April is Oral, Head and Neck Cancers Awareness Month--an appropriate time to share information about these serious cancers. While not common, these types cancers are on the rise, especially in young adults.
Oral, head and neck cancers include those within the mouth, throat, voice box, sinuses and thyroid gland. They only make up about 4% of all cancers in the U.S. but we have higher rates locally due to certain risk factors.
Head and neck cancers are serious medical conditions for several reasons--they spread (metastasize) easily because the cells grow closely to many lymph nodes, and many times the disease goes undiagnosed for weeks or months because it appears about the same way as an infection..
These cancers can also be very disfiguring, as surgeries and treatments that are sometimes needed to keep the cancer from spreading may change someone’s appearance quite drastically. An example would be when someone has to have a significant portion of their face and/or neck removed because of a cancer that has spread.
What are the risk factors?
There are three major risk factors for head and neck cancers:
- Tobacco usage. Whether it’s from smoking or using smokeless tobacco (chewing tobacco, dip or snuff)
- Alcohol. When combined with tobacco use, alcohol accounts for at least 75% of head and neck cancers.
- HPV infection. The human papilloma virus, particularly HPV 16, is a significant risk factor, especially for cancers in the back of the mouth and in the throat. This virus is sexually transmitted via oral sex.
I know this isn’t the first time anyone has heard that smoking and tobacco usage are bad for a person’s health and can cause cancer; however, it may be surprising to know that HPV can cause mouth and throat cancer and represents one of the fastest growing cancers diagnosed in young people.
More about HPV
About 70% of oropharyngeal cancers are caused by HPV infections, and this particular type of infection has been on the rise in recent decades. There are several ways to lower risk, including limiting sexual partners, always using a barrier (male/female condom) during oral sex, and receiving the HPV vaccine (Gardasil 9). More than half of oropharyngeal cancers in the US are linked to a specific type of HPV infection, HPV 16 (or P16). The HPV vaccine helps prevent this type of HPV infection.
Currently, the HPV vaccine is indicated for the prevention of genital warts and cervical cancers. However, new studies are showing that it may help prevent the development of oral and throat cancers.
What are the symptoms of head and neck cancers?
- In the mouth: a white or red patch on the gums, tongue or cheek; a growing swelling; unusual bleeding or pain in the mouth; loosening of teeth; bad breath that doesn’t respond to oral hygiene.
- In the throat: trouble speaking; pain when swallowing; pain in the throat or neck that does not go away; headaches or ear troubles; changes in the voice, such as hoarseness.
- Sinuses/nasal cavity: sinuses that are blocked and do not clear; chronic sinus infections that do not respond to treatment with antibiotics; bleeding through the nose; frequent headaches, swelling or other trouble with the eyes; pain in the upper teeth; or problems with dentures.
- Overall: pain, numbness or swelling around the face, neck or jaw that does not go away.
Anyone experiencing these symptoms--especially someone who uses tobacco and alcohol—should see their physician immediately.
How are oral, head, and neck cancers diagnosed?
Dentists include an oral screening as part of cleanings and checkups, so they are often the experts who first notice signs of oral cancer. However, many patients make an appointment with a primary care provider when they have pain or chronic issues with their throat, neck, or head.
For example, if a patient notices a lump in their neck, they usually see their family physician and then the doctor may send the patient to a specialist, such as an ENT (ear/nose/throat) doctor. More tests will be ordered, and can include CT scans, MRIs, scopes and biopsies (taking a small sample of the concerning area).
From there, if cancer is diagnosed, the patient will be referred to an oncologist to discuss the best treatment plan for that patient. As the head and neck cancer navigator, I attend nearly every head and neck cancer patients’ initial consult with one of our oncologists. Because treatment for head and neck cancers is often complex, and can have fairly significant complications, I work closely with patients in helping them manage the process.
How do you treat this type of cancer?
Because oral, head and neck cancers include many types of cancers, and because each patient’s situation is different, treatment can vary.
It often includes one or a combination of the following:
- Surgery. In addition to surgery for biopsy/diagnosis reasons, sometimes surgery takes place to remove the tumor/mass. Sometimes, drastic surgery is needed to slow down or remove a rapidly growing cancer. As mentioned earlier, these surgeries can significantly change a person’s appearance.
- Radiation. Because radiation can be so carefully and precisely targeted to the cancerous area, it’s often used for head and neck cancers. Though this treatment is very precise, it can cause skin changes, changes in taste, dry mouth, and difficulty swallowing or eating.
- Chemotherapy. Chemo works by killing rapidly growing cells. There are many different types of chemotherapy, and the type of chemo drug is selected based upon clinical guidelines and the patient’s overall health. Different types of cancer get different types of chemotherapy.
In conclusion, I want to encourage everyone to know the basic facts about head and neck cancers:
- Using tobacco and alcohol can raise your risk of oral, head and neck cancers as much as 100 times over those who don’t use tobacco or drink alcohol.
- Anyone with a history of HPV, or a current or former partner who has/had HPV, is also at increased risk.
- If someone has HPV, and smokes and drinks, they are at very high risk of oral, head and neck cancers.
- Even non-smokers and non-drinkers are at risk for head and neck cancers because of HPV (human papilloma virus) infection.
- Any abnormality (pain, swelling, changes in the voice, trouble swallowing, etc.) should be discussed with your primary care doctor as soon as possible.
As with nearly every cancer, early detection saves lives, so don’t be afraid to see your doctor if you feel concerned.
HPV infections can be prevented with vaccines. The recommendations for these vaccines continue to change to help more and more people be able to receive them. To learn more from the CDC about who can receive the HPV vaccine, and when, visit https://www.cdc.gov/vaccines/vpd/hpv/hcp/recommendations.html