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What we call head and
neck cancer is actually cancer of the mouth and throat.
It also includes cancer of the glands in the neck.
Lymph nodes and also salivary glands and the thyroid gland.
So one of the main symptoms that people come
to Johns Hopkins to be seen for is a lump in their neck.
Now you have a number of different structures in
the neck.
We're concerned about lumps that grow larger than the width of
your finger, larger than about two centimeters, and
have lasted for more than six weeks or so.
So lumpy is one important symptom, others are difficulty
with swallowing and speech, pain, sore areas in the mouth,
particularly areas that are red or white, perhaps something that
your dentist has seen would be of concern.
And then deep pain, pain that lasts for more than a few weeks
and particularly pain that radiates or
seems to involve your ear on one side or the other.
Deep ear pain is often missed as being something that might be in
the throat, but can be a sign of head and neck cancer.
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There are about 50,000 cases of head and
neck cancer in the United States each year, so
with 400 million people, that's only about one in every 10,000.
The people who are at risk for
head and neck cancer traditionally have been people
who have a history of tobacco use.
Also, alcohol adding to smoking or
using chewing tobacco increases the risk.
So if you have a history of having smoked more than a pack
a day for more than 10 years you are at increased risk for
head neck cancer.
In addition we're finding more and more patients who
have cancer of the tonsils and lingual tonsil or
the back of tongue because of a human papillomavirus.
HPV is a sexually transmitted virus and it causes
other kinds of cancer such as cancer of the uterine cervix.
It has quite a lag time, about 20 years from the time of
exposure to the development of cancer in some individuals.
And does effect people who are non-smokers.
So most of the patients that we see now a days with HPV related
cancer are men in their fifth, sixth, and seventh decades.
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Cancer of the mouth and throat is complex because of
both the importance of offering curative therapy but
also maintaining good function.
Your mouth, and throat, are, obviously, involved in
a lot of important things, things that I'm doing right now,
talking, and being seen in public, but, also eating, and,
obviously, breathing.
And so, we combine treatments to optimize cure,
but also to maintain function.
There are four basics types of treatment that are used for
head neck cancer.
Surgery is one, radiation therapy is the second,
chemotherapy a third, and more recently, immunotherapy.
Which is similar to chemotherapy, it's a drug or
treatment by intravenous therapy
modality that's combined with others.
Radiation and surgery are the two mainstays of head and
neck cancer treatment.
Chemotherapy by itself doesn't cure head/neck cancer but
can be used in combination with the other therapies.
And so the treatment is designed, based on the stage and
the site, to give us a best chance of curing the cancer but
also maintaining function.
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When we're deciding about surgery for the head and neck,
we attempt to minimize the impact on the function and
a lot of the tools that we use are endoscopic, and so
an effort to treat larynx cancer for example with the laser or
the new robotic surgery that is useful for
cancers of the back of the throat.
A lot of the cancers that we're seeing nowadays are rising in
the tongue base, which is the vertical part of your tongue
that drops down towards the voicebox.
It's way back in the back of the mouth, and difficult to see.
It's also difficult for
the surgeon to reach that area with that instruments.
The robot gives us that opportunity by
allowing an angled telescope to visual the area.
And instruments that come in from the side of the mouth and
are controlled by the surgeon out of console next to
the operating table.
This allows us to remove portions of tumor in the back of
the tongue or the entire tumor in the back of a tongue without
having a bad impact or
a negative impact on swallowing and speech.
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The first question people have when they are seeking treatment
for head and neck cancer is, will I survive?
Will I be cured?
And that's obviously our top priority as well.
But a second and important question is,
what will my life be like after I'm done with therapy?
And the cancer therapy for more advanced tumors in particular is
quite difficult to get through, and you really need the support
of a multi-disciplinary team with speech therapists and other
physical therapists to help you with going through that therapy.
Radiation therapy can leave a person with dryness and
difficulties swallowing.
Surgery obviously can impact speech and swallowing.
And so we work to
reduce the impact of those therapies, by combining and
focusing them to achieve the highest likelihood of cure.
And to maintain
function throughout the course of therapy.
One of the important things, for example, is to keep swallowing
while you're going through treatment and so
at John's Hopkins our swallowing therapist meet with each cancer
patient at the multidisciplinary clinic at the beginning of your
visit and then meet with you regularly on a weekly basis
during treatment to encourage and
assist each individual to maintain their best function.
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