Melanie Cole, MS (Host): Welcome to Back to Health, your source for the latest in health, wellness, and medical care. Keeping you informed, so you can make informed healthcare choices for yourself and your whole family. Back to Health features conversations about trending health topics and medical breakthroughs from our team of world-renowned physicians at Weill Cornell Medicine. I'm Melanie Cole. And joining me today is Dr. David Kutler. He's the Director of the Head and Neck Surgery Division in the Department of Otolaryngology at New York Presbyterian Hospital Weill Cornell Medical Center, and he's here to talk about head and neck cancers with us today.

Dr. Kutler, it's a pleasure to have you join us. Tell the listeners just a little bit about head and neck cancer. How common is it and what are the different types that you see?

Dr. David Kutler: Sure. I would say that probably about 4% of the cancers total are head and neck cancer in the United States. So, it's a pretty small group of cancers. If you go to the whole world, it actually increases significantly. There are actually something like 800,000 cases of new head and neck cancer throughout the world. So, I think the reason for that where the United States has less head and neck cancer is lately we've been smoking and drinking less compared to the rest of the world. For example, in India, they have huge rates of head and neck cancer because they kind of smoke a lot and drink a lot of alcohol as a general rule and also chew a lot of tobacco.

Melanie Cole, MS (Host): Wow, that's a very interesting statistic. So as we're kind of along those lines, and you're telling us about risk factors, expand on that and tell us some of the risk factors besides smoking and drinking and now we know chewing tobacco as well. Are there any other? Is there a genetic component to these?

Dr. David Kutler: Yeah. There are some head and neck cancers that are involved with genetics. One of the diseases I actually am somewhat of an expert on, it's called Fanconi's anemia, which is a pretty rare, recessive disorder where they have other problems including like bone marrow failure, but they get a very high rate, almost like 700-fold increase in head and neck cancer at a very early age, but that's very rare.

I think the other risk factor, especially nowadays, and it's been a little bit of an epidemic, is human papillomavirus, which we call HPV. And these patients who have HPV will get tonsil and base of tongue cancer, also called oropharyngeal cancer. So, those are basically smoking, drinking and HPV and some very rare genetic diseases. But otherwise, that's pretty much the risks.

Melanie Cole, MS (Host): So Dr. Kutler, you mentioned HPV, and I'm glad you brought that up. As we're learning more about HPV and now our kids at 11 years old are getting Gardasil, in your own opinion, where do you think in this continuum that HPV is going to continue to be a factor in this trend now that we're able to not necessarily stop it before it begins, but hopefully stop it before it begins?

Dr. David Kutler: Right. Well, unfortunately, it's already kind of started because, you know, usually, you get HPV infections usually when you start, you know, sexual activity. So, you get it at a pretty early age. But unfortunately, you don't get to cancers for another 20 years or so, usually after you get infected. It's already kind of on the upswing. Now, what's going to happen, and it's going to take a while, is that with Gardasil and the vaccines, now we're kind of vaccinating against HPV. And so, I think it's going to reach a peak and then kind of head downward. But it's going to be probably 10, 20 years before we see any difference unfortunately.

Melanie Cole, MS (Host): Yeah, that'll be interesting to watch. Now, what makes these types of cancers so challenging and unique? I'd like you to speak about some of the effects of these cancers in the treatment on the quality of life because, I mean, these types of head and neck cancers can affect our speech and our swallowing and our appearance. They're really pretty devastating cancers.

Dr. David Kutler: Yeah, I mean, especially the large ones, Melanie. I mean, these cancers can get very large if not treated early. And unfortunately, no matter how we treat them, you know, if you're going to resect them or cut them out, you're going to affect a lot of different things that are involved in speaking, swallowing, especially. And if it's a very large tumor, sometimes cosmetic. But I think the new thing that's really happening, and this has been since I've been, you know, in practice, is we have better reconstructive ability than we did when I first started. You know, we do some pretty amazing reconstructions at this point where even if we take a very large cancer out of someone's face or mouth, we can reconstruct it and they can look actually pretty good from a cosmetic standpoint.

Melanie Cole, MS (Host): Tell us about any signs or symptoms. When does it become apparent? Because now I find out that, when I go to the dentist, they've got this little thing, they flash around in my mouth and he does an oral cancer check. Is there any way to know ahead of time?

Dr. David Kutler: Yeah. I mean, most people who show up in my office usually have some kind of lesion. When I say a lesion, I mean like an ulcer or a lump along their mouth or tongue. So, the most common thing that usually happens is they'll show up with like a painful ulcer along the side of their tongue. If you have an ulcer that does not go away and it's sticking around, then that's a concern for cancer.

Another sign that's very common is a lymph node in the neck. A lot of these cancers will spread to lymph nodes. So, some people don't even know they have had a neck cancer, but they have a lump in their neck that just developed. And then, we do a biopsy and find that it's, you know, what's called head and neck cancer, and then we have to look for where that cancer is coming from.

