This Issue

Head and neck cancer

Effective treatments require early diagnosis

Tobacco and alcohol: A dangerous combination

Keeping children on a safe path

Helpful Resources

Q & A

A closer look


Signs and symptoms

The following symptoms do not always indicate cancer; an infection or other problem can cause similar warning signs. If they persist, however — more than two weeks — have them checked out.

  • Sore throat

  • Difficulty or pain when swallowing or chewing

  • Prolonged changes in your voice, such as hoarseness

  • Ear pain or an earache that does not go away

  • A sore in your mouth or on your lip that does not heal

  • Unusual white or red patches inside your mouth or on your lips

  • Swelling in the neck or jaw

  • A lump in the neck

  • Dentures that no longer fit properly or comfortably

  • Bleeding in the mouth

  • A feeling that something is caught in your throat

Signs and symptoms

Helpful Resources:


A closer look

Head and neck cancer – although not well known – strikes around 40,000 people each year. Head and neck cancer actually refers to cancers at several different sites:

• Lips

• Gums

• Tongue

• Lining of the cheeks

• Salivary glands

• Roof and floor of the mouth
• Lymph nodes in upper neck

• Tonsils

• Sinuses

• Pharynx (throat)

• Nasal cavity

• Larynx (voice box)


Image: National Cancer Institute


A peak inside

Risk factors

Another good reason to visit the dentist

Get screened for head
and neck
cancer

Disturbing disparities

Risk factors
• Tobacco use

• Heavy alcohol use

• Combined tobacco and
alcohol use

• HPV infection
• Sun (cancer of the lip)

• Exposure to chemicals,
such as asbestos

• Poor diet — lacking in
fruits and vegetables
Another good reason to visit the dentist


“All you have to do is open your mouth.”

— The Head and Neck Cancer Alliance


The oral cancer examination is painless and quick … and life-saving. When cancers of the head and neck are found early, the cure rate is high. Annual screenings by a doctor or dentist should be a part of your regular physical or dental checkup. The provider:

• Inspects your face, neck, lips and mouth.

• Feels the area under your jaw and the sides of your neck, checking for unusual lumps.

• Asks you to stick out your tongue to check for swelling, color and texture.

• Using gauze, lifts your tongue and pulls it from one side, then the other.

• Checks the roof and floor of your mouth and the back of your throat.

• Feels and examines the insides of your lips and cheeks for red or white patches.

• Places one finger on the floor of your mouth and, with the other hand under your chin, presses down to check for unusual lumps or sensitivity.

Source: National Institute of Dental and Craniofacial Research

Oral, Head and Neck Cancer
Awareness Week is May 8 – 14.


Photo by Vannessa Carrington/Mass. Eye and Ear

Get screened for head and neck
cancer. It’s free, quick and painless.

Boston Medical Center
Moakley Building Lobby
830 Harrison Avenue
Date: April 2
Time: 8 a.m. - noon
617-638-8260

Tufts Medical Center
860 Washington Street
Date: May 12
Time: 2:30 – 4:30 p.m.
617-636-1664
Mass Eye and Ear
243 Charles Street
Date: May 13
Time: TBA
617-573-3340
Dedham Family Dental
Dr. Helaine Smith
30 Milton Street, Dedham
Date: May 11
Time: 9 a.m. – 1 p.m.
781-326-4600

Mass General Hospital
Voice Center

One Bowdoin Square,
11th Floor
Date: May 13
Time: 9 a.m. – 1 p.m.
617-726-0218
Remember to call ahead to confirm
time and date
of screenings.

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Keeping children on a safe path

Wondering how to keep children from starting to drink or smoke? Start young — preferably before your child experiments with either one — to build a sturdy foundation.

• Talk to a school guidance counselor or your child’s doctor about free, helpful programs for parents on guiding healthy behaviors.

• Brainstorm with your child about ways to say no to risky behavior. Aim for a full scale of options between “No, thanks” and “Stop asking — I said no.”

• Discuss good reasons not to drink or smoke. Ask children what they think and share your beliefs and values. Talk honestly about relatives who had health problems or died due to tobacco or alcohol addictions. Problems like bad breath, yellow teeth and embarrassing behavior may be persuasive, too.

