For patients with a diagnosis of cancer of the head or neck, the priorities are always the same: getting the very best treatment that affords the best outcome possible, and finding hope in the process.
From diagnosis through treatment and follow up, City of Hope offers a truly comprehensive approach to treating head and neck cancers.
Our renowned head and neck surgeons specialize in the complex procedures often necessary to eradicate these tumors while preserving vital structures and function.
Robert Kang, MD is here to discuss head and neck cancer, it's diagnoses and treatments.
Selected Podcast
Head and Neck Cancers and the HPV Link
Featured Speaker:
Robert Kang, MD
Robert Kang, M.D. is a highly skilled surgical expert at City of Hope specializing in advanced facial reconstructive and microvascular procedures for patients with complex and challenging head and neck cancers. Transcription:
Head and Neck Cancers and the HPV Link
Melanie Cole (Host): For patients with the diagnosis of cancer of the head or neck, the priorities are always the same: getting the very best treatment that affords the best outcome possible and finding hope in the process. My guest today is Dr. Robert Kang. He is a highly skilled surgical expert at City of Hope specializing in advanced facial reconstructive and microvascular procedures for patients with complex and challenging head and neck cancers. Welcome to the show, Dr. Kang. Tell us a little bit about what are the causes of head and neck cancers.
Dr. Robert Kang (Guest): When we talk about head and neck cancers, we’re talking primarily about not just their anatomic location in the head and neck, but we’re talking about where the cancers arise from in terms of cell lines. So when we’re talking about head and neck cancers today, we’re going to talk about when they arise from what are called squamous cells, which are cells that line the upper aerodigestive tract in the mouth, in the throat, the sinuses, things like that. Traditionally, the head and neck cancers are caused by lifelong habits of smoking, tobacco, and ingesting alcohol. That was the traditional risk factors independently and also synergistically. There have been some developments in terms of what causes head and neck cancer—namely HPV, sexually transmitted disease—which has risen over really the last 10 years.
Melanie: What are some symptoms that people might experience that would send them to see somebody to even worry about these?
Dr. Kang: Head and neck cancers, as you can imagine, can affect us pretty early on. If you have cancer in the tongue, you’ll notice a sore, an ulcer, pain in your tongue when you speak, when you swallow. The same occurs for other areas in the throat. If the cancer’s arising from the cells that line the vocal cords, then you’ll develop hoarseness fairly early on. And we’re talking pain that does not go away, pain that gets worse, hoarseness that does not go away, hoarseness that gets worse. When the ulcers become a little deeper, then you can have bleeding as well.
Melanie: Talk about that HPV link that you mentioned as we’re seeing cancers of the head and neck increasing or decreasing, which are they? And how is HPV linked to it?
Dr. Kang: The HPV-related cancers usually occur primarily in the oropharynx, and that’s the part of the throat that includes the base of the tongue and the tonsils, primarily. Those types of head and neck cancers that are related to HPV in that particular area, the frequency of that is increasing. And as we have less smokers, the traditional head and neck cancers linked to smoking is decreasing.
Melanie: Also, when people go to see a doctor, how is this diagnosed, and then what treatments are available? People get afraid if they have a head and neck cancer that they’re going to be deformed or they’re not going to be able to eat or talk. Speak about the treatments just a little bit.
Dr. Kang: Right. As you can imagine, any of these areas that we just talked about in the head and neck can… if you have treatment related to those areas, you can imagine there might be some deficit in your ability to speak or swallow. The key is to really diagnose this early. When the symptoms occur, having someone take a look at the specific areas and then take a biopsy if necessary, if there appears to be something abnormal, then that’s how the diagnosis is ultimately established. Obviously, there are other things that are involved. Just getting imaging studies, CAT scans, PET scans, MRIs that kind of show us what’s below the surface. In the office, we also use an endoscope, which slips through the nose while you’re awake and we just sort of numb the area and you can get a good bird’s eye view of the entire throat that you can’t see just through the mouth. That’s primarily how it’s diagnosed. In terms of the effect on the quality of life, then we’re talking about speaking and swallowing. The earlier that we can catch these things, the smaller the tumors, are and we’re moving smaller tumors, which means smaller defects and smaller deficits in these things.
Melanie: How are they treated?
