Deadly, Lesser-Known Head and Neck Cancers Can't be Ignored (Op-Ed)
Dr. Kavita Pattani and Dr. Rafael Torro-Serra, surgical oncologists at UF Health Cancer Center-Orlando Health, contributed this article to Live Science's Expert Voices: Op-Ed & Insights.
The public doesn't hear about head and neck cancers as often as other cancers, possibly because they comprise about three percent of all forms of the disease.
But, the statistics are still shocking. According to an estimate from the National Cancer Institute, in 2012 alone, more than 52,000 men and women were diagnosed with head and neck cancers in the United States.
Realizing the risks
The reality is, the risk for head and neck cancer is present in more Americans than you might think, particularly those of us who smoke and drink alcohol, the two biggest risk factors for head and neck cancers of the mouth, oropharynx, hypopharynx and larynx.
In fact, at least 75 percent of head and neck cancers are caused by tobacco and alcohol use, according to the National Cancer Institute. However, environmental exposures may also play a role. For instance, individuals working in some jobs in the construction, textile, ceramic, wood and metal industries could have an increased risk of paranasal sinus and nasal cavity cancer. Exposure to smoking and Epstein Barr Virus (EBV) is a risk factor for nasopharyngeal cancer, while certain other industrial exposures, like asbestos and synthetic fibers, have been linked to larynx cancer. [Smoking Causes 14 Million Medical Conditions in US Yearly, Study Finds ]
Human papillomavirus virus (HPV) is also a big risk factor for some kinds of head and neck cancers, specifically ones that involve the tonsils or base of the tongue. In fact, a large amount of oropharyngeal cancers, even reaching back 40 years, have actually been from HPV-positive tumors. Today in the United States, cancers caused by HPV infection are rising while cancers caused by smoking are falling.
Additionally, sun exposure to the head and neck is a risk factor for skin cancers, and genetics can also play a role. Extended periods of sun exposure, history of prior sunburns and cumulative lifetime exposure to the sun can result in various forms of skin cancers. This is especially true for patients with fair skin, and those who may not use sun precautions. Patients with a family history of skin cancers such as melanoma are at increased risk of being predisposed to developing skin cancers, as well. And, a prior history of radiation exposure or metastatic disease from skin cancers can result in cancers of the salivary glands.
A cancer with subtle warning signs
By definition, head and neck cancer arises in the head or neck region, impacting such sites as the nasal cavity, sinuses, oral cavity, salivary glands, throat and larynx or voice box.
When patients get screened for cancer, it's usually because that individual felt pain in a certain area of the body. Unfortunately, there is little warning that someone may have a head or neck cancer, because often pain is not involved, which may lead to delay in care. As surgical oncologists at Orlando Health, we've seen patients who think they simply have a sinus infection or allergic rhinitis that can be treated with antibiotics and medical management. Many times, however, they actually have sinus cancer.
While something like a sinus infection is not always cancerous, there a few telltale signs that it may be more than just an infection, like pain or numbness in the teeth, decreased sense of smell, difficulty opening the mouth, a lump or sore inside the nose that does not heal, or pain and swelling in the face. When these warning signs persist or worsen over several weeks, it's time to schedule a detailed physical exam with a doctor.
Many of these symptoms can be caused by other noncancerous health conditions, but that's why it's so important to receive regular health and dental exams, especially if you routinely smoke or drink alcohol. It's much easier to successfully treat sinus cancer when detected early.
According to a Harris Interactive survey on behalf of the Head and Neck Cancer Alliance, 71 percent of Americans say they have not been examined by a medical professional for oral, head or neck cancer. Given the rise in oropharynx cancers related to human papillomavirus (HPV), routine examinations for early detection of this disease are more important than ever.
If any abnormality is suspected, such as difficulty swallowing, persistent pain, a mass in the neck, changed or muffled voice and non-healing ulcers or sores, it is necessary to make an appointment with a dentist, oral surgeon, primary care physician, and when appropriate, an Ear-Nose-Throat (ENT)/head and neck specialist.We recommend routine checkups at least annually, but in addition to this, further evaluation is recommended with any worrisome or persistent findings.
