Cancers of the head and neck frighten patients, but there are new methodologies that should ease minds, according to Thomas Gernon, M.D., surgeon in the Division of Head and Neck Surgery in the Department of Surgery at City of Hope. He specializes in the cancers that strike from the neck up. Now, during Head and Neck Cancer Awareness Month, we take a closer look at the disease — and new ways of dealing with it.
A Variety of Struggles
Many kinds of cancers can occur in this area of the body, but Gernon narrows them down into two categories: “Cancers of the face and upper aerodigestive tract. This includes basal cell cancers and squamous cell cancers. Then inside are tumors of the sinuses; the oral cavity, which is the anterior part of the tongue; the jaw bone; and the oropharynx, which are tumors of the tonsils and the back of the tongue.”
The Two Sections of the Tongue
The tongue is susceptible to many cancers, and Gernon differentiates these by where the cancer is located. “Tumors of the oral cavity are tumors of the anterior tongue, the front two-thirds of your tongue. Oropharynx tumors include the posterior one-third of your tongue and the tonsils.” Patients with tumors here are typically smokers or heavy drinkers, and often are diagnosed with squamous cell cancers.
The HPV Connection
One thing that is no longer a mystery is the connection between these tumors and the human papillomavirus (HPV) — the same virus that causes cervical cancer. Because of HPV vaccines, there is cause for optimism for eventually rooting out all HPV-caused cancers. Gernon explains: “We are all subjected to the HPV virus at some point in our adolescence, and it lays dormant in our system and then reactivates when we are in our fifties or sixties. Even
“If you are negative for HPV, your chance of getting this cancer is significantly decreased,” Gernon added. “Interestingly, women who are exposed to the virus in the cervix are actually able to immunize themselves against the virus, and that’s why we are seeing fewer incidences in women with head and neck HPV-related tonsil- or tongue-based cancer in comparison to men. The men are exposed in the oropharynx to a larger amount of virus, and that virus lays dormant as the immune system drops off, then reactivates in your fifties to sixties as a cancer.”
Symptoms, Diagnosis and Hope
Most learn of head and neck cancer due to a variety of symptoms. These include changes in the voice, trouble swallowing, earaches or lumps in the neck due to tumors of the tongue or tonsils spreading into nearby lymph nodes.
But, although cancers of this area of the body may frighten us, Gernon is proud of what science can do.
“Fortunately, these tumors respond well to treatment,” he said. “Patients do very well. Most patients are going to live into their later ages, and we focus on quality of life 10 years after their treatment. There is nonsurgical treatment, or less-invasive robotic surgery through the mouth. Treatment is moving toward de-escalation of the radiation dose, because radiation 10 years down the road can have significant effects on swallowing and jaw function and viability. So, we are really trying to decrease therapy overall for these patients.”