Dr. Kang: The main treatment is surgery or radiation. Those are the two types of treatment that are used when cure is the intent. Sometimes, chemotherapy is added to radiation in order to increase its efficacy in more advanced cancers. As there is a small tumor in the tip of the tongue, for example, or the side of the tongue, which is a common area of head and neck cancer, it can be removed surgically. If there are no lymph nodes involved, if it was a small tumor, surgery is all you need. If there are multiple lymph nodes involved or the tumor was a little bit larger, then you can remove those things with surgery and then add radiation in order to prevent or decrease your chance of recurrence. Then again, if there is the tumor in an area that’s hard to remove surgically, such as in the back of the throat and it’s involving kind of a broad area, you can’t simply remove that all surgically without a major impact. In those scenarios, we can use radiation where nothing needs to be removed, but that entire area can be treated. Obviously, radiation doesn’t remove anatomy. A surgery does, but it also has its own side effects. Those are the main types of treatments that we have.
Melanie: Does the HPV vaccine that’s being given to younger girls and boys right now protect one from developing that HPV-related throat cancers?
Dr. Kang: That is unknown. The HPV relation to oropharyngeal cancer is fairly recent, but we do know that exposure to HPV doesn’t result in head and neck cancer in the time frame that we’ve known about it. It can linger for 10, 20 years before the person ever develops head and neck cancer as a result. Now that we know, certainly in the next 10, 20 years we’ll have more information about that.
Melanie: Tell us about the research that you’re doing at City of Hope, Dr. Kang, for people with head and neck cancers.
Dr. Kang: Well, there are a lot of different types of molecular and cell studies that are being done here. We looked at recently the effect of people who have undergone treatments for other type of cancers, like leukemia with bone marrow transplant, and whether that relates to people developing higher risk of developing HPV-related head and neck cancers later on down the line. That’s something we’re writing up right now.
Melanie: Okay, so give advice in the last couple of minutes here, your best advice for patients that are newly diagnosed with head and neck cancers and why they should come see you at City of Hope.
Dr. Kang: When you are diagnosed with the cancer, it’s imperative that, number one, you get multiple opinions, because different centers will treat cancers differently and it’s best to get as much information as possible. Number two, you definitely want to present to an academic institution where the latest in research, the latest in radiation treatments, the latest in surgical techniques are available. Because if these things are not available, then you will not even hear about that in the discussion. If you come to City of Hope, we have folks who are heavily involved in research. Everything that we do is related to our knowledge of the latest research and outcomes available. In terms of surgical procedures, specifically here at City of Hope, we perform weekly or biweekly robotic surgery techniques as well as the latest surgery techniques, which are also gaining traction now that these oropharyngeal tonsil-based tongue cancers are arising. Because these allow us to remove these areas of cancer that we previously were unable to remove and used to relegate to chemotherapy and radiation only, the advantages of coming to academic cancer centers such as the City of Hope is that you have all of these tools at our disposal, and we can make the best decisions accordingly.
Melanie: Thank you so much, Dr. Kang. You’re listening to City of Hope Radio. For more information, you can go to cityofhope.org. That’s cityofhope.org. This is Melanie Cole. Thanks so much for listening.
Head and Neck Cancers and the HPV Link
Melanie Cole (Host): For patients with the diagnosis of cancer of the head or neck, the priorities are always the same: getting the very best treatment that affords the best outcome possible and finding hope in the process. My guest today is Dr. Robert Kang. He is a highly skilled surgical expert at City of Hope specializing in advanced facial reconstructive and microvascular procedures for patients with complex and challenging head and neck cancers. Welcome to the show, Dr. Kang. Tell us a little bit about what are the causes of head and neck cancers.
Dr. Robert Kang (Guest): When we talk about head and neck cancers, we’re talking primarily about not just their anatomic location in the head and neck, but we’re talking about where the cancers arise from in terms of cell lines. So when we’re talking about head and neck cancers today, we’re going to talk about when they arise from what are called squamous cells, which are cells that line the upper aerodigestive tract in the mouth, in the throat, the sinuses, things like that. Traditionally, the head and neck cancers are caused by lifelong habits of smoking, tobacco, and ingesting alcohol. That was the traditional risk factors independently and also synergistically. There have been some developments in terms of what causes head and neck cancer—namely HPV, sexually transmitted disease—which has risen over really the last 10 years.
Melanie: What are some symptoms that people might experience that would send them to see somebody to even worry about these?
Dr. Kang: Head and neck cancers, as you can imagine, can affect us pretty early on. If you have cancer in the tongue, you’ll notice a sore, an ulcer, pain in your tongue when you speak, when you swallow. The same occurs for other areas in the throat. If the cancer’s arising from the cells that line the vocal cords, then you’ll develop hoarseness fairly early on. And we’re talking pain that does not go away, pain that gets worse, hoarseness that does not go away, hoarseness that gets worse. When the ulcers become a little deeper, then you can have bleeding as well.
Melanie: Talk about that HPV link that you mentioned as we’re seeing cancers of the head and neck increasing or decreasing, which are they? And how is HPV linked to it?
