Cheryl Martin (Host): We don't hear as much about them, head and neck cancers. They have many names based on where the cancer starts. And here to discuss the risk factors, signs and symptoms of head and neck cancers, as well as treatment is Dr. Lewis Overton. He's an ear, nose, and throat physician with a specialty in head and neck oncology. This is WakeMed Voices brought to you by WakeMed Health and Hospitals in Raleigh, North Carolina. I'm Cheryl Martin. Dr. Overton, thanks for being on to educate us on head and neck cancers.

Lewis Overton, MD: Yes, of course. Thanks for having me. 

Host: Now, are there particular risk factors for head and neck cancers?

Lewis Overton, MD: Absolutely. Essentially the most classic risk factors are smoking and drinking exposure. More so now we're encountering a lot of head and neck cancers that are precipitated by the HPV virus. And then you have things like skin cancers of the head and neck that are of course brought on by significant amounts of sun exposure.

Host: So how common are these cancers?

Lewis Overton, MD: They're not relatively common when you compare them to things like lung cancer, colon cancer, or prostate cancer, but they're becoming more common, especially in the back of the throat where the tonsils are, at the base of the tongue.

Host: So what are the signs and symptoms of head and neck cancers that should eventually prompt a person to see a doctor?

Lewis Overton, MD: It kind of depends on what part of the head and neck is involved, but I'd say the more general features would be, of course feeling a lump or bump in your neck, seeing something like a growth in the back of your mouth or on your tongue, that doesn't go away. Maybe having some swallowing difficulties or some changes to your voice. All those would be kinda your classic broad indications.

Host: Tell us a little bit more about the common types of head and neck cancers. You know, what are they called?

Lewis Overton, MD: Please Yeah, so the most common kind is called squamous cell carcinoma, generally coming from the surface cells in the mouth or the throat. If you're thinking like a mouth cancer, like an ulcer on the tongue, if you're thinking of like a throat cancer, maybe an ulcer or a growth in the tonsil or the back of the tongue, sometimes you get growths on the voice box or where the vocal cords are. Those would be your kind of, your classic places. Other places can be where the salivary glands are, so the small salivary glands underneath your jawline or in front of your ear.

Host: So if someone is diagnosed with a head and neck cancer, what is a continuum of care from the start to treatment? In other words, where does a person start and where does a person finish?

 I.

Lewis Overton, MD: Sure. I mean, if you present or start to feel any of those symptoms, like we just briefly hit on, people enter into the medical system in multiple ways, either through emergency department, their primary care, even their dentist. Once there's a concern that, that reaches us, you know, we do a pretty thorough physical exam where we try to identify where this might be coming from and if we see a lesion or a mass, the initial treatment is to biopsy it some way, shape or form. Either we'll take a piece of it, in the office or we'll stick a needle in it and try to get some cells out. From there, we do some imaging, generally a CAT scan to try to clarify its size and scope a little bit more. And then essentially, based on that, after we've staged the cancer fully, we'll determine next steps generally in communication with our teammates that are chemotherapy doctors, the medical oncologists, or the radiotherapy doctors, the radiation oncologists.

Host: Do you find that a lot of people initially ignore the symptoms because it's not one of the other cancers? So cancer never comes to the mind.

Lewis Overton, MD: You definitely do see that. There are people that may have voice change for a relatively long period of time that happens gradually. They may have other conditions that could contribute to difficulty swallowing. So a new change in swallow isn't really noticed. They may have like a big beard or be a relatively large person where a small lump in the neck is harder to identify. So you do see it occasionally.

Host: So is there anything a person can do to prevent these cancers?

Lewis Overton, MD: A lot of it's lifestyle related. If you're a significant smoker or a drinker, pulling back on that is probably the best thing to do. With regards to the HPV virus mediated cancers, taking the Gardasil vaccine, especially when young, the same way that it was kinda originally, devised to manage cervical cancer is going to be helpful with preventing HPV related head and neck cancer in the back of the throat. For head and neck cancers that arise from aggressive skin cancers, then of course sun exposure, sun protection is really important.

Host: Are these kinds of cancers particularly deadly or is there a strong cure rate?

Lewis Overton, MD: It does kind of vary. There is a bit of a spectrum. Your classic head and neck cancers brought on mostly by a significant smoking history are pretty rough, and they are difficult to cure. That cure rate hasn't gotten much better in the past several decades, but we're hopeful with more targeted therapies.

Head and neck cancers that are brought on by the HPV virus though, especially ones in the tonsil or the back of the tongue, do have relative relatively really high cure rates. So we want to to still catch it relatively early so that you can limit the side effects of treatment.

Host: Great. Anything else you want to add about head and neck cancers?

Lewis Overton, MD: In generalities, the head and neck cancer possibilities are pretty broad. We talked a little bit about cancers that are brought on by smoking and drinking in the tongue, in the back of the throat. And those are generally the cancers people most think about or associated it with the head and neck.

But there are cancers too that kind of happen out nowhere or randomly that come out of the salivary glands. And those are really important to be aware of because they can get into nerves and disrupt other functions, including like facial weakness or cause facial weakness or paralysis.

You don't think of thyroid cancer very much in terms of head and neck cancer because it is kind of in its own world. But, sometimes we'll see thyroid cancer that gets really aggressive and gets into lymph nodes throughout the head and neck and may present with a big lump in the neck. So we have to think about all these possibilities, when we're initially working up a lump or essentially a non-diagnosed lesion or mass in the head or neck region.

Host: So your advice then is when we see something or feel something that is unusual, just don't ignore it.

Lewis Overton, MD: Pretty much, yeah, there's plenty of times where something might feel unusual or look unusual, and a trained head and neck physician or ear, nose and throat physician will be able to look at it and pretty clearly tell you if they're worried or not. There are things that definitely aren't cancer that may kind of be worrisome to general population, so if you start to see something that feels off, you definitely want to have somebody do a pretty thorough physical exam who knows that area well.

Host: Dr. Lewis Overton, this has been extremely insightful. Thank you so much for making us aware of head and neck cancers, the risks, and especially the signs and symptoms. Thank you.

Lewis Overton, MD: I appreciate it. Thank you for having me.

Host: To learn more about ENT or cancer care services offered at WakeMed, please visit wakemed.org. If you found this podcast helpful, please share it on your social channels, and you can check out our entire podcast library for other topics of interest to you. 

Thanks for listening to WakeMed Voices, brought to you by WakeMed Health and Hospitals in Raleigh, North Carolina.