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Head and Neck Cancer

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Posted 10/13/2014

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Cancers of the mouth, head and neck have cure rates as high as 90%. But early detection of these cancers is very important. Dr. Bill Lydiatt describes the symptoms and causes. Many of these cancers are caused by tobacco use, but an emerging trend is a connection between oral cancer and HPV (human papilloma virus). For more information, call 1-800-922-0000 or visit http://www.nebraskamed.com.

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Catching it at any stage generally is still quite treatable with the potential for cure.

Success rates are outstanding. If we find cancer in the first or even second stage, the chances of curing it are greater than 80 or 90 percent, depending on where exactly it is and some of the nuances of care and the person’s health. Even stage four cancers (something that is caught rather later) is still potentially curable and I think that’s one of the more important things as well; clearly it’s important to find it early, your prognosis is much much better, the chance of cure is much higher.

Even with stage four cancers the cure-rates can be anywhere from 30 to 50 percent (sometimes even slightly higher).

Head and neck cancer is a cancer that can be related to smoking cigarettes, chewing tobacco, alcohol, but also a virus named human papoloma virus. And for all of those causes, catching the diagnosis early is the most important part, as far as assuring a positive and a good outcome.

Human papoloma virus clearly has been most solidly associated with cervical cancer, however what we found is that cancers (particularly of the tonsil and the base of the tongue, very back of the tongue) due tend to be associated with human papoloma virus in as many as 70 percent of cases. And what we know about that is that those patients due tend to be younger, it tends to occur in the early to mid 50s, their prognosis is clearly better, and that the treatment for it tends to be based with radiation therapy. Sometimes chemo therapy (in fact, not in frequently chemo therapy will be used in addition to the radiation) for the human papoloma virus associated cancers. We also know that it is associated with frequent sex partners, likely at a younger age and oral sex, there is an association with oral sex as well. Smoking and human papoloma virus actually can both be co-factors as well. So just because someone smokes, doesn’t mean their cancer’s not human papoloma virus related. And not every cancer in a non smoker will be human papoloma virus associated, but certainly the likelihood is much higher particularly in tonsil and base of tongue cancer.

For all cancers of the head and neck, the things that you should be looking for are those symptoms that happen on one side and not the other; that persist for longer than one to three weeks, and for example they will include things like hoarseness (which doesn’t go away) and particularly hoarseness which gets progressively worse. A sore in the mouth and particularly a lump in the mouth, a white patch in the mouth or a red patch in the mouth that actually is not painful. One of the thing that frequently surprises people is that they have a cancer in their mouth, yet it doesn’t hurt. And we often associate cancers with pain, but in early stages especially frequent that head and neck cancers won’t be painful. Nosebleeds that occur on one side only, hearing loss which occurs on one side and a neck mass (a lump in the neck), especially of again those that are not painful, not associated with fever or a recent illness. Those should all be evaluated by a dentist or a physician.

The treatment for head and neck cancer comes down to one of two major types; either surgery or radiation therapy. Those two are the only two curative types of cancer. We tend to then select that treatment which will give us the highest chance of cure, as well as the lowest chance of having complications and side effects from the treatment. And that tends to be for cancers of the mouth, tends to be surgery first. And for cancers of the voice box, we often will use radiation first. For cancers of the throat and areas of the voice box, sometimes surgery is better, sometimes radiation is better. We basically have to make a determination based on exactly where the cancer is and what the stage of the cancer is.

I think the most critical thing we have to offer is what’s called a multi-disciplinary approach to care; and this is a care that’s based on many different specialists working together to design and then institute the best possible treatment plan for the individual patient. And that includes what’s called a tumor board, where we meet on at least a weekly basis or biweekly basis, where we discuss all new patients [their pathology, their biopsies, their radiology (that is their x-rays or cat scans, ultrasounds)] will be evaluated by radiologists, pathologists and then the group of surgeons and medical oncologists, radiation oncologists, dental oncologists and other specialists in particular to that type of disease will discuss options of care and present what they think is the best treatment. The patient will then presented with that result and then we can institute that based again on having multiple people that have areas of the expertise in a given field for example speech and swallowing therapy, or in radiation oncology or in social work or are nurse case managers which are really the first line in the fundamental glue that holds all this together.