According to the American Cancer Society, head and neck cancer accounts for about 3% of all cancers in the United States. A diagnosis of head and neck cancer can be life-changing.
This year, an estimated 61,760 people (45,330 men and 16,430 women) will develop this type of cancer. Men, African-Americans, and people older than age 40 are all at a higher risk for head and neck cancer. Still, most risk factors are things you can control.
Listen as Dr. David Kotlyar, Medical Oncologist and Hematologist with Meritus Cancer Specialists, discusses treatments for head and neck cancers and which risk factors you can control to help prevent them.
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Head and Neck Cancers: Risk Factors You Can Control
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Learn more about David Kotlyar, MD
David Kotlyar, MD
David Kotlyar, M.D. earned his medical degree from the University of Pennsylvania School of Medicine in Philadelphia, PA. Dr. Kotlyar’s primary interest are gynecologic oncology including cervical cancer causes and treatment, breast cancer and HIV-associated malignancies. He is board certified in internal medicine and board eligible for hematology, oncology.Learn more about David Kotlyar, MD
Transcription:
Head and Neck Cancers: Risk Factors You Can Control
Melanie Cole (Host): A diagnosis of head and neck cancer can be life changing. According to the American Cancer Society, head and neck cancer accounts for about three percent of all the cancers in the United States. My guest today is Dr. David Kotlyar. He’s a medical oncologist/hematologist with Meritus Cancer Specialists. Welcome to the show, Dr. Kotlyar. So, what constitutes head and neck cancers? What type of cancers are we talking about?
Dr. David Kotlyar (Guest): Sure. So, thank you for having me on your program today. Head and neck cancer, in terms of the epidemiology, in 2009, there was approximately 40,000 new cases of oral cavity and pharynx cancer and about 8,000 or so deaths in the United States. Worldwide, there are many more cases. There are several hundred thousand cases a year at the minimum. And the incidence rates are more than twice as high in men compared to women. Traditionally, the risk factors for head and neck cancer have been things like smoking, alcohol, and generally it has been seen in older patients in their seventh decade of life or older. Head and neck cancer consists of three different anatomic sites. Predominantly, most cancers are the oropharynx which is the base of the tongue, the tonsils, the back of the throat. There are also other tumors that involve the nasopharynx, which is the nasal area above the throat, above the mouth rather. And then, below the mouth into the larynx. Laryngeal cancers are the third type of head and neck cancer. It’s an important cancer to be aware of because there is a very dramatic increase in the amount of cases, especially in younger patients. So, it’s a topic I wanted to discuss a little bit about today.
Melanie: So, you mentioned risk factors. Go over those again for us, Dr. Kotlyar. And, is there a genetic component to these?
Dr. Kotlyar: Sure. So, generally, risk factors include things like age where, again, traditionally, head and neck cancer has been seen in patients in the seventh decade of life, so in the sixties and older. Risk factors also include tobacco, alcohol and, occasionally, there are hereditary cases where those are the family history of head and neck cancer can have up to three- to four-fold increased risk. But, what’s also important about head and neck cancer is that there are actually two main subtypes. One subtype is associated with a virus called “human papilloma virus” which is a very common viral infection that a majority of the population will have it at some point or another. Another subtype are head and neck cancers that are not associated with that virus. In the cases that are associated with that virus, they’re more often found in patients in their thirty’s, forty’s, and fifty’s and they have a different prognosis and a different pathophysiology.
Melanie: So, just along those lines for a minute, Dr. Kotlyar. As we’re seeing the vaccine and Gardasil and the HPV vaccine coming into our early teenagers, do you think, and this is your opinion, that we will see a reduction in HPV-related head and neck cancers coming up as this generation of kids gets older and has this vaccine?