Symptoms of head and neck cancers
Understanding some of the different kinds of head and neck cancers and their symptoms is the first step in prevention. Here are the main types everyone should be aware of:
HPV (Human Papillomavirus) Induced Cancer HPV is a type of virus that more commonly causes abnormal tissue growth, like warts, and other changes to cells. Certain strains of HPV are associated with oropharynx cancers in the head and neck. This type of infection can also lay dormant for many years and even decades prior to manifesting as a malignancy. A large majority of sexually active people will have some lifetime exposure to HPV. Most tend to clear the virus from the system and only a small percentage of the population exposed will develop cancer. At this time a routine screening is not performed for the HPV virus for head and neck cancers. The HPV is tested for its prognosticator value in those patients who develop oropharyngeal cancer.
Sinus and Nasal Cavity Cancer The paranasal sinuses are small, narrow spaces in the bones of the head around the nose. The most common type of paranasal sinus and nasal cavity cancer is squamous cell carcinoma. This type of cancer forms in the squamous cells (thin, flat cells) lining the inside of the paranasal sinuses and the nasal cavity. Some risk factors can include environmental exposures such as exposure to wood or nickel dust or formaldehyde. Some of the most likely symptoms of this type of cancer are blocked sinuses that do not clear, or frequent sinuses that do not respond to treatment with antibiotics, bleeding through the nose, headaches, and pain in the upper teeth. Many of these symptoms are not always cancerous, but it's still key to get regular examinations, especially for people who routinely smoke or drink alcohol. These individuals should actually receive a physical exam at least once a year even if symptoms do not surface. Even if you don't consistently drink alcohol or smoke, if you notice pain, swelling or blockage that continues for a few weeks or a month, schedule an appointment with a specialist.
Oropharyngeal Cancer The oropharynx is the middle part of the pharynx (throat) behind the mouth. It includes the back one-third of the tongue (base of tongue), the soft palate, side and back walls of the throat and the tonsils. Some common symptoms of this cancer include a sore throat that does not go away, trouble swallowing and opening the mouth fully, or difficulty moving the tongue. Other signs include a change in voice like persistent hoarseness and/or continuous ear pain. Many times, the presenting symptoms will be a lump or swelling in the neck.
Salivary Gland Cancer This type of cancer may be found during a regular dental check-up or physical exam. The major salivary glands are in front of the ear (parotid), at the bottom of the mouth (sublingual) and near the jawbone (submandibular). Minor salivary glands line the entire aerodigestive tract. A persistent lump (usually painless) occurs in the area in front of or just below the ear, cheek, jaw, lip, or inside the mouth. Sometimes there is numbness or pain in the face that does not go away or the facial nerve can lose function.
Avoiding cancer risks
Alcohol and tobacco use are two of the biggest risk factors for head and neck cancers. In fact, a huge majority of the patients we see use, or formerly used, these substances. Oral, head and neck cancers tend to form in the areas where tobacco or alcohol has had the most contact. For example, where a cigarette sits on the lip, where the chewing tobacco is placed in the mouth, and other areas of inhalational contact.
The best way to prevent oral, head and neck cancer is to avoid these substances altogether, or to work with your doctor on figuring out how to quit. [Top 10 Cancer-Fighting Foods ]
A red or white patch in the mouth, a non-healing ulcer or a sore throat can also be the first signs of cancers of the mouth and throat. Hoarseness or a change in the voice can be the first sign of cancer of the voice box.
The bottom line is, when pain, swelling, soreness and other abnormalities persist over a reasonable period of time, which is usually no more than a few weeks to a month, it's time to see a doctor. Some of our patients have allowed pain to persist for several months at a time — and that's not normal. Earlier detection could mean detecting the cancer at an earlier stage. This, in turn, would pose a better prognosis, in general.
While taking courses of antibiotics will help curb pain and swelling, and in many cases it is the appropriate course of first action, if a physician is indeed dealing with cancer, antibiotics won't actually treat the cancer. Further antibiotic courses may just be delaying the treatment process. Ignoring the pain, nodule or lump is the largest factor that leads to delay of care; listening to your body is key in prevention of head and neck cancers.
We can't stress enough the importance of early detection. If you start to notice any of these signs, don't wait. See a specialist right away.
To find screening locations in your area, visit the Head and Neck Cancer Alliance website.
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