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Taylor Leddin McMaster (Host): Hello, listeners, and thank you for tuning into the Well Within Reach podcast, brought to you by Riverside Healthcare. I'm your host, Taylor Leddin McMaster and joining me today is Afton Swanson, board-certified family nurse practitioner in Radiation Oncology with the Riverside Cancer Institute to discuss head and neck cancer. Thanks for being here today.

Afton Swanson: Thank you for having me.

Host: Before we get into today's episode, we're going to take a quick break for a message about myChart.

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Host: All right. Now, we're back here with Afton Swanson to talk about head and neck cancer. But first, I'm curious, how long have you been with Riverside and what do you do in your role with Radiation Oncology?

Afton Swanson: So, I've been with Riverside working as a nurse since 2018, and more recently as a nurse practitioner with Radiation Oncology since January of last year. I work alongside Dr. Rashed, the radiation oncologist. We have a whole radiation team and a multidisciplinary cancer center team. We see the patients from the time they come to us with a new diagnosis. We support them through their radiation treatments, which can be anywhere from one day of treatment, up to seven to eight weeks of treatments. And then, we continue to follow them after and see how they're doing.

Host: Great. Thank you for that. Can you explain what head and neck cancer is and how it affects the body?

Afton Swanson: Yeah. So, head and neck cancer is kind of a broad term and there's many organs in the head and neck that can be affected. The most common. Head and neck cancers are what we call squamous cell cancers, but there are other types as well. They can develop anywhere from the mouth, the oral cavity, the pharynx, which it extends from behind the nose, down to the back of the mouth, and a little lower. It also can include the larynx or the voice box, sinuses, nasal cavity, and multiple glands in the head and neck.

It affects the body in a lot of ways, but typically patients will first experience symptoms based on where the cancer is. So, they might have like a mouth sore or a throat sore, some pain with swallowing, changes in their voice. Sometimes they feel swelling or lumps or we'll see some swelling, sometimes weight loss because they can't eat or drink.

Host: That's really interesting. So when it comes to risk factors or common causes, are there some that you see more frequently? Factors, causes, lifestyle choices, things like that, that play a role into it?

Afton Swanson: Absolutely. And there are many modifiable risk factors that contribute to the development of these cancers. The biggest one is tobacco use, smoking, and chewing tobacco. Alcohol consumption is another big risk factor. Exposure to certain viruses such as HPV or EBV, occupational exposures, sun exposure and diet, so consumption of some processed meats. It's also more prevalent in males, people over the age of 50. And some people are just genetically predisposed

Host: Oh, wow. Okay. What are the early warning signs or symptoms? You touched on it a little bit with sores and some lumps and things like that. Anything else that people should look out for when they seek early intervention?

Afton Swanson: Yes, similar to before, yeah, some of the initial signs and symptoms can be a little vague. So, sores in the mouth or throat, swelling or lumps, a sore throat that's not getting better, difficulty swallowing or voice changes. Of course, some of these symptoms happen for other reasons. It doesn't necessarily mean cancer, but it's just always important to have these things checked out and make sure you're keeping up with your regular dentist and medical visits.

Host: Absolutely. Research shows that this type of cancer is prevalent in farmers. You had mentioned occupational. Can you tell us why that is?

Afton Swanson: Yeah. So, there is research that shows us farmers are at an increased risks a lot due to their occupational exposures, certain pesticides, which contain carcinogens. The risk, of course, can be decreased by proper handling and wearing of personal protective equipment. They also work outside a lot of the time. So, they get a lot of UV and sun exposure that can also contribute to that.

Host: That's interesting because I didn't realize that sun exposure could do more than just skin cancer or melanoma. So, that's important to know.

Before we continue our conversation, we're going to take a minute to talk about the importance of primary care.

At Riverside Healthcare, your primary care provider is dedicated to being in your corner, helping you and your family stay healthy and thrive. Find the right primary care provider for you at Riverside healthcare.org/acceptingnew.

From annual screenings to well checks and everything in between, having a primary care provider that you can trust makes all the difference.

All right. Now, we're back with our conversation about head and neck cancer. Afton, can you walk us through the typical treatment options for this type of cancer and how the best course of action is determined for patients?

Afton Swanson: Head and neck cancer is one of those where there is a very broad range of treatment options. it is determined based on the type of cancer that it is, the location of the cancer, the stage of the cancer. And treatment is often multimodal. So, it can include surgery, radiation, systemic therapies including chemo or immunotherapies, either individually or a combination of all three.

Host: What makes head and neck cancer different from other types of cancer in terms of diagnosis and treatment?

Afton Swanson: So prior to treatment, patients will undergo a biopsy, often followed by body imaging to determine the type of cancer, the location, and the extent of the cancer, whether it's in lymph nodes, surrounding structures, or other parts of the body. Typically, they'll see an ENT, an Ear, Nose, throat doctor. They're often the ones who make the diagnosis. If the patient needs surgery, they're often ones doing the surgery. So, they're a big part of the diagnosis, treatment, and followup. They'll also see medical oncologists and radiation oncologists to determine their best course of treatment.

And treatment for head and neck cancer can be difficult, because there's a lot of important structures in the head and neck. Since I work in radiation, I can kind of talk from a radiation standpoint. It can be a very difficult treatment. Many of these patients require feeding tubes because, you know, this is where we eat and swallow, and that becomes affected during treatment.

We also have a dietician who works here who's an extremely important part of The treatment course for our head and neck cancer patients. Mouth pain, throat pain can be quite severe. They can also have kind of a sunburn reaction of the skin, but also inside it feels like a sunburn. So, things we take for granted like eating and swallowing can be affected. They also experience changes in taste. The taste buds get affected. The saliva production is affected. They can have dry mouth or thick saliva. And some voice changes too can happen. These patients do require a lot of support during treatment and we have a big team here who helps them through.

Host: Yeah. Thank you. That was a really thorough answer. I appreciate that. What is the current state of research and advancements in treating head and neck cancer?

Afton Swanson: There has been a lot of advancements in the field of head and neck cancer just over the years, and it's greatly deescalated the treatment-related effects. Like I just said, it can be a very difficult treatment to get through. So, there's been a lot of surgical advances as well as studies on immunotherapy and targeted therapies.

But for radiation, the goal is to target the cancer with precision and minimize the damage to healthy tissues. So, it's really focused on improving their quality of life before, during, and after treatment without compromising their cure rate or outcomes.

Host: Is there anything else on this subject that you would like our listeners to know about?

Afton Swanson: So, April coming up is Head and Neck Cancer Awareness Month. It accounts for about 3-4% of all new cancers diagnosed in the U.S. last year. And while there are no routine screenings for head and neck cancers, it's just important to see your providers for routine visits and address concerns as early as possible. Early detection is key, being aware of some of the signs and symptoms and modifying those risk factors that we talked about earlier.

Host: Definitely. Well, thank you so much for all of that information. And thank you to listeners for tuning into the Well Within Reach Podcast with Afton Swanson of the Riverside Cancer Institute and your host, Taylor Leddin McMaster. To learn more about the Riverside Cancer Institute, visit my rhc.net/cancer.