Terry Day, an MUSC Health surgeon who specializes in head and neck cancers at Hollings Cancer Center, is president of the international Head and Neck Cancer Alliance, Inc. The group focuses on advocacy and survivorship, providing a free screening that’s held worldwide every year during the oral, head and neck cancer awareness week (https://www.headandneck.org/) in April.
Here, he explores why the incidence of head and neck cancers is rising and what people should know about their risks. It is estimated that in the U.S. about 3,400 news cases of HPV-associated oropharyngeal cancers are diagnosed in women each year and 14,800 in men, which makes it more common than cervical cancer.
What are head and neck cancers?
Cancers can occur almost everywhere in the head and neck including the skin, mouth, throat, voice box, thyroid gland, parotid gland and other areas. However, the type that has recently emerged and is seeing a lot of publicity is the HPV throat cancers.
Why are we hearing more about head and neck cancers?
They are becoming much more popular in news and media because it’s considered to be an epidemic in the U.S., so people are more aware of it, and many celebrities have been diagnosed and are becoming advocates for early diagnosis and HPV vaccination. Of course, we would like to see the cancers at an early stage when they are small and more curable. When we treat them later — at stage 3 or 4 – the treatment becomes more complicated, and there can be more side effects.
I’m glad to see more celebrities are coming forward to recommend early diagnosis – Michael Douglas, Jim Kelly. They are helping spread the word for early detection.
What role does HPV or the human papillomavirus play?
In the last decade, HPV’s connection to the back of the tongue and tonsil cancers really has emerged. Surprisingly, research shows throat cancer from HPV has surpassed cervical cancer in incidence in the U.S.
People ask me, ‘How do I find out if I have HPV cancer in my throat?’ There’s not a great test yet that is FDA-approved to detect HPV in the throat. We do know that it’s occurring more frequently in younger males, Caucasians, than it used to and in those who don’t smoke. The earliest signs and symptoms include a swelling or enlarged lymph node or cyst in the neck or a constant sore throat that doesn’t go away. I’ve seen teens and young people in their 20s diagnosed with these cancers.
My top advice: If they have a spot in the mouth or throat, lump in the neck or sore throat that isn’t going away, they should be checked immediately.
What do you wish people knew about the HPV vaccine?
It’s important for people to get the vaccination before they are exposed to the virus, so that’s why it’s recommended for boys and girls and was recently FDA-approved for adults up to age 45. It’s clearly established the vaccination can prevent HPV in the body, and therefore prevent HPV that causes throat cancer. Unfortunately, South Carolina ranks near the bottom in HPV vaccination rates. I’m not sure why that is, but I feel it’s important for parents to go to their pediatrician, talk about the vaccination and know that sometimes you have to ask. It’s not always on the radar of pediatricians.
Why is this cancer often misdiagnosed or caught late?
The important thing to know is this is so new in the U.S. and South Carolina that many physicians and dentists didn’t receive this training in school. Often, we are educating doctors as we are educating the public. Anyone who has a lump in the neck, red or white spot, sore throat or trouble swallowing that is consistent should see a specialist. This is something that is commonly misdiagnosed. It is important to have your family physician or dentist refer you to a specialist to do an exam and a biopsy.
Who is particularly at risk?
Nearly all sexually active people will get HPV at some time in their life if they don’t get the HPV vaccine, so everyone should be aware of the risk. Males between 40 and 60 should be particularly aware since head and neck cancers affect more men than women and are more common with older age. Men also tend to ignore symptoms and wait later to seek treatment.
What’s the prognosis for those who do get head and neck cancers?
If you are diagnosed with an HPV-related throat cancer, overall there’s a much better cure rate than other throat cancers. It’s important to seek treatment at a cancer center with a multidisciplinary team. Most patients should have a team that includes a head and neck surgeon along with radiation and medical oncologists, speech/swallowing therapists, and we also have two of the top maxillofacial prosthodontic specialists in the U.S. The goal is to have the best quality of life after the cancer is cured. Having the newest technology also is important, and our minimally invasive robotic surgery allows patients to have the tumor removed without incisions on the face or neck. Now it can all be done through the mouth without any incision of the skin, so the patient often goes home in one to two days, not the seven to 10 days that it used to be. We have four head and neck cancer surgeons specially trained in robotic surgery.
Our head and neck cancer team is unique. We have a multidisciplinary team with specialists led by a top nursing and nurse practitioner team who have depth in fields that you can’t find in other places in the country. It’s likely why we get referrals from all over the country and internationally because we have no gaps in expertise. We have two of the top maxiollofacial prosthodontic specialists, and we can make artificial body parts (eyes, ears, nose, mouth) via 3-D printing to improve outcomes and cosmetic results in patients. We also have a head and neck and facial plastic surgery team allowing reconstruction of the face, jaw, tongue and throat with tissue transplants to replace areas that need to be removed due to cancer. Another exciting development is immunotherapy, which can now be used to boost the patient’s immune system to fight the cancer cells to help improve survival rates and outcomes. We have several clinical trials open at Hollings Cancer Center related to mouth and throat cancers that are not available at other cancer centers, including one that is looking at reducing side effects by decreasing the amount of surgery, chemotherapy or radiation that’s needed. Dr. Evan Graboyes’ research focuses on improving patient outcomes in both quality of life and cancer cure.
Why are these advances so important?
In the past, if you had head and neck cancer, most people would never go out in public because it affects the way you look, the way you breathe, eat, drink – even the way you talk. Some people weren’t able to do those normal functions after treatment. Now, with advances, almost everyone is able to regain those functions post-treatment.
As you can imagine, if you have to have parts of your face or mouth or throat removed, it’s going to affect every single day of your life, and it will affect the way you look.
What drew you to this field?
I like the challenge of helping the field advance and providing patients care that can’t be provided elsewhere. For example, robotic surgery was controversial at first, but now we know patients have better outcomes. As a surgeon, with the magnification of the camera, I can see the location of cancer cells in the throat magnified and in 3-D, which helps us ensure we can get all the cancer out, and we don’t take healthy tissue. We get to places we couldn’t get to before.
This is not an easy field for surgeons. There are devastating consequences for many patients if not cured of their cancers in some of these cases. We can’t cure everyone. Sometimes there’s not more we can do. What’s rewarding is that while I was in training, there were very few places you could go to have this expertise. Being able to train the students, residents and fellows in head and neck cancers and taking great care of patients from around the world has been rewarding. Now we have experts in almost every state and every country who are trained to take care of these patients.
We also are developing new standards of care. Dr. Graboyes on our team is researching cancer survivorship – body image disturbance. People are realizing how people think about themselves and their bodies is an important part of beating cancer. Another researcher, Dr. Neskey, is exploring benefits of administering immunotherapy before having surgery. It’s one of the few trials like that going on in the country.