factors
If you have risk factors for head and neck cancer, it’s important to be aware of them.
“Alcohol and all tobacco use are major risk factors. Others include having had the Epstein-Barr virus infection or poor oral health,” Dr. Moore says. “Environmental or occupational factors such as breathing wood or nickel dust, or formaldehyde, also increase risk. Human papillomavirus (HPV) may cause cancer in the back of the throat, tonsils, and back of the tongue.”
2. Watch for these warning signs
“Don't ignore sores in the mouth or throat that don't get better, or a sore throat only on one side, ear pain, impacted speech or swallowing, or coughing up blood,” says Dr. Moore. “Same for a lump in the neck that doesn't get better with a short course of antibiotics — it doesn't always mean cancer, but get it assessed.”
Other reasons to get to the doctor or dentist include a loose tooth, numbness of the tongue or lips, or colored skin sores that don't heal, with pain, itching, or bleeding.
3. Head and neck cancer treatment comes in several forms
Treatment can include surgery, radiation therapy, chemotherapy, or a combination, says Dr. Moore.
“You'd typically ask your doctor which modality would give you the best chance of a cure, have the fewest long-term side effects and least impact on speech and swallowing, and least amount of mouth and throat dryness,” he says. “We typically strategize to optimize the cancer cure, while minimizing short- or long-term side effects.”
4. The stage of the cancer guides the treatment
Your health care team will look at the stage of your cancer — with I and II being early stages and III and IV being more advanced — to help determine a treatment plan.
“Staging depends not only on the primary tumor, but also on whether it has spread to lymph nodes or not,” Dr. Moore explains. “Recurring or more advanced tumors usually need surgery with radiation afterwards, or surgery with radiation and chemotherapy.”
5. The location of the cancer can direct treatment, too
Depending on where your cancer is located, surgery may or may not be the first-line approach. For example, Dr. Moore says, “For tumors, such as HPV-related in the back of the throat or in the larynx, surgery isn't always the first step. It can be used, but radiation or chemotherapy are also heavily considered. Again, it depends on location and how easy it will be to remove. All of this depends on the individual and the specifics of their case.”
6. Some head and neck cancers are more responsive to treatment than others
One of the first steps in treating this type of cancer is to find out whether it is related to the HPV virus, Dr. Moore says. This is done with a biopsy.
"[HPV-related] tumors do tend to be more responsive to treatment," he says. "Tumors caused by chronic tobacco and/or alcohol use tend to be less responsive to therapy. Both can be treated, however."
7. HPV-related cancers are preventable
HPV-related head and neck cancers are on the rise. The virus is passed through intimate skin-to-skin contact. While there’s no screening test for HPV in the head and neck, there is one highly effective way to prevent HPV-related cancer: “Do this by avoiding the infection altogether and get vaccinated against HPV,” Dr. Moore says. The vaccines are recommended for boys and girls at age 11 or 12, but can be given as early as 9 and as late as 26 (women) or 21 (men).
8. Treatment comes with harsh side effects
Side effects depend on the type of treatment you receive.
“Radiation can cause neck ‘sunburn,’ real dryness of the mouth and throat, thick mucus in the throat, and trouble with swallowing so eating and drinking become difficult," Dr. Moore says. "The voice can change, and the sense of taste, because taste buds have been altered. Chemotherapy enhances effects of radiation, and can cause mucusitis — ulceration of the digestive tract lining — along with irritation of the throat, hair loss, and nausea.”
9. New treatments are on the horizon
Beyond the current standard treatments, promising new therapies are being developed.
“Immunotherapy that helps your own immune system fight the cancer can be used with certain types of head and neck cancer — and that's being done primarily in clinical trials,” Dr. Moore says. “It's also for people who have recurrent cancer that's been resistant to standard treatment. It doesn't work for everyone, but when it does work, it can be very effective.”
10. Advancements have improved surgery
And there's more good news: “Surgery used to impact appearance much more than today since we have new reconstructive surgical techniques to rebuild head and neck areas, the jawbone, portions of the mouth and throat, and skin of the neck,” Dr. Moore says. “Replaced tissue can be removed and combined with a conscious effort to conceal the surgery site and preserve functionality.”
Additionally, new robotic and other techniques have improved function and appearance, and therefore quality of life, he says.
11. Why I became a head and neck cancer oncologist
Lastly, Dr. Moore shares why he is passionate about changing the lives of people diagnosed with head and neck cancer: “I have the ability to help people through a very difficult time. Head and neck cancer can affect their ability to eat and drink, and it can affect their appearance,” he says. “I want to treat people and help them to be cancer-free, as well as to maintain their function and their identity and self-esteem. I find it all very rewarding.”