What are the most common forms of head and neck cancer, and what treatment options are available.
Get the facts from a UVA expert in head and neck surgery.
Selected Podcast
Head and Neck Cancer
Featured Speaker:
Dr. Mark Jameson
Dr. Mark Jameson is an otolaryngologist – head and neck surgeon whose specialties include head and neck cancer. Transcription:
Head and Neck Cancer
Melanie Cole (Host): This year, more than 55,000 Americans will develop cancer of the head and neck. Which are the most common forms of head and neck cancer and what treatment options are out there? My guest is Dr. Mark Jameson. He is an otolaryngologist, head and neck surgeon, whose specialties include head and neck cancer. Welcome to the show, Dr. Jameson. What are the most common head and neck cancers that you see?
Dr. Mark Jameson (Guest): Well, the term “head and neck cancer” is actually a very broad term. We use it to refer to all of the cancers that occur in the head and neck with the exception of brain and eye cancers. That includes cancers of the skin, salivary gland, the thyroid gland, sinuses, and the team at UVA manages all of these types of cancers. But the most common brand of head and neck cancer that we see is the squamous cell carcinoma that occurs in the mouth, that we refer to as the oral cavity, the throat or the pharynx, and the voice box or larynx. As you said, that’s a relatively small number of cancers in the United States every year, but in our practice, because it’s dedicated to head and neck cancer, that’s what we see predominantly.
Melanie: What most commonly causes these cancers, and are any of them preventable?
Dr. Jameson: Well, the biggest risk factor for head and neck squamous cell carcinoma is tobacco use. That’s been well established for a long time. That includes smoking and also chewing tobacco. And we know as well that excessive alcohol use is also a risk factor. While alcohol is not as big a risk factor as smoking, when the two are used together, they’re more than additive, so there’s a synergistic effect between those two things. Classically, our head and neck cancer patient has been a longtime smoker and someone who has used alcohol frequently. However, in the last decade, we have seen the emergence of a new form of throat cancer that is caused by the human papilloma virus or HPV, and most folks are becoming aware of this. The virus is often acquired early in adulthood and then often resides in the tonsil tissue for a long period of time, sometimes decades, before it causes cancer. What’s interesting is that while the incidence of smoking-related head and neck cancers is declining over time, actually, the incidence of HPV-related head and neck cancer is rising steadily. So we’re seeing that change in our practice.
Melanie: Dr. Jameson—because I think this is one of the scarier cancers for people because they think of their ability to talk and to eat, to swallow—what are some symptoms that might scare somebody or send them in to see you?
Dr. Jameson: You’re right. It is a scary cancer. It affects very important parts of our day-to-day life. There are a variety of symptoms, but they tend to depend on where cancer occurs. The cancer usually develops as a mass at what we call the primary site, and that mass sometimes has an ulcer or an erosion that’s very painful. Often, the presentation is, for instance, with an ulcer in the mouth that isn’t going away. Sometimes folks present with a painful or loose tooth that is sort of out of the ordinary for them. If these cancers arise in the throat, the voice box, then often, folks don’t see or feel a mass because they can’t look there. But they might notice pain when they swallow or difficulty swallowing, not being able to eat things that they could eat before. Or they might notice a change in their voice, and sometimes even difficulty breathing or shortness of breath with exertion, more so than their baseline. Cancers in the throat, interestingly, often cause ear pain just on one side because of the nerve wiring in our head and neck. There’s nothing wrong with the ear, but it’s referred pain to the ear. Sometimes we see folks that have ear pain just on one side. Then, as these cancers begin to spread, they will grow in lymph nodes in the neck. Sometimes patients just present with a lump in the neck or something. Maybe they notice when they’re shaving or doing their daily routine that there’s a lump there. Often, it doesn’t hurt, but sometimes it does. Really, any of those symptoms that linger for more than a couple of weeks are concerning to us, and those need to be evaluated.
Melanie: How is it diagnosed, Dr. Jameson?
