Oral and Head and Neck Cancer | What You Need to Know

Oral and Head and Neck Cancer | What You Need to Know

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>>Welcome to Facebook Live from Johns Hopkins Medicine. I’m Elizabeth Tracey. This is Head and Neck
Cancer Awareness Week and we are so privileged
to have here with us in the studio two experts in that field. And I’m gonna ask them
to introduce themselves.>>Sure, so I’m Rina Abrams. I’m a speech pathologist. I specialize in speech
and swallowing disorders, specifically with patients who
have head and neck cancers.>>My name is Christine Gourin. I’m a specialist in head
and neck cancer surgery.>>Thank you so much for taking
the time to be here today. I deeply appreciate it. I’d like to start first by asking a question about head and neck cancers. It seems like there’s an awful lot more head and neck cancer out there.>>Christine: You’re correct. The incidence of head and neck cancer is rising for several reasons, but we can expect to see
more cases in the future.>>I think we have a graphic we’d like to take a look at that
describes this thing incidence or the number
that are taking place.>>Elizabeth: 70,000. Wow that seems like an awful lot. Are you surprised by this number?>>I’m not surprised. We know that in the last two decades the number of head and neck cancer cases that are seen in the developed world is increasing. So it’s not just a phenomenon
unique to the United States. And projections suggest that those numbers are gonna increase even further in the next several decades.>>Elizabeth: Are there
populations that are disproportionately affected? Specifically are men
more affected than women? I think we have a graphic about that also. [Elizabeth] So my goodness. Way more men than women. Why is that?>>Christine: It’s true. And there are several reasons for that. You asked about populations at risk. Class historically, head and neck cancer or most head and neck cancers not all are related to tobacco and alcohol use. And historically men have always used those substances at greater
numbers than women have. But we also know that men are at a particular increased risk for reasons that are incompletely understood. But we do see more head and neck cancers in men than women. It’s true. Not to say that women
are not at risk though.>>There’s a virus. Human papillomavirus or
HPV frequently abbreviated that at least as far I’ve
been able to determine is also involved with
head and neck cancers pretty often. Is that right?>>Christine: It’s true. HPV is the newest thing
in head and neck cancer. I say thing because about 20 years ago we weren’t really aware of its role in carcinogenesis or causing
a head and neck cancer. It has always been known
to be a causative virus in the development of cervical cancer. But in the head and
neck about 20 years ago we started to see more patients who didn’t have the risk factors of
tobacco or alcohol use. And who seemed to be younger. Getting cancers that they did very well as a result of treatment from. And subsequent research has shown that this is related to
the human papillomavirus. That is right now what’s
considered an epidemic. The numbers of HPV
related cancers is rising and that accounts for
the greatest increase that we see in head and neck cancer today.>>Can you help me to understand how a viral infection might be related to the development of a cancer.>>I don’t pretend to
be able to understand the exact pathogenesis, but we know that people that are exposed to the HPV virus, and that’s most of us. Most of us contract an HPV type
infection in our lifetimes, and the majority of us clear it. But in some small percentage
of people the virus persists. And when the virus persists after about a historically 10 year period when we look to cervical
cancer guidelines. Even smaller percentage of patients will develop cancer related to viral infection. I don’t pretend to understand
the reasons why that happens, but that is a known association.>>Are there specific strains? Because I know right now we have a vaccine against HPV that are related
to the development of cancer.>>Christine: Yeah so
there are what are called high-risk strains of HPV
in the head and neck area primarily it’s 16 that is the most common
strain of HPV virus associated with cancer. But there are some other
high-risk strains too. And there are two vaccines available now. One covers two strains and the other covers four strains.>>Elizabeth: And would
it be your guess then that when we give that
vaccine to more adolescents that we’re gonna see a decline ultimately in head and neck cancers?>>That is the hope. It has been shown in
countries like Australia that the incidence of cervical cancer can be almost entirely eliminated in women because of early vaccination. And so our hope is that if
enough people get vaccinated, we’ll see a decrease
or perhaps elimination of head and neck HPV related cancers. But not only young people
should get vaccinated. The current FDA guidelines are for anyone up to the age of 46.>>Elizabeth: Rina let’s
turn to you for a second. What about HPV infection
and rehabilitation of someone who’s been treated
for head and neck cancer?>>Sure so a lot of these patients that have head and neck cancers require some degree of rehabilitation whether it be speech
or swallowing or both. And one of the, I guess, good things about the HPV virus is
that their prognosis for, prognosis for cure
and survival is much better than the non-HPV related cancers. And so what that means is that the rehabilitation process
is even more important because these patients
are living so much longer. We wanna make sure that they have what we call prehab so they’re getting rehabilitated upfront.>>Elizabeth: And so
