Head And Neck Cancer Awareness

by GregP_WN

April is head and neck cancer awareness month, along with testicular cancer and esophageal cancer. This piece will focus on head and neck cancer since there is so much to cover for this group of cancers. I have been unfortunate enough to have three diagnoses in this category. Tonsil, hypopharyngeal, and thyroid cancer.

Head And Neck Cancer Awareness Month Wn Logo

Head and neck cancer is a group of several types of cancer that originate in the head and neck area. Tongue, tonsil, eye, salivary gland, larynx, throat, lips, nose, and more, are all in the head and neck cancer group. 

What causes head and neck cancer?

Alcohol and tobacco use (including smokeless tobacco, sometimes called “chewing tobacco” or “snuff”) are the two most important risk factors for head and neck cancers, especially cancers of the oral cavity, oropharynx, hypopharynx, and larynx . At least 75% of head and neck cancers are caused by tobacco and alcohol use . People who use both tobacco and alcohol are at greater risk of developing these cancers than people who use either tobacco or alcohol alone . Tobacco and alcohol use are not risk factors for salivary gland cancers.

Infection with cancer-causing types of human papillomavirus (HPV), especially HPV type 16, is a risk factor for some types of head and neck cancers, particularly oropharyngeal cancers that involve the tonsils or the base of the tongue  In the United States, the incidence of oropharyngeal cancers caused by HPV infection is increasing, while the incidence of oropharyngeal cancers related to other causes is falling. More information is available at the HPV and Cancer page from the National Cancer Institute.

Other risk factors for cancers of the head and neck include the following:

Paan (betel quid). Immigrants from Southeast Asia who use paan (betel quid) in the mouth should be aware that this habit has been strongly associated with an increased risk of oral cancer.

Preserved or salted foods. Consumption of certain preserved or salted foods during childhood is a risk factor for nasopharyngeal cancer.

Oral health. Poor oral hygiene and missing teeth may be weak risk factors for cancers of the oral cavity. Use of mouthwash that has a high alcohol content is a possible, but not proven, risk factor for cancers of the oral cavity.

Occupational exposure. Occupational exposure to wood dust is a risk factor for nasopharyngeal cancer. Certain industrial exposures, including exposures to asbestos and synthetic fibers, have been associated with cancer of the larynx, but the increase in risk remains controversial. People working in certain jobs in the construction, metal, textile, ceramic, logging, and food industries may have an increased risk of cancer of the larynx. Industrial exposure to wood or nickel dust or formaldehyde is a risk factor for cancers of the paranasal sinuses and nasal cavity.

Radiation exposure. Radiation to the head and neck, for noncancerous conditions or cancer, is a risk factor for cancer of the salivary glands. This is most likely what caused two of my diagnoses, tonsil cancer, pharyngeal cancer, and thyroid cancer.

Epstein-Barr virus infection. Infection with the Epstein-Barr virus is a risk factor for nasopharyngeal cancer and cancer of the salivary glands.

Ancestry. Asian ancestry, particularly Chinese ancestry, is a risk factor for nasopharyngeal cancer.

What are the symptoms of head and neck cancers?

The symptoms of head and neck cancers may include a lump or a sore that does not heal, a sore throat that does not go away, difficulty in swallowing, and a change or hoarseness in the voice. These symptoms may also be caused by other, less serious conditions. It is important to check with a doctor or dentist about any of these symptoms. Symptoms that may affect specific areas of the head and neck include the following:

Oral cavity. A white or red patch on the gums, the tongue, or the lining of the mouth; a swelling of the jaw that causes dentures to fit poorly or become uncomfortable; and unusual bleeding or pain in the mouth.

Dental Care During Chemotherapy

Pharynx. Trouble breathing or speaking; pain when swallowing; pain in the neck or the throat that does not go away; frequent headaches, pain, or ringing in the ears; or trouble hearing.

Larynx. Pain when swallowing or ear pain. My diagnosis of  hypopharyngeal cancer came after months of me prodding my ENT to look into a strange sensation I had been having in my throat. I was scoped 4 times before finally seeing something that warranted a biopsy.

Paranasal sinuses and nasal cavity. Sinuses that are blocked and do not clear; chronic sinus infections that do not respond to treatment with antibiotics; bleeding through the nose; frequent headaches, swelling or other trouble with the eyes; pain in the upper teeth; or problems with dentures.

Salivary glands. Swelling under the chin or around the jawbone, numbness or paralysis of the muscles in the face, or pain in the face, the chin, or the neck that does not go away.