Dr. Kotlyar: Yes, I think that’s a great question. So, right now, so the FDA approved indications for the use of the vaccine are, in men and women between ages 9 and 26, for women, for prevention of cervical cancer; and men and women, anal cancers and genital warts. Head and neck cancer is not yet an indication but I think logically that you could say that in the next few years, it’s most likely going to get approved. So, the number of cases involving HPV, the human papilloma virus are dramatically increasing. I think about three hundred percent in the last twenty years. I think that those cases will start to come down with increased use of the vaccine. I think the main issues with the vaccine, I think the participation rate has been about forty percent on average. I think increased education and understanding what the risks and benefits are is actually going to be important moving forward. I think in terms of the vaccine, I think the main risk that needs to be known is that the chance of a blood clot tends to be the after effect that could be the most serious after effect and it’s only in one in several hundred thousand patients. The risk of passing away from being vaccinated for HPV is about one in a million. So, every medical intervention has risks but these are extremely remote and I think it is important that we’ll increase education about the vaccine as time moves forward.
Melanie: And, is there yet available a screening tool? Now we screen for HPV now as sort of an adjunct to cervical cancer screening. Do you see that coming down the line or is there a screening for head and neck cancers?
Dr. Kotlyar: So, we don’t do that yet. That’s a good question actually. Should we start looking for HPV in cheek swabs, things like that. As far as I know, that’s not standard of care. That’s not something we do routinely. You know, what a patient should be or what anybody in the population should be looking for, you know, if there’s anything like persistent hoarseness; a mass in the neck or an area that’s unusual when shaving; you know ear infection or pain, persistent ear infections or pain; altered oral sensations or lesions on the mouth that aren’t resolving; things that are, for example, early red lesions or white lesions or ulcers that are in the mouth for more than two or three weeks. You know, that would be something that I would probably want to discuss with my dentist and just to ask about if I were to have that happen. I think people should be aware of it; that it’s important just to take a look inside their mouth and just be aware of what’s going when they’re brushing their teeth and just to be cognizant about it. I think that that will be helpful. I’m sure there is research going on in terms of HPV screening. In cervical cancer, it has been found that adding HPV to the Pap smears has been very helpful in preventing new cases of cervical cancer. So, I’m sure that in going forward, it will have a role in head and neck cancer.
Melanie: And, I think you’ve made a good point that sometimes the screening might involve your dentist and people might not think of that but the dentists nowadays are looking for oral cancer, yes?
Dr. Kotlyar: Yes. I think that’s right. I think that would sort of be the first person I would speak with if the person was concerned about something like a lesion in their mouth or something not being right and they can take a look at that. Also, anytime that there are things that are concerning like, as I mentioned, if somebody feels a mass in their neck or persistent hoarseness. They could also see an ear, nose, and throat specialist also that can also assess whether that needs evaluation or treatment. So, either a dentist or an ear, nose, and throat physician would be the professional to see to evaluate a potential problem.
Melanie: So, while we’re talking about many different types of cancers, Dr. Kotlyar, what are some of the basic treatments out there today to deal with these cancers? People hear that diagnosis and they think this is a very scary thing because it involves eating and talking--things that people think of as a high quality of life.
Dr. Kotlyar: Yes, certainly. So, I can briefly touch upon treatments. So, generally, for head and neck cancer, there are two main approaches. One is surgery where they simply remove the tumor. The other is a combination of chemotherapy and radiation to treat tumors. The benefits of surgery are shorter treatment and no long-term radiation toxicities; whereas, the benefits of radiation and chemotherapy would be better organ preservation, better swallowing and speech as opposed to potential complications from surgery. But, with more advanced cancers, generally treatment is chemotherapy and radiation together. Usually during treatment patients do need to watch out for mucositis which is inflammation in the mouth and some patients require a feeding tube during the time of treatment because of the pain involved with the treatment. But, generally, patients do recover from that and after several months, the main side effects after treatment would be things like dry mouth and things that can be managed with symptomatic treatment.
Melanie: So, wrap it up for us if you would. Give your best advice for possible prevention and information about head and neck cancers--what you really want the listeners to know and why they should come to Meritus Health for their care.
