Head and Neck Cancer Awareness Month

Transcript

00:00 --> 00:03Funding for Yale Cancer Answers is
00:03 --> 00:06provided by Smilow Cancer Hospital.
00:06 --> 00:08Welcome to Yale Cancer Answers
00:08 --> 00:10with Doctor Anees Chagpar.
00:10 --> 00:11Yale Cancer Answers features the
00:11 --> 00:13latest information on cancer care
00:13 --> 00:15by welcoming oncologists and
00:15 --> 00:17specialists who are on the forefront
00:17 --> 00:19of the battle to fight cancer.
00:19 --> 00:21This week it's a conversation about head
00:21 --> 00:23and neck cancers with Doctor Ansley Roche.
00:24 --> 00:26Doctor Roche is an assistant professor
00:26 --> 00:28of surgery and otolaryngology at
00:28 --> 00:29the Yale School of Medicine
00:29 --> 00:30where Dr. Chagpar is
00:30 --> 00:32a professor of surgical oncology.
00:34 --> 00:36Ansley, maybe we can start off by you
00:36 --> 00:38telling us a little bit more about
00:38 --> 00:40yourself and what it is you do.
00:40 --> 00:43I'm a head and neck cancer surgeon.
00:43 --> 00:45I did my training and after medical school,
00:45 --> 00:47I did my residency
00:47 --> 00:49training in otolaryngology,
00:49 --> 00:50which is ear, nose and throat.
00:50 --> 00:53And then within the field of otolaryngology,
00:53 --> 00:55there are numerous subspecialties.
00:55 --> 00:58I subspecialize in head and neck cancer.
00:58 --> 01:01So I went on to obtain additional training,
01:01 --> 01:03a fellowship in head and neck cancer,
01:03 --> 01:06both in the management of
01:06 --> 01:07resecting these cancers
01:07 --> 01:08as well as reconstructing them.
01:11 --> 01:13Now that we are celebrating head
01:13 --> 01:15and neck cancer awareness Month,
01:15 --> 01:16maybe you can tell us a little bit
01:16 --> 01:17more about head and neck cancers.
01:17 --> 01:20I mean it sounds like it's a rather
01:20 --> 01:24large bucket, kind of like saying
01:24 --> 01:26cancers of the abdomen or cancers
01:26 --> 01:28of the chest, it sounds like every
01:28 --> 01:30time we say head and neck cancers
01:30 --> 01:32I think that's a pretty large
01:32 --> 01:35area with a lot of things in it.
01:35 --> 01:37Tell us a bit more about what goes
01:37 --> 01:39into head and neck cancer and
01:39 --> 01:41why it is that those are all kind
01:41 --> 01:42of clumped together as opposed
01:43 --> 01:44to specific organs like we have
01:44 --> 01:46in other parts of the anatomy.
01:47 --> 01:48Yeah, that's an excellent
01:48 --> 01:50point and you're exactly right.
01:50 --> 01:53It is a heterogeneous group of cancers
01:53 --> 01:56that are clumped together essentially
01:56 --> 01:59because of their anatomic location.
02:01 --> 02:04Within this region, there are many different
02:04 --> 02:07types of cancers that can arise,
02:07 --> 02:08mostly because there are many
02:08 --> 02:10different types of cell types
02:10 --> 02:12within the head and neck,
02:12 --> 02:14there's the digestive tract, which
02:14 --> 02:17you can think of it sort of as skin
02:17 --> 02:19but on the inside, it's the
02:19 --> 02:20lining of the mouth, the nose,
02:20 --> 02:22the sinuses, the throat.
02:22 --> 02:23There's also skin
02:23 --> 02:24of the head and neck.
02:24 --> 02:28So there are cutaneous cancers,
02:28 --> 02:29squamous cell carcinoma as we know,
02:29 --> 02:30basal cell Melanoma,
02:30 --> 02:33just to go back to the oral cavity,
02:33 --> 02:36the digestive tract that also most
02:36 --> 02:38commonly is squamous cell carcinoma,
02:38 --> 02:40but there are others that arise there.
02:40 --> 02:42And then there's also things
02:42 --> 02:44like salivary gland tumors.
02:44 --> 02:45So growths that arise
02:45 --> 02:47within the saliva glands,
02:47 --> 02:49we have some within our cheeks,
02:49 --> 02:51some under our chin and under our jaw and
02:51 --> 02:54then thousands and thousands in our mouth.
02:54 --> 02:56And so cancers can arise in any of those.
02:56 --> 02:57Those are rare.