Dr. Jameson: We diagnose by obtaining a tissue biopsy, and the way we start when they’re just concerned for a lump or a bump or some pain is we do a full physical exam. We look in the mouth and the throat. We feel the neck. And then in our clinic, we’re able to actually, with the patient awake and comfortable, pass a small camera through the nose and down into the throat so we can get an extra look around at the back of the tongue, the throat, the voice box. That allows us to see something that might be of concern. If there’s something of concern in the mouth, often in clinic, we can get a small piece of that tissue. Or if there is a lump in the neck, we can put a tiny needle into that, just with the patient awake in our clinic—a little bit of pain, but not too bad—and we can send that tissue to the pathologist and they can answer the question for us. If it’s something farther back or they’re in the voice box, then we usually have to put folks to sleep in the operating room and do a procedure where we look back there, examine everything, and also get a piece of that tissue to send to the pathologist.
Melanie: If they test positive for one of the head and neck cancers, then what treatments are available? Because again, as scary as these are, there are really innovative treatments out there that can help live this normal quality of life.
Dr. Jameson: In general, as with other cancers, there are really three big options, and those are surgery, radiation, and chemotherapy or medication. Occasionally, we can use just a surgery or just a radiation, but many of these cancers need to be treated with a combination of the two. So often we’ll do an operation to remove the cancer and follow that with some radiation or use radiation and chemotherapy together. Occasionally, we need to use all three for the more difficult cancers. We really work to provide that treatment that not only provides the best chance of a cure but also provides the best chance of preserving function, as you mentioned. Since we breathe, talk, and eat with the mouth, throat, and voice box, we really need to think about how our treatment will impact those functions. We’re really trying to optimize how a patient will function after their treatment. Now, for cancers in the mouth, the treatment of choice usually is to remove those, and often that can involve removing part of the tongue or part of the jawbone, which can be very debilitating. We have developed ways to transfer tissue from other parts of the body to reconstruct those areas. We can take bone from the leg to reconstruct the jawbone or tissue from the forearm to reconstruct the tongue and return a lot of the native function to those folks. Cancers in the throat have usually been treated in the past with radiation and chemotherapy, but a lot of these now, because of HPV, are occurring in younger folks, and radiation and chemotherapy has some downsides in terms of long-term impact on swallowing, risk of secondary cancers, and some other risks. We’re now trying to operate on these if we can. We’re using the da Vinci robot to operate through patients’ mouths and remove these surgically so that we can usually eliminate their need for chemotherapy and often reduce the dose of radiation and reduce the related side effects. For cancers in the voice box, obviously folks want to maintain their voice if they can. We try to use radiation and chemotherapy for those in very creative ways so that folks can keep their voice box, if possible. But sometimes we do have to remove the voice box, and when we do that, we have special valves that we can put in after the voice box is gone to help folks restore their voice. Part of our team specializes in restoring voice and helping folks get back their communication skills if that’s what has to happen. None of these are really a perfect scenario, but what we work at is developing an opportunity to get the patient as much back to normal as we possibly can.
Melanie: Dr. Jameson, in just the last minute or so, why should patients come to UVA Cancer Center for head and neck cancer care?
Dr. Jameson: Well, I think there’s a few big reasons. First of all, this is a fairly uncommon cancer, and yet it’s really what we spend our time doing. So we have a great experience with this illness. We have a team of experts that works in a multidisciplinary way, and we’re able to provide very complete care. We offer a comprehensive array of treatments and surgery, radiation, chemotherapy, as we mentioned, and we have all the folks that are needed to get that done in addition to surgeons and radiation oncologists and medical oncologists. We need speech and language specialists. We need dental specialists, eye care. We need nutrition and pain management, physical therapists, all those things. We have them all here and committed to caring for these patients. As we talked about, we have some exciting advanced treatment options. We have specialty reconstructive skills that really return people to great function. We have an opportunity for minimally invasive robotic surgery, and we have brand new concepts in radiation oncology that are helping us reduce side effects in addition to some new drug trials in the chemotherapy area. Lots of opportunities for folks to get the very most advanced care in the field. Then, I think finally this entire team that takes care of these patients, I know them all well. And while being some of the best docs in the country, they are also committed to a very compassionate, patient-centered care, and I’m very proud of the care that we provide to patients here.