Dr. Kotlyar: Sure. Sure. So, again, you know, I think that the fact that there has been such a dramatic increase in the number of cases of head and neck cancer over the last several decades that are HPV-related, I do think patients should, actually, the people of the general population should be aware of the risk. The fact is that nearly half of the population will be infected with the human papilloma virus at some point and about two to five percent will have the infection with what’s called a high risk virus, which are responsible for most of the HPV positive cancers, which are HPV number 16 and HPV number 18. These are covered by the Gardasil vaccine. So, I think one aspect of prevention is thinking about, and definitely in children and young adults, whether the vaccine might be a good choice as a preventative tool, obviously, for cervical cancer as well as prevention of genital warts. But, also I think there will be a benefit, although it’s not an indication formally, but that there would be a benefit in prevention of head and neck cancer going forward. In terms of, the second thing is just again, just to be aware of the health of your mouth--having good dental hygiene, brushing your teeth at least once a day, flossing, being aware of what’s going on in terms of any ulcers or lesions. If there’s something that’s been present for a couple of weeks, it’s not healing, something that doesn’t seem right, it’s worth going to your dentist and just bringing it up to them. Just being aware of your oral health and what’s going on in your mouth and throat I think would be beneficial. I think as time goes forward, like I said, I think we’ll have a better understanding of improved screening tools perhaps using HPV testing in the mouth and sort of a swish and spit or a cheek swab to check for those things. The other aspect of this is that there are premalignant lesions that also occur in the cervix and certainly in the mouth as well and things called “dysplasia” and we don’t yet have tools to really manage those outside of observation for premalignant lesions in the mouth. So, I think this is another aspect that’s very interesting that we’ll have improved treatments for and improved ways to manage that in the future. In terms of things at Meritus, so we’re an Intermediate Cancer Center. We have radiation oncology and medical oncology under the same roof and it’s very helpful. We can easily confer about the status of our patients. We’re a major hospital here in the Hagerstown area and also in Southern Central Pennsylvania, the Saskatchewan area and I think we also have several clinical trials and we’re expanding our clinical trials program here at the Cancer Center and hope to have an increased collaboration with the University of Pittsburgh as well as the NIH in Bethesda, Maryland. So, I think we have a number of exciting things going forward and I’m looking forward to seeing you know new research protocols and the new collaborations we have in the future.
Melanie: Thank you so much for being with us today. It’s such great information. You’re listening to Your Health Matters with Meritus Health. And for more information, you can go to www.meritushealth.com. That’s www.meritushealth.com. This is Melanie Cole. Thanks so much for listening.
Head and Neck Cancers: Risk Factors You Can Control
Melanie Cole (Host): A diagnosis of head and neck cancer can be life changing. According to the American Cancer Society, head and neck cancer accounts for about three percent of all the cancers in the United States. My guest today is Dr. David Kotlyar. He’s a medical oncologist/hematologist with Meritus Cancer Specialists. Welcome to the show, Dr. Kotlyar. So, what constitutes head and neck cancers? What type of cancers are we talking about?
Dr. David Kotlyar (Guest): Sure. So, thank you for having me on your program today. Head and neck cancer, in terms of the epidemiology, in 2009, there was approximately 40,000 new cases of oral cavity and pharynx cancer and about 8,000 or so deaths in the United States. Worldwide, there are many more cases. There are several hundred thousand cases a year at the minimum. And the incidence rates are more than twice as high in men compared to women. Traditionally, the risk factors for head and neck cancer have been things like smoking, alcohol, and generally it has been seen in older patients in their seventh decade of life or older. Head and neck cancer consists of three different anatomic sites. Predominantly, most cancers are the oropharynx which is the base of the tongue, the tonsils, the back of the throat. There are also other tumors that involve the nasopharynx, which is the nasal area above the throat, above the mouth rather. And then, below the mouth into the larynx. Laryngeal cancers are the third type of head and neck cancer. It’s an important cancer to be aware of because there is a very dramatic increase in the amount of cases, especially in younger patients. So, it’s a topic I wanted to discuss a little bit about today.
