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.

Effective treatments require early diagnosis


Willia Goins, right, shown with her daughter, Tracy, says that with the help of a prosthesis, she is able to speak after the removal of her larynx due to cancer. (Daryl Goins photo)
Willia Goins, 70, now speaks in a whisper.

She had her larynx, or voice box, removed about 14 years ago, and the whisper is as loud as it gets. Goins might speak quietly, but her message comes through loud and clear. “I always had problems with my throat,” she explained. “Even when I was young.”

Back then she said she paid no attention to the intermittent pain she had when swallowing and attributed it to the cold weather or perhaps a cold. But as she grew older, the pain continued and got worse with time.

Goins finally gave in and visited a doctor. “Something is terribly wrong,” she told her physician. She underwent weeks of testing until the diagnosis was confirmed. “It [cancer] was in my throat,” she said.

The doctors warned her that it was possible that her larynx might have to be removed if her throat cancer was extensive. When her initial treatment of chemotherapy failed to solve the problem, she welcomed the surgery.

She was 56 at the time. “Maybe I’ve talked enough,” she said.

Treatment for oral cancer varies by its location and extent, according to Dr. Scharukh Jalisi, the director of the Division of Head and Neck Surgery and Skull Base Surgery at Boston Medical Center, and may include surgery, radiation and in some cases, chemotherapy. A diverse team of professionals is involved, including oncologists (cancer specialists), dentists, reconstructive surgeons and speech therapists. The team is extensive because of the potential losses suffered from oral cancer. The disease can compromise the ability to speak, swallow and eat, and result in irreversible damage to the area impacted.

A funny thing happened after Goins’ surgery. She was not able to speak, but that didn’t stop her from communicating. Her daughter walked into her hospital room with a chalk board.

“From day one I was ‘talking,’ ” she said. “After that I carried a notebook with me.” It was a year before Goins could talk again with the assistance of a prosthesis and speech therapy.

Her surgery was followed by radiation. She has had no treatment since then — and that was 14 years ago.

In hindsight Goins realizes that her smoking probably played a role in her disease. She’s cured of that habit. “You don’t want to pick up a cigarette after you’ve had a throat operation,” she explained.

Kenneth Tucker still marvels at the fact that he had oral cancer though he says he never smoked. His age of 46 at the time of diagnosis made his situation even more unusual, since the median age at diagnosis of oral cancer is 62.


After two surgeries for cancer of the mouth, Kenneth Tucker has returned to work in the shipping and receiving department at Volvo Parts North America. (Derrick J. Haire photo)
Tucker, who is now 49, remembers the story well. “I started having pain and bleeding in my right cheek when I chewed and brushed my teeth,” he said. He noticed a red spot on the inside of his right cheek, but chalked it up to a sore of some kind.

When his home remedies of salt water and peroxide provided no cure, he knew he had a problem. The pain intensified.

Tucker admitted that he had never heard of oral or head and neck cancer. He said that cancer was the farthest thing from his mind.

Fortunately, he had a dental appointment the following month and credits the dental hygienist for her keen observation — and luck. The hygienist’s mother had cancer of the mouth, and the red spot looked suspiciously familiar.

Her suspicions were correct. The dentist took a look and didn’t like what he saw. An oral surgeon biopsied the sore. A week later a diagnosis of cancer was confirmed.

In October 2006 Tucker underwent surgery to have the cancer removed. “We thought everything was all right,” he said. But a few months later the pain — and the cancer — recurred in the same spot, but now involved the lymph nodes.

He underwent another surgery to remove the tumor and lymph nodes followed by seven weeks of radiation.

That was almost four years ago and Tucker has had a clean bill of health since then. Checkups have been good. He had a couple of scares when white spots appeared in his mouth, but a fungus was to blame. Red and white spots in the mouth can be signs of oral cancer.

Tucker’s day-to-day life has changed. The radiation impaired his salivary glands, resulting in dry mouth. “Every 30 minutes I have to drink water,” Tucker explained. He also uses dental trays filled with fluoride gel 10 minutes each day to decrease the risk of dental decay. Saliva prevents the buildup of bacteria in the mouth that can lead to caries. Every morning he bites into a tool that he says allows him to release his jaws.

“Jaws stiffen from radiation,” he explained.

When he could finally return to work Tucker knew he was on his way. He’s become a preacher of sorts at work. When he sees young men who dip, or use smokeless tobacco, he has a few choice words.

“You take a look at me,” he warns. “You don’t want to go through what I went through.”