there’s no real difference than whether they have HPV or not in what you do for rehabilitation?>>Correct. Yes.>>But really important
to get rehabilitation.>>Yes. Very important.>>Before we dive further into that topic let’s talk about treatment. Treatment frequently of
course does require surgery.>>Well it’s true that often times a surgical procedure is
required to make the diagnosis. Head and neck cancers can involve anywhere from the back of the nose to
the opening of the esophagus. So all those areas need to be inspected for tumor development. And we always confirm a biopsy site, so you never want to treat somebody based on your assumption that that’s where it’s coming from. So some degree of surgery
in the form of biopsy at a minimum is required. And then the treatment options consist of surgery,
radiation, chemotherapy, increasingly immunotherapy. And these are given alone
or in some combination. And the exact treatment recommendation is based on the stage, the site, and patient’s goals and wishes.>>Well let’s talk about that. So let’s factor back even
a little bit further. How is it that someone even suspects that they have a head or neck cancer?>>There are some symptoms that are unique to the head and neck. We always worry about anybody with unilateral or one-sided ear pain, trouble swallowing, a change in your voice, difficulty swallowing, a lump in the neck. These are the most common symptoms, but the truth is, particularly with HPV related cancers, the only symptom one may
have is a lump in the neck. So we encourage everybody
to get checked out if they feel a new mass or have any symptoms that are new or formal to the head and neck.>>Elizabeth: Do you get
referrals from dentists sometimes? Do they detect them?>>Christine: Sometimes they do. A good dental exam will
pick up oral cancers sometimes in their earliest stages, so we never discount a
referral from a dentist. They know what they’re looking for.>>Is there a familial
component or genetic component to the development of these cancers?>>There is one familial
link in the form of a disease called Fanconi’s anemia. People with Fanconi’s anemia are at risk of oral cancers usually earlier in life
in the teenage years. Fortunately this disease is very rare. We’re not aware of any other genetic link to head and neck cancer.>>And how about staging? We hear an awful lot about
what stage a cancer is. How is a head and neck cancer staged?>>It’s staged based on three things. One is the size of the primary tumor. And the primary tumor is somewhere in the lining of the tissues, the back of the nose, back of the throat, down near the voice box. So that’s the T stage. The N stage refers to node status and whether or not there are any enlarged lymph nodes present and how big they are
and how many there are. And then the M stage is for metastasis. Is it anywhere else in the body? An overall stage is assigned
based on that combination. So it’s primarily the size of the tumor, and whether or not there’s
lymph node involvement.>>Rina, after somebody has staging. Yes, staging, diagnosis, treatment, that could be any one of these modalities they come to you. Can you give me an overview of the kind of assessment that you do and how you develop a treatment plan?>>Rina: Sure so a lot of it varies depending on what the plan is, whether they get surgery upfront or if they’re getting
radiation or chemoradiation or a combination. So usually if they’re
getting surgery upfront, we evaluate them preoperatively with some type of swallowing evaluation. There’s a few different
types that I can get into if we have enough time later. But we are talking to them, or counseling them really on what to expect after surgery as well. And then we usually see
them postoperatively depending on what the surgery is and how extensive it is. And then for patients that are getting radiation or chemoradiation, again we see them per baseline evaluation, evaluate their swallowing. Again, counsel on what side effects we would anticipate going
through their treatment. And then we follow them, usually for about five
years after treatment, because they can have
changes postradiation in their swallow function.>>And even for five years,
you would be involved in that rehabilitation.>>Yes.>>Now that’s impressive.>>Yeah it’s a long time. They get to know us well. (laughs)>>But that sounds like that’s also some really great vigilance.>>Yes.>>Yeah.
>>Yeah. It’s a lot of work that they put in, but it’s worth it in the end.>>One fear I’ve heard people express about treatment and
subsequent rehabilitation of head and neck cancers is “oh gosh am I gonna
need a feeding tube?”>>Rina: Sure. Yeah that’s a tough question and you’re gonna get some variation dependent on where you’re going, who your doctors are you know. So from a surgery standpoint, again it’s totally
dependent on the surgery and the extent of resection. So I think it’s kind of impossible to answer whether or not people need that, but, you know we work
closely with the surgeons to determine preoperatively
if we think they’ll need one and also postoperatively. For patients that are getting radiation, our general kind of
thought or knowledge is that we want patients to keep swallowing. So we encourage them to try to get through treatment without a feeding tube unless they need it. And that’s again
something that we do here. People may go to other facilities and find that they’re recommending a feeding tube upfront. And we know that by using those muscles they have a lower risk of long-term dysfunction of those muscles. So using the muscles, whether it be by doing
swallowing exercises by continuing to swallow, are both two really important factors.>>I imagine that could