Melanie: So, you mentioned risk factors. Go over those again for us, Dr. Kotlyar. And, is there a genetic component to these?
Dr. Kotlyar: Sure. So, generally, risk factors include things like age where, again, traditionally, head and neck cancer has been seen in patients in the seventh decade of life, so in the sixties and older. Risk factors also include tobacco, alcohol and, occasionally, there are hereditary cases where those are the family history of head and neck cancer can have up to three- to four-fold increased risk. But, what’s also important about head and neck cancer is that there are actually two main subtypes. One subtype is associated with a virus called “human papilloma virus” which is a very common viral infection that a majority of the population will have it at some point or another. Another subtype are head and neck cancers that are not associated with that virus. In the cases that are associated with that virus, they’re more often found in patients in their thirty’s, forty’s, and fifty’s and they have a different prognosis and a different pathophysiology.
Melanie: So, just along those lines for a minute, Dr. Kotlyar. As we’re seeing the vaccine and Gardasil and the HPV vaccine coming into our early teenagers, do you think, and this is your opinion, that we will see a reduction in HPV-related head and neck cancers coming up as this generation of kids gets older and has this vaccine?
Dr. Kotlyar: Yes, I think that’s a great question. So, right now, so the FDA approved indications for the use of the vaccine are, in men and women between ages 9 and 26, for women, for prevention of cervical cancer; and men and women, anal cancers and genital warts. Head and neck cancer is not yet an indication but I think logically that you could say that in the next few years, it’s most likely going to get approved. So, the number of cases involving HPV, the human papilloma virus are dramatically increasing. I think about three hundred percent in the last twenty years. I think that those cases will start to come down with increased use of the vaccine. I think the main issues with the vaccine, I think the participation rate has been about forty percent on average. I think increased education and understanding what the risks and benefits are is actually going to be important moving forward. I think in terms of the vaccine, I think the main risk that needs to be known is that the chance of a blood clot tends to be the after effect that could be the most serious after effect and it’s only in one in several hundred thousand patients. The risk of passing away from being vaccinated for HPV is about one in a million. So, every medical intervention has risks but these are extremely remote and I think it is important that we’ll increase education about the vaccine as time moves forward.
Melanie: And, is there yet available a screening tool? Now we screen for HPV now as sort of an adjunct to cervical cancer screening. Do you see that coming down the line or is there a screening for head and neck cancers?
Dr. Kotlyar: So, we don’t do that yet. That’s a good question actually. Should we start looking for HPV in cheek swabs, things like that. As far as I know, that’s not standard of care. That’s not something we do routinely. You know, what a patient should be or what anybody in the population should be looking for, you know, if there’s anything like persistent hoarseness; a mass in the neck or an area that’s unusual when shaving; you know ear infection or pain, persistent ear infections or pain; altered oral sensations or lesions on the mouth that aren’t resolving; things that are, for example, early red lesions or white lesions or ulcers that are in the mouth for more than two or three weeks. You know, that would be something that I would probably want to discuss with my dentist and just to ask about if I were to have that happen. I think people should be aware of it; that it’s important just to take a look inside their mouth and just be aware of what’s going when they’re brushing their teeth and just to be cognizant about it. I think that that will be helpful. I’m sure there is research going on in terms of HPV screening. In cervical cancer, it has been found that adding HPV to the Pap smears has been very helpful in preventing new cases of cervical cancer. So, I’m sure that in going forward, it will have a role in head and neck cancer.
Melanie: And, I think you’ve made a good point that sometimes the screening might involve your dentist and people might not think of that but the dentists nowadays are looking for oral cancer, yes?
Dr. Kotlyar: Yes. I think that’s right. I think that would sort of be the first person I would speak with if the person was concerned about something like a lesion in their mouth or something not being right and they can take a look at that. Also, anytime that there are things that are concerning like, as I mentioned, if somebody feels a mass in their neck or persistent hoarseness. They could also see an ear, nose, and throat specialist also that can also assess whether that needs evaluation or treatment. So, either a dentist or an ear, nose, and throat physician would be the professional to see to evaluate a potential problem.