Dr. Kang: The HPV-related cancers usually occur primarily in the oropharynx, and that’s the part of the throat that includes the base of the tongue and the tonsils, primarily. Those types of head and neck cancers that are related to HPV in that particular area, the frequency of that is increasing. And as we have less smokers, the traditional head and neck cancers linked to smoking is decreasing.
Melanie: Also, when people go to see a doctor, how is this diagnosed, and then what treatments are available? People get afraid if they have a head and neck cancer that they’re going to be deformed or they’re not going to be able to eat or talk. Speak about the treatments just a little bit.
Dr. Kang: Right. As you can imagine, any of these areas that we just talked about in the head and neck can… if you have treatment related to those areas, you can imagine there might be some deficit in your ability to speak or swallow. The key is to really diagnose this early. When the symptoms occur, having someone take a look at the specific areas and then take a biopsy if necessary, if there appears to be something abnormal, then that’s how the diagnosis is ultimately established. Obviously, there are other things that are involved. Just getting imaging studies, CAT scans, PET scans, MRIs that kind of show us what’s below the surface. In the office, we also use an endoscope, which slips through the nose while you’re awake and we just sort of numb the area and you can get a good bird’s eye view of the entire throat that you can’t see just through the mouth. That’s primarily how it’s diagnosed. In terms of the effect on the quality of life, then we’re talking about speaking and swallowing. The earlier that we can catch these things, the smaller the tumors, are and we’re moving smaller tumors, which means smaller defects and smaller deficits in these things.
Melanie: How are they treated?
Dr. Kang: The main treatment is surgery or radiation. Those are the two types of treatment that are used when cure is the intent. Sometimes, chemotherapy is added to radiation in order to increase its efficacy in more advanced cancers. As there is a small tumor in the tip of the tongue, for example, or the side of the tongue, which is a common area of head and neck cancer, it can be removed surgically. If there are no lymph nodes involved, if it was a small tumor, surgery is all you need. If there are multiple lymph nodes involved or the tumor was a little bit larger, then you can remove those things with surgery and then add radiation in order to prevent or decrease your chance of recurrence. Then again, if there is the tumor in an area that’s hard to remove surgically, such as in the back of the throat and it’s involving kind of a broad area, you can’t simply remove that all surgically without a major impact. In those scenarios, we can use radiation where nothing needs to be removed, but that entire area can be treated. Obviously, radiation doesn’t remove anatomy. A surgery does, but it also has its own side effects. Those are the main types of treatments that we have.
Melanie: Does the HPV vaccine that’s being given to younger girls and boys right now protect one from developing that HPV-related throat cancers?
Dr. Kang: That is unknown. The HPV relation to oropharyngeal cancer is fairly recent, but we do know that exposure to HPV doesn’t result in head and neck cancer in the time frame that we’ve known about it. It can linger for 10, 20 years before the person ever develops head and neck cancer as a result. Now that we know, certainly in the next 10, 20 years we’ll have more information about that.
Melanie: Tell us about the research that you’re doing at City of Hope, Dr. Kang, for people with head and neck cancers.
Dr. Kang: Well, there are a lot of different types of molecular and cell studies that are being done here. We looked at recently the effect of people who have undergone treatments for other type of cancers, like leukemia with bone marrow transplant, and whether that relates to people developing higher risk of developing HPV-related head and neck cancers later on down the line. That’s something we’re writing up right now.
Melanie: Okay, so give advice in the last couple of minutes here, your best advice for patients that are newly diagnosed with head and neck cancers and why they should come see you at City of Hope.
Dr. Kang: When you are diagnosed with the cancer, it’s imperative that, number one, you get multiple opinions, because different centers will treat cancers differently and it’s best to get as much information as possible. Number two, you definitely want to present to an academic institution where the latest in research, the latest in radiation treatments, the latest in surgical techniques are available. Because if these things are not available, then you will not even hear about that in the discussion. If you come to City of Hope, we have folks who are heavily involved in research. Everything that we do is related to our knowledge of the latest research and outcomes available. In terms of surgical procedures, specifically here at City of Hope, we perform weekly or biweekly robotic surgery techniques as well as the latest surgery techniques, which are also gaining traction now that these oropharyngeal tonsil-based tongue cancers are arising. Because these allow us to remove these areas of cancer that we previously were unable to remove and used to relegate to chemotherapy and radiation only, the advantages of coming to academic cancer centers such as the City of Hope is that you have all of these tools at our disposal, and we can make the best decisions accordingly.
Melanie: Thank you so much, Dr. Kang. You’re listening to City of Hope Radio. For more information, you can go to cityofhope.org. That’s cityofhope.org. This is Melanie Cole. Thanks so much for listening.