02:57 --> 02:59I would say the most common head
02:59 --> 03:00and neck cancer that we deal with
03:00 --> 03:02and that we treat and talk about
03:02 --> 03:04and where most of the research
03:04 --> 03:06efforts go is within addressing
03:06 --> 03:08squamous cell carcinoma of the
03:09 --> 03:10upper digestive tract.
03:11 --> 03:14And so how common the
03:15 --> 03:16head and neck cancers are,
03:16 --> 03:18depending on the year,
03:18 --> 03:22anywhere from the 6th to the 8th most
03:22 --> 03:24common type of cancer worldwide.
03:24 --> 03:26So not the most common, but we
03:26 --> 03:28see quite a bit of it.
03:29 --> 03:31And can you tell us a bit
03:31 --> 03:33more about risk factors?
03:33 --> 03:35I mean who gets these cancers and why?
03:36 --> 03:37Yes, excellent question.
03:37 --> 03:39How do we prevent these?
03:39 --> 03:40How can we minimize our risk?
03:40 --> 03:42So understanding the risk factors
03:42 --> 03:44is incredibly important here.
03:44 --> 03:47For a long time, we attributed the
03:47 --> 03:48majority of head and neck cancers,
03:48 --> 03:50again specifically squamous cell
03:50 --> 03:52carcinoma of the air digestive tract,
03:52 --> 03:55to things like smoking and drinking,
03:55 --> 03:57things that we know are risk
03:57 --> 03:59factors for other types of cancers
03:59 --> 04:01and those remain risk factors for
04:01 --> 04:03squamous cell carcinoma of certain
04:03 --> 04:05sites within the head and neck,
04:05 --> 04:06within the oral cavity,
04:06 --> 04:08larynx, the voice box.
04:08 --> 04:12What we're also seeing now though is a rise
04:12 --> 04:15in HPV associated head and neck cancer.
04:15 --> 04:17Specifically of the oropharynx
04:17 --> 04:18and the oropharynx,
04:18 --> 04:20that's the tonsils and
04:20 --> 04:22the back of the tongue.
04:22 --> 04:24So the area kind of at the back of the mouth,
04:24 --> 04:25back of the throat,
04:25 --> 04:26back of the tongue,
04:26 --> 04:28that's the oropharynx and that's where
04:28 --> 04:31we're seeing HPV associated squamous
04:31 --> 04:35cell carcinoma that is on the rise
04:35 --> 04:37and accounts for at this point about
04:37 --> 04:4170% of oropharynx cancers and it's
04:41 --> 04:44anticipated that by about 2030
04:44 --> 04:47that the head and neck cancers
04:47 --> 04:49associated with a with HPV will be
04:49 --> 04:51higher than those not associated
04:51 --> 04:53with HPV which will be
04:53 --> 04:55a reverse of what it is currently.
04:55 --> 04:58So as people kind of smoke less,
04:58 --> 05:00those sorts of non HPV related cancers,
05:00 --> 05:02the incidence of those are going
05:02 --> 05:04down but HPV associated
05:04 --> 05:05ones are increasing.
05:06 --> 05:08It's interesting that you
05:08 --> 05:10say that the HPV cancers will
05:10 --> 05:12overtake smoking and alcohol.
05:12 --> 05:15While it's understood that people
05:15 --> 05:17are smoking less and perhaps
05:17 --> 05:20drinking a little bit less too,
05:20 --> 05:22you know, when we think about HPV,
05:22 --> 05:26we have vaccines for HPV to
05:26 --> 05:28prevent HPV associated cancers.
05:28 --> 05:31So why is it that we still think
05:31 --> 05:33that HPV cancers are going
05:33 --> 05:35to be rising to the extent
05:35 --> 05:37that they are?
05:37 --> 05:42There's a bit of a lag in the age of
05:42 --> 05:44patients that have been vaccinated and
05:44 --> 05:48when patients are getting this diagnosis.
05:48 --> 05:53So the vaccine Gardasil was FDA
05:53 --> 05:55approved in early 2000,
05:55 --> 05:57maybe around 2010, 2012.
05:57 --> 06:00Actually it was a little bit before that,
06:00 --> 06:02but there are generations of
06:02 --> 06:04people that have already
06:04 --> 06:07acquired the HPV virus
06:07 --> 06:09and sort of have fallen out of
06:09 --> 06:11the window of vaccination.
06:11 --> 06:13So the hope is that over time as more
06:13 --> 06:16and more people get vaccinated that
06:16 --> 06:18the rates will eventually go back down.