Melanie: Thank you so much, Dr. Mark Jameson. For more information, you can go to uvahealth.com. That’s uvahealth.com for more information on the UVA Cancer Center. You’re listening to UVA Health System Radio. This is Melanie Cole. Thanks so much for listening.
Head and Neck Cancer
Melanie Cole (Host): This year, more than 55,000 Americans will develop cancer of the head and neck. Which are the most common forms of head and neck cancer and what treatment options are out there? My guest is Dr. Mark Jameson. He is an otolaryngologist, head and neck surgeon, whose specialties include head and neck cancer. Welcome to the show, Dr. Jameson. What are the most common head and neck cancers that you see?
Dr. Mark Jameson (Guest): Well, the term “head and neck cancer” is actually a very broad term. We use it to refer to all of the cancers that occur in the head and neck with the exception of brain and eye cancers. That includes cancers of the skin, salivary gland, the thyroid gland, sinuses, and the team at UVA manages all of these types of cancers. But the most common brand of head and neck cancer that we see is the squamous cell carcinoma that occurs in the mouth, that we refer to as the oral cavity, the throat or the pharynx, and the voice box or larynx. As you said, that’s a relatively small number of cancers in the United States every year, but in our practice, because it’s dedicated to head and neck cancer, that’s what we see predominantly.
Melanie: What most commonly causes these cancers, and are any of them preventable?
Dr. Jameson: Well, the biggest risk factor for head and neck squamous cell carcinoma is tobacco use. That’s been well established for a long time. That includes smoking and also chewing tobacco. And we know as well that excessive alcohol use is also a risk factor. While alcohol is not as big a risk factor as smoking, when the two are used together, they’re more than additive, so there’s a synergistic effect between those two things. Classically, our head and neck cancer patient has been a longtime smoker and someone who has used alcohol frequently. However, in the last decade, we have seen the emergence of a new form of throat cancer that is caused by the human papilloma virus or HPV, and most folks are becoming aware of this. The virus is often acquired early in adulthood and then often resides in the tonsil tissue for a long period of time, sometimes decades, before it causes cancer. What’s interesting is that while the incidence of smoking-related head and neck cancers is declining over time, actually, the incidence of HPV-related head and neck cancer is rising steadily. So we’re seeing that change in our practice.
Melanie: Dr. Jameson—because I think this is one of the scarier cancers for people because they think of their ability to talk and to eat, to swallow—what are some symptoms that might scare somebody or send them in to see you?
Dr. Jameson: You’re right. It is a scary cancer. It affects very important parts of our day-to-day life. There are a variety of symptoms, but they tend to depend on where cancer occurs. The cancer usually develops as a mass at what we call the primary site, and that mass sometimes has an ulcer or an erosion that’s very painful. Often, the presentation is, for instance, with an ulcer in the mouth that isn’t going away. Sometimes folks present with a painful or loose tooth that is sort of out of the ordinary for them. If these cancers arise in the throat, the voice box, then often, folks don’t see or feel a mass because they can’t look there. But they might notice pain when they swallow or difficulty swallowing, not being able to eat things that they could eat before. Or they might notice a change in their voice, and sometimes even difficulty breathing or shortness of breath with exertion, more so than their baseline. Cancers in the throat, interestingly, often cause ear pain just on one side because of the nerve wiring in our head and neck. There’s nothing wrong with the ear, but it’s referred pain to the ear. Sometimes we see folks that have ear pain just on one side. Then, as these cancers begin to spread, they will grow in lymph nodes in the neck. Sometimes patients just present with a lump in the neck or something. Maybe they notice when they’re shaving or doing their daily routine that there’s a lump there. Often, it doesn’t hurt, but sometimes it does. Really, any of those symptoms that linger for more than a couple of weeks are concerning to us, and those need to be evaluated.
Melanie: How is it diagnosed, Dr. Jameson?
