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.

Head and neck cancer
Though the combination of smoking tobacco and drinking alcohol accounts
for nearly three-fourths of all cases, race and gender remain factors

 


Susan L. Curry stands in front of the community center that bears her name. Curry underwent minimally invasive surgery to treat her head and neck cancer four years ago at Boston Medical Center. (Ernesto Arroyo photo)
To her credit, Susan Curry didn’t scream when she learned she had cancer.

She became very quiet, almost bewildered, as the doctor described how the disease had invaded her gums, the roof of her mouth and sinuses. It even crept into the base of her skull where countless delicate nerves and blood vessels travel to the brain.

On one level, Curry said she couldn’t help respecting what her doctor described as cancer of the head and neck. “Wow!” Curry recalled thinking to herself. “That bad boy goes anywhere.”

But on a deeper level, she admits that she was confused. “I had no idea that you could get cancer of the mouth,” she said.

Head and neck cancer is typically defined as cancers that occur in a slew of sites — the nasal cavity, the oral cavity, throat and larynx (voice box). It is often referred to as oral cancer.

Of all the cancers, none are as least publicized as cancer of the head and neck. But if left unchecked, it is just as deadly.

The American Cancer Society (ACS) estimated that in 2010 there were almost 37,000 new cases of cancers of the oral cavity and 8,000 deaths. If cancer of the larynx is included, the incidence jumps to 50,000 and more than 11,000 deaths.

The list of luminaries who are victims of head and neck cancer is long — Sammy Davis Jr., Yul Brynner, movie critic Roger Ebert, Beatle George Harrison and singer Mary Wells. Actor Michael Douglas has recently been added to the list.

Gender and race matter. Head and neck cancer is twice as common in men as in women. According to the ACS, oral cancers are the eighth most common cancer in all men and the sixth most common in black men. Although the incidence is comparable in black and white men, the death rates tell a different story. Black men die of oral cancer at roughly twice the rate of whites, American Indians and Asians and almost three times the rate of Hispanics.

So significant is the problem in black males that the National Institute of Dental and Craniofacial Research, an arm of the National Institutes of Health, has developed a campaign — Oral Cancer: What African American Men Need to Know — to increase awareness.

Dr. Scharukh Jalisi is the director of the Division of Head and Neck Surgery and Skull Base Surgery at Boston Medical Center. He attributes the gender differences in part to lifestyles. “Men smoke more,” he said, “and indulge in worse habits.”

Age is also a factor. The median age at diagnosis is 62; the median age at death is 67 years.

The tricky thing about head and neck cancer is that symptoms may occur but are not readily recognized. And there are many, according to the Head and Neck Cancer Alliance — sores in the mouth that do not heal; difficulty swallowing or chewing; prolonged hoarseness or other change in the voice; unusual white or red patches in the mouth and bleeding in the mouth, to name a few.

Jalisi stresses to be aware of the symptoms and do a simple self-check. “Feel your neck for lumps,” he says. “Look in your mouth for sores or spots that should not be there. Be alert for pain on swallowing, especially if you’re not sick.”

Jalisi cautions if these symptoms do not resolve within a few weeks, they require medical attention. The key is not to delay treatment. “The earlier you detect cancer,” he says, “the less invasive the treatment and the better the outcome.”

If caught early, survival and cure rates are high. When localized — meaning it has not spread — 5-year survival rates exceed 82 percent. Once it spreads to the lungs or other sites, survival drops to 32 percent.

Tobacco of all kinds — including cigarettes, cigars, pipes and smokeless tobacco — is the biggest risk factor for head and neck cancer. The longer a person smokes, the higher the risk.

And it’s not necessary to light up. Contrary to an oft-repeated myth, smokeless tobacco is not safer than cigarettes or cigars, and has been found to contain 28 or more chemicals that cause cancer.

Curry admitted that she smoked for several years a long time ago, but her youngest son, who is now in his 30s, cured her of the habit. When he was just 3 years old, he asked her why she smoked. She didn’t have an answer and said she stopped almost immediately.

It’s not surprising then that Curry, 76, had more questions that answers. “Where did it come from?” she wondered. “How could that happen?”


Scharukh Jalisi, M.D., F.A.C.S.
Director
Head and Neck Oncologic Surgery and Skull Base Surgery
Boston Medical Center
It started four years ago with an irritation on her gums on the upper right side. “Something was there that shouldn’t have been,” she remembered.

She had difficulty wearing her dentures. It got to the point that she said she felt better without them. Her home treatments of baking soda did not work. Nor did adjustment and realigning of her dentures by the dentist.

What Curry did not know at the time is that dentures that no longer fit properly or comfortably can be a sign of head and neck cancer.

Curry was planning to attend a family reunion and wanted to be able to eat the good food she knew would be plentiful. When she visited the doctor before her affair she received unexpected news. A biopsy revealed that the gum irritation was actually an intrusive cancer. “The gums were the tip of the iceberg,” said Jalisi, her surgeon.

Curry underwent surgery and radiation. She says she counts her blessings. Because of the extent of her cancer she was expecting a debilitating and deforming surgery. She was in for a surprise. She underwent minimally invasive skull base surgery, a less intrusive type of surgery, and when she awoke, she had no scars as proof of treatment. “There wasn’t a scratch,” she said.

Jalisi says much has changed in the last decade in the treatment of head and neck cancer — fortunately for the better. Years ago, he explains, the treatment was often disfiguring. But different approaches, including use of robotic surgery — a type of minimally invasive surgery — have improved the outcomes.

Although the hazards of tobacco use are well known, it is less well known that alcohol also is linked to cancers of the mouth, throat and larynx. Ethanol, the type of alcohol found in beer, wine and distilled spirits, such as scotch, is the guilty party here, so the type of alcoholic beverage is not the problem.

Experts theorize that alcohol acts as an irritant in the mouth and throat and may even act as a solvent, paving the way for tobacco to damage cells.

Tobacco or alcohol by itself is damaging enough, but the combination of the two packs a double wallop and has more dire effects than either drinking or smoking alone, according to the ACS. Three out of four people with oral cancer have used tobacco, alcohol or both.

But the face of oral cancer is changing a bit. It is still more common in males, but younger men are now stricken in higher numbers — and not necessarily because of tobacco or alcohol. Another culprit has emerged — the human papillomavirus, or HPV, the virus responsible for genital warts and cervical cancer.

Recent studies suggest that multiple sex partners and especially oral sex may increase the risk of cancers of the tongue, tonsils and throat.

A 2007 report in the New England Journal of Medicine found that men and women who reported having six or more oral sex partners had an almost nine fold increased risk of developing cancer of the tongue and tonsils. Jalisi cautions that more research is required to understand fully the connection between oral cancer and HPV.

As far as Curry is concerned she may never fully understand all of oral cancer’s complexities. What she does know is that her life has returned to almost normal.

She does have dry mouth following her surgery and radiation, and must use a special toothpaste and mouthwash. Cold wind hurts her face. She now wears dentures that are built up on the right side to take the place of gum tissue that was removed.

But other than that she says life is good. She remains very involved in her community. And her nine children and 10 grandchildren keep her hopping.

“God wasn’t ready for me,” she said.