Oral Cancers: Know Your Risk Factors

Robert Wood says he knew something was wrong last April when he began to experience unusual symptoms in his throat and neck. He noticed a lump in his neck that appeared to come and go. At other times, there seemed to be something stuck in his throat, or he had difficulty swallowing. Finally, in a frightening episode, he felt as though he were choking.

Mr. Wood, who is 60 and lives on Grand Cayman Island, visited his primary physician and spoke with other doctors about the symptoms as they appeared, but on examination they found nothing unusual. In January of this year, on the morning he was traveling to Texas for a business trip, Mr. Wood saw an ear, nose and throat specialist. After a thorough examination, including an ultrasound and a CT scan, the specialist later called Mr. Wood, who was already checked in at the airport, to tell him that his business trip was canceled. He was instead flying to Miami that day to see specialists with Baptist Hospital’s Head and Neck Cancer Support Team.

“You could have knocked me over with a feather,” he says. He recalls that within ten minutes, he received a call from Baptist Hospital staff to help him arrange for care.

At the hospital he was given a diagnosis — stage IV cancer — and a description from his doctors. Floating deep in his throat, located at the back base of the tongue, was what looked like a piece of cauliflower on a stalk.  Like in the case of actor Michael Douglas, who was also diagnosed with a cancer at the back of the tongue in 2010, Mr. Wood is being treated with aggressive chemotherapy and radiation. The size of the cancer has been dramatically reduced. Along with the success of ongoing treatment, however, are side effects including dry mouth and pain.

April is Oral Cancer Awareness Month, and Mr. Wood has a message for anyone who believes they have symptoms: be persistent.

“Whenever you feel something, you go deeper,” he says. “I don’t care what someone tells you.”

Head and Neck Cancers: Causes and Treatment
According to the National Cancer Institute, part of the National Institutes of Health, most cancers of the head and neck start in the squamous cells that line moist surfaces inside the head and neck, in the mouth, pharynx, larynx, sinus and nasal cavity and salivary glands.

• Use of tobacco and alcohol and human papillomavirus, or HPV, are key risk factors, with HPV being the fastest growing.
• Head and neck cancers may be treated with chemotherapy, radiation, surgery or a combination.

More than 43,000 people will be diagnosed with cancer of the head and neck this year, according to the Oral Cancer Foundation. In addition to your primary care physician, your dentist is also on the front line of detection of oral cancers.

Oropharyngeal Cancers on the Rise
According to the American Cancer Society, the number of oropharyngeal cancers (affecting the part of the throat just behind the mouth) linked to HPV rose dramatically over the past several decades, and HPV DNA can be found in about 2 out of 3 oropharyngeal cancers — and in a much smaller fraction of oral cavity cancers. Those affected tend to be younger and less likely to use cigarettes or abuse alcohol.

“It has better treatment outcomes, particularly if you have no smoking or alcohol history,” says Joseph P. McCain, DMD, chief of oral and maxillofacial surgery at Baptist Hospital. “It’s good news and bad news, because there’s definitely an increase.”

Dr. McCain, a member of the Baptist Head and Neck Cancer Support Team treating Mr. Wood, says prevention is critical, as are treatments that cure. It’s also important to increase quality of life after cancer and aggressive treatments have taken a toll. To that end, he said, treatments are either better targeted to decrease ravaging of the body, or de-intensified if possible. Continued advances in reconstructive surgery are also allowing patients who have lost part of a nose, an ear or jaw to return to the outside world, he said. With multi-disciplinary care, patients who might have lost their teeth are being treated, to ensure better outcomes.

“Early detection means early treatment, which means improved outcomes,” Dr. McCain says.

Any symptoms lasting longer than two weeks should be investigated including:

• Hoarseness (could be a sign of cancer of the vocal cords)
• Difficulty swallowing
• Lumps in the neck or anywhere on the tongue, in the mouth or on the face
• White, red or rough patches on the tongue or anywhere inside the mouth

To further its mission of education and prevention, Baptist Hospital is offering two events this month, the Fourth Annual Head and Neck Cancer Symposium for medical professionals April 11, which will focus on quality of life after treatment.

On April 9, a community event will also focus on quality-of-life issues for survivors of head and neck cancers as well as treatment and prevention. Mr. Wood will be a speaker.

“We’re not only trying to cure,” Dr. McCain says, “but markedly improve quality of life.”

Tags: oral cancer, surviving cancer