Melanie: So, while we’re talking about many different types of cancers, Dr. Kotlyar, what are some of the basic treatments out there today to deal with these cancers? People hear that diagnosis and they think this is a very scary thing because it involves eating and talking--things that people think of as a high quality of life.
Dr. Kotlyar: Yes, certainly. So, I can briefly touch upon treatments. So, generally, for head and neck cancer, there are two main approaches. One is surgery where they simply remove the tumor. The other is a combination of chemotherapy and radiation to treat tumors. The benefits of surgery are shorter treatment and no long-term radiation toxicities; whereas, the benefits of radiation and chemotherapy would be better organ preservation, better swallowing and speech as opposed to potential complications from surgery. But, with more advanced cancers, generally treatment is chemotherapy and radiation together. Usually during treatment patients do need to watch out for mucositis which is inflammation in the mouth and some patients require a feeding tube during the time of treatment because of the pain involved with the treatment. But, generally, patients do recover from that and after several months, the main side effects after treatment would be things like dry mouth and things that can be managed with symptomatic treatment.
Melanie: So, wrap it up for us if you would. Give your best advice for possible prevention and information about head and neck cancers--what you really want the listeners to know and why they should come to Meritus Health for their care.
Dr. Kotlyar: Sure. Sure. So, again, you know, I think that the fact that there has been such a dramatic increase in the number of cases of head and neck cancer over the last several decades that are HPV-related, I do think patients should, actually, the people of the general population should be aware of the risk. The fact is that nearly half of the population will be infected with the human papilloma virus at some point and about two to five percent will have the infection with what’s called a high risk virus, which are responsible for most of the HPV positive cancers, which are HPV number 16 and HPV number 18. These are covered by the Gardasil vaccine. So, I think one aspect of prevention is thinking about, and definitely in children and young adults, whether the vaccine might be a good choice as a preventative tool, obviously, for cervical cancer as well as prevention of genital warts. But, also I think there will be a benefit, although it’s not an indication formally, but that there would be a benefit in prevention of head and neck cancer going forward. In terms of, the second thing is just again, just to be aware of the health of your mouth--having good dental hygiene, brushing your teeth at least once a day, flossing, being aware of what’s going on in terms of any ulcers or lesions. If there’s something that’s been present for a couple of weeks, it’s not healing, something that doesn’t seem right, it’s worth going to your dentist and just bringing it up to them. Just being aware of your oral health and what’s going on in your mouth and throat I think would be beneficial. I think as time goes forward, like I said, I think we’ll have a better understanding of improved screening tools perhaps using HPV testing in the mouth and sort of a swish and spit or a cheek swab to check for those things. The other aspect of this is that there are premalignant lesions that also occur in the cervix and certainly in the mouth as well and things called “dysplasia” and we don’t yet have tools to really manage those outside of observation for premalignant lesions in the mouth. So, I think this is another aspect that’s very interesting that we’ll have improved treatments for and improved ways to manage that in the future. In terms of things at Meritus, so we’re an Intermediate Cancer Center. We have radiation oncology and medical oncology under the same roof and it’s very helpful. We can easily confer about the status of our patients. We’re a major hospital here in the Hagerstown area and also in Southern Central Pennsylvania, the Saskatchewan area and I think we also have several clinical trials and we’re expanding our clinical trials program here at the Cancer Center and hope to have an increased collaboration with the University of Pittsburgh as well as the NIH in Bethesda, Maryland. So, I think we have a number of exciting things going forward and I’m looking forward to seeing you know new research protocols and the new collaborations we have in the future.
Melanie: Thank you so much for being with us today. It’s such great information. You’re listening to Your Health Matters with Meritus Health. And for more information, you can go to www.meritushealth.com. That’s www.meritushealth.com. This is Melanie Cole. Thanks so much for listening.