Dr. Jameson: We diagnose by obtaining a tissue biopsy, and the way we start when they’re just concerned for a lump or a bump or some pain is we do a full physical exam. We look in the mouth and the throat. We feel the neck. And then in our clinic, we’re able to actually, with the patient awake and comfortable, pass a small camera through the nose and down into the throat so we can get an extra look around at the back of the tongue, the throat, the voice box. That allows us to see something that might be of concern. If there’s something of concern in the mouth, often in clinic, we can get a small piece of that tissue. Or if there is a lump in the neck, we can put a tiny needle into that, just with the patient awake in our clinic—a little bit of pain, but not too bad—and we can send that tissue to the pathologist and they can answer the question for us. If it’s something farther back or they’re in the voice box, then we usually have to put folks to sleep in the operating room and do a procedure where we look back there, examine everything, and also get a piece of that tissue to send to the pathologist.
Melanie: If they test positive for one of the head and neck cancers, then what treatments are available? Because again, as scary as these are, there are really innovative treatments out there that can help live this normal quality of life.
Dr. Jameson: In general, as with other cancers, there are really three big options, and those are surgery, radiation, and chemotherapy or medication. Occasionally, we can use just a surgery or just a radiation, but many of these cancers need to be treated with a combination of the two. So often we’ll do an operation to remove the cancer and follow that with some radiation or use radiation and chemotherapy together. Occasionally, we need to use all three for the more difficult cancers. We really work to provide that treatment that not only provides the best chance of a cure but also provides the best chance of preserving function, as you mentioned. Since we breathe, talk, and eat with the mouth, throat, and voice box, we really need to think about how our treatment will impact those functions. We’re really trying to optimize how a patient will function after their treatment. Now, for cancers in the mouth, the treatment of choice usually is to remove those, and often that can involve removing part of the tongue or part of the jawbone, which can be very debilitating. We have developed ways to transfer tissue from other parts of the body to reconstruct those areas. We can take bone from the leg to reconstruct the jawbone or tissue from the forearm to reconstruct the tongue and return a lot of the native function to those folks. Cancers in the throat have usually been treated in the past with radiation and chemotherapy, but a lot of these now, because of HPV, are occurring in younger folks, and radiation and chemotherapy has some downsides in terms of long-term impact on swallowing, risk of secondary cancers, and some other risks. We’re now trying to operate on these if we can. We’re using the da Vinci robot to operate through patients’ mouths and remove these surgically so that we can usually eliminate their need for chemotherapy and often reduce the dose of radiation and reduce the related side effects. For cancers in the voice box, obviously folks want to maintain their voice if they can. We try to use radiation and chemotherapy for those in very creative ways so that folks can keep their voice box, if possible. But sometimes we do have to remove the voice box, and when we do that, we have special valves that we can put in after the voice box is gone to help folks restore their voice. Part of our team specializes in restoring voice and helping folks get back their communication skills if that’s what has to happen. None of these are really a perfect scenario, but what we work at is developing an opportunity to get the patient as much back to normal as we possibly can.
Melanie: Dr. Jameson, in just the last minute or so, why should patients come to UVA Cancer Center for head and neck cancer care?
Dr. Jameson: Well, I think there’s a few big reasons. First of all, this is a fairly uncommon cancer, and yet it’s really what we spend our time doing. So we have a great experience with this illness. We have a team of experts that works in a multidisciplinary way, and we’re able to provide very complete care. We offer a comprehensive array of treatments and surgery, radiation, chemotherapy, as we mentioned, and we have all the folks that are needed to get that done in addition to surgeons and radiation oncologists and medical oncologists. We need speech and language specialists. We need dental specialists, eye care. We need nutrition and pain management, physical therapists, all those things. We have them all here and committed to caring for these patients. As we talked about, we have some exciting advanced treatment options. We have specialty reconstructive skills that really return people to great function. We have an opportunity for minimally invasive robotic surgery, and we have brand new concepts in radiation oncology that are helping us reduce side effects in addition to some new drug trials in the chemotherapy area. Lots of opportunities for folks to get the very most advanced care in the field. Then, I think finally this entire team that takes care of these patients, I know them all well. And while being some of the best docs in the country, they are also committed to a very compassionate, patient-centered care, and I’m very proud of the care that we provide to patients here.
Melanie: Thank you so much, Dr. Mark Jameson. For more information, you can go to uvahealth.com. That’s uvahealth.com for more information on the UVA Cancer Center. You’re listening to UVA Health System Radio. This is Melanie Cole. Thanks so much for listening.