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

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

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

Mass General Hospital
Voice Center

One Bowdoin Square,
11th Floor
Date: May 13
Time: 9 a.m. – 1 p.m.
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.

Questions & Answers

Anand K. Devaiah, M.D., F.A.C.S.
Associate Professor
Departments of Otolaryngology - Head and Neck Surgery and Neurological Surgery
Boston Medical Center
1. Is head and neck cancer preventable?

The answer to this is more complicated than yes or no. We know that there are things which significantly increase the risk of some head and neck cancers, such as tobacco and alcohol use, which account for the majority of people struck with this disease. Exposure to occupational inhalants such as asbestos is also a known source. Yet, many cancers of the head and neck are not associated with any known risk factor. That is why it is important to understand the signs and symptoms so that the cancer can be detected early when treatment is more successful.

2. Why does alcohol increase the risk of head and neck cancer?

Alcohol causes changes in the function of cells which in turn spur uncontrolled growth and the development of cancer. It can have harmful effects on its own or act synergistically with other cancer-causing agents, most notably tobacco. Alcohol and tobacco are a very dangerous combination and account for roughly 85 percent of the cases of head and neck cancer.

3. Since human papillomavirus (HPV) is a contributing factor for oral cancer, should males as well as females be vaccinated against the virus?

We do know that there is a link between HPV and oral cancer and that giving the vaccine to males poses no significant risk of adverse reactions. It seems logical that there is potential benefit to immunizing both genders. This question is under study as researchers determine whether we end up losing more by not immunizing versus immunizing.

4. Does HPV increase the risk of oral cancer in both males and females?

At this time, there appears to be increased risk for both men and women, specifically with HPV16.

5. Since snuff or chew is not smoked, is it less likely to cause cancer of the mouth?

There is a misperception that smokeless tobacco is safer than cigarettes or cigars. However, smokeless tobacco also contains cancer causing agents and is associated with many cancers of the mouth, including the lip and tongue. It is still harmful and should be avoided.

6. Can some head and neck cancers be found early when survival is higher?

Through regular oral exams by a doctor or dentist, it may be possible for find a head and neck cancer when it is smaller in size and before it spreads. When found early the chance for a cure is generally higher. It underscores the importance of early detection and treatment.

7. Should people check their mouths regularly for signs of oral cancer?

Yes. Like in other cancers, self-examination is important. Check yourself for areas in your mouth that are painful, swollen or bleeding or for sores that do not heal. These symptoms are not always cancer, but should be evaluated by one’s health care provider to help determine if further investigation into the possibility of cancer is necessary.

8. Why is this type of cancer more fatal in African American males?

Many factors can contribute to higher deaths, including — but not limited to — genetics, access to health care and use of available health care resources. It is believed that African American males also present at a more advanced extent of cancer, which makes this more fatal to them.

9. Does a person’s diet play a role in oral cancer development?

There have been studies that suggest that a healthy diet may help reduce the risk of developing head and neck cancer, including fruits and vegetables and low-fat foods. Avoiding known cancer causing substances, such as tobacco and alcohol, can also reduce the risk.