• Set expectations for healthy behaviors. Use simple rewards and consequences to encourage good behavior.

• Set an example. If necessary, try to quit smoking or drinking too much.

• Keep lines of communication open. Check in regularly about how the day went. Ask about plans, friends and activities.

• Call your child’s doctor or guidance counselor for more help if you think your child is smoking or drinking.

Tobacco and alcohol:
A dangerous combination

What is head and neck cancer?

Cancer cells have glitches that keep them alive long past their normal lifespan. The rogue cells multiply again and again, snowballing into a tumor. Over time, they invade nearby tissue, crowding out normal cells. Some may travel to distant sites in the body and spark additional tumors.

Usually, the first flickers of trouble for head and neck cancers start in the moist tissue cells lining the mouth, nose and throat.

What causes head and neck cancers?

Tobacco and heavy alcohol use are the two key risks for most head and neck cancers, according to the National Cancer Institute. A whopping 85 percent of these cancers are linked to tobacco — cigarettes, cigars, pipe tobacco and smokeless tobaccos like chewing tobacco and snuff. What’s more, using both tobacco and alcohol puts you at greater risk than either of these habits alone.

Depending on where the cancer occurs, other risks vary. A few examples are sun exposure (lip cancer), radiation to the head and neck (cancer of the sinuses or nasal cavity) and asbestos (cancer of the voice box). Chewing betel nut — a big health issue in some Asian cultures — causes oral cancer.

What can I do to avoid getting these cancers?

The short answer is simple. If you use tobacco, quit. If you drink too much, put a stop to that too. However, as many people know, this advice is easy to give and often much harder to follow.

“Tobacco and alcohol can be powerful addictions,” says Dr. Jan Cook, Medical Director of Innovation & Leadership at Blue Cross Blue Shield of Massachusetts. “Willpower alone is rarely enough to end them. Usually a combination of approaches works best.”

Tips and Resources

Quitting tobacco

• Make a list of great reasons to quit. Smoking is not only unhealthy for you, but second-hand smoke can also ruin the health of those around you — your children, spouse and friends will thank you for quitting. Fewer wrinkles and sweeter breath are also plusses, as are the financial benefits. Calculate your savings at www.smokefree.gov/savings-future.aspx and map out ways to enjoy that cash.

• Identify triggers — do you light up after meals or when you’re bored? Think ahead about ways to avoid or squelch those cravings.

• Talk to your doctor about tools to help you quit like nicotine replacement products (nicotine patches, gum, lozenges, inhaler or spray) and medicines that help ease cravings.

• See if your employer sponsors a free or low-fee program to help you quit. Your health plan may be a great resource as well.

• The National Cancer Institute Quit Line or Smokefree.gov can also be helpful. They offer a step-by-step approach to thinking about quitting, preparing to quit, quitting — and staying quit.

• Ask family, friends and co-workers to support your efforts by cheering you on, sharing hard-earned tips if they’ve quit and not smoking around you. Joining an online or in-person support group helps, too.

Quitting drinking

• Start by asking questions: How much and how often do you drink? The American Cancer Society defines low to moderate use of alcohol as one to two drinks a day for a man or one drink a day for a woman. Has your drinking been harmful in any way? For instance, has it jeopardized your health or your job? Talk to your doctor or check online for quizzes to help you assess your drinking habits and get information on cutting back or stopping.

• Consider joining a self-help group. Best known is Alcoholics Anonymous (AA), which outlines a 12-step program for its members to follow and offers plenty of support. An alternative is SMART Recovery (Self-Management and Recovery Training), a nonprofit, non-spiritual group focusing on a range of addictive behaviors. Family members may find Al-Anon or Alateen helpful.

• Seek counseling from a substance abuse professional if you cannot stop drinking or need additional support.

• Ask your doctor if medicines might help. Medication can often help ease withdrawal symptoms, block the high from alcohol, defuse cravings or relieve depression or anxiety.

• Heavy drinkers require a specialized, intensive program, including detoxing to get alcohol out of the body. Be sure to consult your doctor.