So those are the two, I would say, like a mass or an ulcer in the mouth and an enlarged lymph node in the neck. Some of the symptoms people have is they have hoarseness sometimes. They'll have ear pain, throat pain, difficulty swallowing, are probably the most common symptoms that people have.

Melanie Cole, MS (Host): Well then, doctor, due to the intricate nature, as we're mentioning, the effect on the quality of life, due to that nature of these cancers, I'd like you to speak how medicine has changed in recent years to improve the outcomes, and you mentioned the different types of reconstruction now that can help patients live longer, better lives. I'd like you to speak about some of the emerging technologies, improved imaging advancements that have been made that really can help with that quality of life and indeed help with these cancers.

Dr. David Kutler: Yeah, I mean, one big example that's been probably over the last, you know, 10 years I would say is the use of robots, robotic surgery to basically remove what we call oropharyngeal cancer or cancer in the back of a throat. Before robotics, in order to access the back of the throat, we would have to split the lip with an incision and then saw the jaw open and then basically spread the jaw and get back to the back of the throat. You know, that was basically 20 years ago. But with the robot, now we can access all those tumors that we would have to do a very big surgery to get to now with just a robot through the mouth. So, that's been a very big change, almost a sea change, in terms of how we take these tumors out of the back of the throat.

Melanie Cole, MS (Host): That's very cool.

Dr. David Kutler: It is really cool stuff I have to say.

Melanie Cole, MS (Host): I mean, it is. It's pretty exciting time in your field. And one of the things I'd like you to speak to to the listeners is how you work with the families to deal with the psychosocial aspect of these types of cancers, the emotional wellbeing, because they can be among some of the most disabling and socially isolating defects. So, speak to the listeners right now and their families about how you all work together, the multidisciplinary team, and really helping them through these cancers.

Dr. David Kutler: Yeah, I mean it's very important. As you stated, I mean, it can be pretty devastating for families. And I see a lot of patients and a lot of times they'll say to me like, "This is the worst time of my life, Dr. Kutler." And it is, and they've been diagnosed with cancer and you know, I have to do a big surgery to remove it or they have to get radiation or chemotherapy. And I think it's really this multidisciplinary type situation where I will send them to a social worker, I'll send them to a speech pathologist, I'll send them to a swallow therapist, they'll see a plastic surgeon to basically do reconstruction. So, this whole team is very important to kind of take care of these patients.

And I think the most important thing for me is I always think to myself when I see these patients, you know, if this was my family member, how would they want to be treated? You know what I mean? You know, what would make them feel better? And I go into, you know, seeing patients with head and neck cancer exactly like that. If this was my mother, how would this woman want to be treated? And I do it exactly that. And it's just basically trying to be sympathetic, care for them. I give every patient my cell phone number. you know, if they have a problem, they call me directly, they text me.

Melanie Cole, MS (Host): Wow.

Dr. David Kutler: Yeah. I mean, I think it's important because, I think, sometimes in the medical field, and this is just my opinion, I think sometimes they feel like it's really hard to contact the doctor. And I think sometimes, you know, with a little text, I can make them feel a thousand times better and say, is this normal? And I'll say, yes, that's normal. And they send a picture through my phone and they're like, "Oh, thank you so much. I feel so much better now that it's nothing" type of thing. Where if they were trying to get me through my office or through the regular system, it's really hard, you know? So, I think it does help patients just to be available to them.

Melanie Cole, MS (Host): What a wonderful philosophy of care, Dr. Kutler, because that is rare in your field and, as you say, it can be quite frustrating for patients to try and reach their doctors at the good times, much less during the bad. So, I really love that you said that. What a, great thing that you're doing. I'd like you to wrap up anything exciting in this field, what you see happening on the horizon, anything that's exciting in the oncology area as far as chemo, immunotherapy, biologics, anything you'd like patients to hear?

Dr. David Kutler: I think that the most exciting thing that's happened, and this has to do with drug therapy and you've all heard of it probably on commercials, is immunotherapy. We are using immunotherapy much more common. These drugs use your own immune system to fight your cancer. They don't have a lot of side effects like regular chemotherapy, and they've been shown to be very, very successful in actually kind of shrinking the tumor and sometimes curing the patient. I've had patients that, you know, weren't going to survive very long, , because they've had widely metastatic disease. They go on immunotherapy and they've been alive sometimes 10 years, which is just absolutely amazing. It just didn't happen, you know, back 20 years ago.

Melanie Cole, MS (Host): Wow. That certainly is amazing. And Dr. Kutler, thank you so much for joining us today and telling us about all these exciting advancements and what you're doing for people at Weill Cornell Medicine. And Weill Cornell Medicine continues to see our patients in person as well as through video visits. And you can be confident of the safety of your appointments at Weill Cornell Medicine.

That concludes today's episode of Back to Health. We'd like to invite our audience to download, subscribe, rate, and review Back to Health on Apple Podcasts, Spotify and Google Podcasts. And for more health tips, please go to weillcornell.org search podcasts. And parents, don't forget to check out our Kids Health Cast. I'm Melanie Cole. Thanks so much for joining us today.

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