Download Patient Power Defining Head and Neck Cancers

Patient Power
Knowledge. Confidence. Hope.
Defining Head and Neck Cancers
Carynn Anderson, MD
Assistant Professor, Radiation Oncology
University of Iowa Hospitals and Clinics
Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors,
partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor.
That’s how you’ll get care that’s most appropriate for you.
Andrew Schorr:
Hello and welcome to Patient Power. I’m Andrew Schorr. Well, of course, abnormal cells, cancer, can develop anywhere in
the body. But what does it mean when we call it head and neck cancer? Joining us to help us understand is Dr. Carryn
Anderson. She’s a specialist at the University of Iowa Hospitals and Clinics.
Dr. Anderson, thank you for being with us. Help define for us head and neck cancer.
Dr. Anderson:
Head and neck cancer is an abnormal growth of cells located in the head and neck. Usually it occurs on the surfaces of the
mouth or throat. Those abnormal cells can grow in a pattern that spreads to lymph nodes of the head and neck, so it’s not
uncommon that people present with already enlarged lymph nodes. The staging process for head and neck involves
looking at the tumor site and what size is the tumor at its original location as well as what structures has it invaded. The
nodal staging has to do with what number and size of lymph nodes are involved, and are those lymph nodes located only on
one side of the neck or are they on both sides of the neck? And the overall stage is also impacted on whether or not the
cancer has spread to elsewhere in the body.
So head and neck cancer is most commonly a squamous cell cancer type. That is the type of cell that lines our mouth and
throat. And so when that becomes abnormal, that is the tumor type that we most commonly see.
Andrew Schorr:
Dr. Anderson, what are the typical symptoms of head and neck cancer?
Dr. Anderson:
Many of our patients present with an enlarged neck mass, a lump in their neck. They might discover this when they’re
shaving or when they’re showering. It is often that the primary site may or may not cause problems. Other patients may
present with things like a sore throat or ear pain that’s not otherwise explained by an infection. Some of our patients come
having received several courses of antibiotics thinking this is a common infectious process. However, they discover that
the antibiotics are not working and then subsequently learn that there is some sort of abnormal growth on one of the
locations of the mouth or the throat. For voice box cancer in particular, that can cause hoarseness. For other patients, if
it’s located at a different location, they may have a sore on their tongue. Or if there’s tumor growing inside the throat, for
example, they might notice swallowing difficulties.
The most common causes of head and neck cancer are either smoking and tobacco and alcohol-related behaviors. We are
also seeing a new era where there is a virus component. It’s called human papilloma virus. This is the same virus that
causes cervical cancer. It is a sexually transmitted virus, and it turns out that it can cause cancers in particular in the back
part of the tongue or in the tonsil region to grow up in the subsequent years after exposure to this virus. It turns out the
majority of the population in the United States has been exposed to this virus at some time in their lifetimes. You can be at
increased risk for exposure if you have increased number of sexual partners, and it turns out that males tend to have more
difficulty clearing the virus, and they also have increased difficulty in making antibodies to the virus. And so it leads to an
increased incidence of this HPV-related cancer in the tonsil and in the tongue in males compared to females.
Andrew Schorr:
Dr. Anderson, help us understand what we may know about the causes of head and neck cancer and how these cancers are
typically treated.
Dr. Anderson:
This is a multi-disciplinary problem. We have groups of physicians—we have surgeons, we have medical oncologists and
radiation oncologists that get together to figure out the best treatment modality for each individual patient. Early stage
diseases are often treated with a single modality whether that would be surgery alone or radiation alone, but more locally
advanced cancers, say that have already reached the lymph nodes, often require at least two and sometimes three
therapies, whether that’s a combination of surgery first and then radiation and chemotherapy after, or maybe use radiation
and chemotherapy together to try to cure someone but then safe surgery for salvage.
So earlier stage cancers tend to be treated with single modality therapy, let’s say surgery alone or radiation therapy alone.
For more advanced cases, it often requires more than one modality, whether that would be surgery first and then radiation
thereafter, and sometimes even chemotherapy after a very good surgery. Other times, we use chemotherapy and
radiation first to try to cure them of their locally advanced disease, and then we use surgery as a backup if that definitive
treatment does not work. By site, there are definitely differences.
For example, if people have a presentation of cancer at the front part of their tongue, surgery is the modality of choice to
address that first. If they have cancer towards the back part of the tongue, we have choices whether that would be a
surgery often with robotic technique to try to remove that tumor yet minimize the morbidity of surgery to that location of
the body. Or we use chemotherapy and radiation to treat those tumors definitively. If the tumor is located in the voice
box, for example, that may include either surgery alone up front, sometimes radiation is used all by itself in the earliest
stages of the disease. In more locally advanced scenarios of the voice box cancer, we use a combination of chemotherapy
and radiation.
Occasionally, in very specialized centers, there are surgeons that can do more complicated surgeries to address those
cancers up front. And let’s say you have a very rare cancer in like, the salivary gland, the parotid gland that sits in front of
the cheek. That is mostly addressed with surgery first and then depending on the pathology, you’ll get treatment with
radiation thereafter.
Andrew Schorr:
Help us understand the different specialists on the team for a head and neck cancer patient and their role.
Dr. Anderson:
The different specialists on a patient’s team for head and neck cancer involves those that are directly involved in the
therapy such as radiation oncologists, surgeons in particular, otolaryngologists, and medical oncologists that specialize in
head and neck cancer. But there is a whole host of supportive members as well. We have dieticians and nutritionists that
are helping these patients to get adequate calories throughout their treatment course. We have speech pathologists that
are helping them with function of their tongue and larynx throughout and after the radiation course is done. And the
nursing help that is needed to provide support for the radiation skin reaction and the mouth care that is required. This is a
very team-based approach for the difficult cases like these.
Andrew Schorr:
Dr. Anderson from University Iowa Hospitals and Clinics, thanks so much for being with us on Patient Power . And to our
audience, be sure to be signed up for alerts on our website, so you’ll know whenever we post something new.
I’m Andrew Schorr. Remember, knowledge can be the best knowledge of all.
Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors,
partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor.
That’s how you’ll get care that’s most appropriate for you.