Head And Neck Cancers

My diagnosis of tonsil cancer in 2008 came after I noticed a small lymphnode swollen behind my ear. After finding that, I scheduled a doctor's visit to take a look at it, at which time he ordered a CT scan. 

Even though my doctor at that time said that a CT scan would tell him everything he needed to know, it in fact did not verify a diagnosis. The radiologist's description was non-impressive and non-conclusive. At that point I insisted on having a needle biopsy of a rather large lymph node that had swollen up in my neck by then. That biopsy confirmed that I had squamous cell carcinoma of the right tonsil. 

Types of treatment for head and neck cancers

There is a quote that is used a lot in the cancer world that says "cancer is not the same for all of us". This simple statement is very true. What tonsil cancer looks like on me might not be the same for your. Each person is different, our overall health, the stage we are diagnosed with, our age, the exact location of the cancer, and more factors, all come into play in the formulation of a treatment plan.

Treatment can include chemotherapy, radiation therapy, targeted therapy, and/or immunotherapy. Your cancer history will also have a bearing on developing your treatment plan. If you have had radiation in the past, you may not be a candidate for radiation again. It depends on how much and where your previous radiation was given. 

Some head and neck cancer diagnoses will include several treatment types together, while others will only be one type of treatments 

Side effects of head and neck cancer treatments

Each treatment type has its own set of side effects. The side effects of chemo treatments for head and neck cancer are similar to those from chemo for any other type of cancer. Nausea, bone pain, loss of hair, weight loss, dental damage, hearing damage, and more are all normal side effects. 

Radiation side effects from radiation to the head and neck area can be quite severe. Dental damage is quite common. Since the radiation is usually directed at the throat/mouth area, it's hard to direct it to a spot that will take care of the cancer spot but not damage the gums, blood vessels, saliva glands, thyroid and more. 

Some of the most serious side effects of radiation for head and neck cancer are:

Dental-Radiation to the mouth/head/neck/throat is also directed at the saliva glands and thyroid. As the saliva glands get more and more radiation they tend to be less and less productive to the point where they stop producing saliva at all. At this point the patient has a dry mouth all the time which leads to more damage to the teeth and gums. Dental damage can be as minor as a cracked tooth or needing a filling, to having to have all your teeth removed due to extensive damage. 

Head And Neck Mask

My experience was the latter. I had some dental damage from a previous cancer diagnosis and radiation treatment in 1988. In 2008 when I had tonsil cancer it was first decided that I could not have any more radiation because of having already had radiation to that spot on my body before. The initial plan was to do surgery only and hope for the best. 

After discussing my case with the tumor board at Vanderbilt Medical Center, i was determined that since it had been almost 20 years since I had treatment before, that I would be alright. The radiation treatment seemed to work as I was cancer free for 21 years. But it left me with some of all of these side effects listed here.

Carotid artery damage. Damage to the internal carotid artle is a common side effect. This one is also very serious and can be fatal. The radiation that is directed towards the side of the throat/neck area also hits the carotid artery. This can be compared to frying a piece of bacon. The artery is nice and fat and limber before treatment, but after treatment it has been fried, shrunken, and occluded which restricts blood flow to the brain. This can cause mini-strokes to full on strokes causing severe damage. I found this problem by having a TIA (mini-stroke) of my own. I had to have a stent put in the right interior carotid artery, go on mediation to reduce cholesterol, and have an ultrasound annually to check for adequate blood flow. 

Thyroid damage. Since the radiation field usually will take in some, if not all, of the thyroid, it is likely that you will have problems with it functioning. The usual ansser for this is to be put on a medicaion that will increase the output of the thyroid or make up for it. 

Esophagus stricture. Again, the esophagus is in the radiation field quite often. Radiation damage to the esophagus is similar to that of the carotid artery. The esophagus shrinks and hardens making swallowing difficult. Having the esophagus stretched after having had radiation to that area is fairly common. 

Stricture of the esophagus causes difficulty swallowing to choking on food or water that may go down the trachea instead of the esophagus. This problem can also cause pneumonia due to food and water making its way into your lungs. 

Head and Neck Cancer Prevention

As with many cancer types, quitting smoking reduces the chances of cancer. Also, excessive alcohol use will increase the odds of a head and neck cancer diagnosis. 

Overall balanced diet, exercise, and good judgement are all factors also. Many ENT clinics nationwide hold free head and neck cancer screenings annually during Head and Neck Cancer Awareness Month. Call your local ENT clinic to find out where your closest facility is for screenings. 

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