be quite troublesome though sometimes isn’t it?>>Rina: Oh absolutely. So radiation especially is very difficult and you know having a team, a multidisciplinary team, to help work through that, with the radiation oncologists, the dietitians, the medical oncologist, speech pathologist, the surgeons, you know everyone needs to
get involved in that care.>>There’s also a consequence of treatment sometimes that develops
this stiffness of the jaw. Trismus. How ’bout that?>>Rina: Yeah so trismus
can come from surgery. It can come from radiation therapy. And so again we treat
that prophylactically with the radiation patients and then also reactively
for radiation and surgery. So there are gentle
stretches that people can do. There are devices out there to work on stretching the jaw. Basically the earlier that it’s caught, the easier it is to treat. So it becomes more of an issue if people let it go.>>I love this concept of prehabilitation. Are there other things that people can do previous to their treatment that would aid in their recovery?>>So aside from doing
swallowing exercises and jaw stretches that’s you know for that’s again for radiation patients. Usually the surgical patients they don’t need to do
anything before surgery.>>Chris would you answer that also. Are there things that people can do to try to make sure that they’re going to achieve the best outcome that they can from their seat in the bleachers?>>There are some things patients can do. If you smoke, quit. If you abuse alcohol, stop that as well. Because both of those things interfere with wound healing after surgery. But also during radiation and chemotherapy those things interfere with your tissues handling the effects of radiation and recovering from that. And then I just wanna
second what Rina said about the swallowing therapy. Wherever you get your care you should see, make sure that your team has recommended you see a speech and language pathologist. This is as critical to you as seeing a surgeon or a radiation oncologist because the exercises that
Rina prescribes are key. Key in preventing late complications from treatment.>>Is there a role for
robotic surgery here?>>There is. We actually do a fair
amount of robotic surgery. The surgical robot allows
us to see around corners. It’s not suitable for all cancer types, but where it’s really shown is, or where it really shines
is in HPV related cancers involving the base of the tongue. Because the robot allows us
to go take out that tissue while minimizing disruptions
to normal tissue. So if patients swallow pretty well, we’ve published our data
that 95% of patients are home the next day eating on their own. They see Rina and her team afterwards for swallow therapy, but it’s really remarkable how TORS has allowed us to still offer
surgery to some patients and reduce the odds of
needing chemotherapy when the tumor is suitable for TORS.>>You both identified not just each other but other professionals as really pivotal to your approach to a
comprehensive strategy for managing people with
head and neck cancer. Of course all those folks are available right here at Johns Hopkins. And why do we need to come to an academic medical center to be treated?>>So we know that outcomes
are better at larger centers because of that team approach. I mean we all meet together
once, sometimes twice, sometimes more than
that every single week. And so I think just having
that collaborative team to work through whatever
issues each person is having makes it, you know, gives
them a much better outcome and allows them to get
through treatment easier.>>It takes a team. It really does. Because if you see a surgeon you’re gonna get a surgical opinion and if you see a radiation oncologist you’ll get their opinion. And what you really need is to have the entire team weigh in and decide collectively
what the best options are. The other factor is that it really matters where you get your care. So we know that volume matters. Places that treat a high volume of head and neck cancer patients have better outcomes. And that’s not opinion, that’s fact. So it’s very important to see a team that is knowledgeable
about head and neck cancer. Is aware of the role of
speech and language pathology and rehabilitation and prehabilitation. That is aware of the importance of ongoing swallowing therapy during treatment. And really is up to date
on the newest advances such as using the robot
when that’s indicated. And some of the newer treatments as well.>>We do have an event that’s taking place here at Johns Hopkins
at the end of this month [Elizabeth] we’d like to advise you about. If you need to learn more
about head and neck cancer and also meet with some survivors on April 27th as you can see there’s an event taking place here and you are certainly welcome. Thanks to both of you for
joining me here today. You’ve both been so informative and I know what your
academic schedules are like. So this was really a big gift. Thank you so much.>>Thank you for having us.>>Thank you. It’s been a pleasure.

5 thoughts on “Oral and Head and Neck Cancer | What You Need to Know”

  1. I had squamous cell carcimona base of the tongue. I am cancer free now but it was all far more difficult than I could have ever imagined, I was driven far past the breaking point.

  2. I am 1 year past diagnosis. I am not exactly 100% but I am doing great. It's just that you have to go through Hell to get to that point. I am very grateful for my awesome medical team and having a second chance at life. I wish that for everyone but unfortunately that can't be.

  3. Thank for the info… i heard proton beam radiation therapy would also able to cure head and neck cancer. Click to know more :
    https://proton.apollohospitals.com/cancer-care/cancer-management-team/bone-soft-tissue-cancers

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