06:18 --> 06:19But again we're
06:19 --> 06:21accounting for this
06:21 --> 06:23window where people are not
06:23 --> 06:24vaccinated but they're at an age
06:24 --> 06:26where they may be diagnosed
06:26 --> 06:28with this which is typically
06:28 --> 06:31anywhere from 40s to 60s that
06:31 --> 06:32they're getting diagnosed with this.
06:33 --> 06:37So tell us more about why it is that people
06:37 --> 06:40get HPV associated oropharyngeal cancers.
06:40 --> 06:42When we think about HPV,
06:42 --> 06:44many of our listeners may be
06:44 --> 06:47thinking about it as, you know,
06:47 --> 06:50a sexually transmitted virus
06:50 --> 06:53that causes cervical cancers.
06:53 --> 06:56So is it systemic spread of that
06:56 --> 06:59virus or is that more, you know,
06:59 --> 07:01a direct inoculation of the virus
07:01 --> 07:04in the mouth due to sexual activity?
07:04 --> 07:06I mean how does that work?
07:08 --> 07:09Great question.
07:09 --> 07:12We do know that the risk
07:12 --> 07:15factor for getting HPV associated
07:15 --> 07:17head neck cancer is having
07:17 --> 07:19numerous oral sex partners, so
07:19 --> 07:23that does speak to your question which is it
07:23 --> 07:26a direct inoculation perhaps
07:26 --> 07:28it could also be you know just
07:28 --> 07:29dormant within the body.
07:29 --> 07:31So the jury is still out on
07:31 --> 07:33exactly how it's transmitted there.
07:33 --> 07:36But we do know that the
07:36 --> 07:38risk goes up the more oral
07:38 --> 07:40sex partners that you've had
07:41 --> 07:44and so getting back to the the vaccine
07:44 --> 07:47and the fact that some
07:47 --> 07:50people have kind of already been exposed
07:50 --> 07:54to the virus, my understanding is
07:54 --> 07:59that now the age criterion for people
07:59 --> 08:01to get the vaccine has increased.
08:01 --> 08:04So it used to be that you had to be,
08:04 --> 08:07you know, in your preteen years
08:07 --> 08:09in order to get vaccinated.
08:09 --> 08:11But my understanding is
08:11 --> 08:13that has now increased.
08:13 --> 08:14So two questions.
08:14 --> 08:18First question is A is that true?
08:18 --> 08:21And B, if it is true,
08:21 --> 08:24if you've already been exposed to the virus,
08:24 --> 08:26does the vaccine still work?
08:27 --> 08:30Yes, it is true that they
08:30 --> 08:31have expanded the age.
08:31 --> 08:33I believe it's up to 45 now.
08:33 --> 08:35There are many different strains
08:35 --> 08:39of the virus and so the thought
08:39 --> 08:40with getting vaccination,
08:40 --> 08:43even if you've already been exposed is that
08:43 --> 08:45the vaccination covers many
08:45 --> 08:46different strains and so perhaps
08:46 --> 08:48it's going to protect you against a
08:48 --> 08:50strain that you have yet to acquire.
08:51 --> 08:56So are those really the only risk factors?
08:56 --> 09:00So smoking, drinking, and HPV
09:00 --> 09:05it sounds like it's the the trifecta of sin,
09:05 --> 09:07but do some people get oropharyngeal
09:07 --> 09:10cancers just due to bum, bad luck,
09:10 --> 09:12or due to genetic factors?
09:12 --> 09:15Are there other things that could
09:15 --> 09:17predispose people to oropharyngeal cancers?
09:19 --> 09:21As far as the oropharynx,
09:21 --> 09:22those are the main risk factors,
09:22 --> 09:24but there are other risk factors
09:24 --> 09:27for oral cavity cancer.
09:27 --> 09:29I mean tobacco is sort of a catchall,
09:29 --> 09:31you know for many different types
09:31 --> 09:33of products, so chewing tobacco
09:33 --> 09:35but also one called beetle nut
09:35 --> 09:38which is used in parts of Asia,
09:38 --> 09:41Southeast Asia that it can also
09:41 --> 09:44be associated or a risk factor
09:44 --> 09:46for acquiring oral cavity cancer.
09:46 --> 09:49And then we think of others that are
09:49 --> 09:52not quite as common that affect the
09:52 --> 09:55nasal area and can be associated
09:57 --> 10:01with things like woodworking,
10:01 --> 10:04you know sort of environmental
10:04 --> 10:06exposures secondary to occupation.
10:06 --> 10:09Some metalworking can be associated
10:09 --> 10:11with some head and neck cancers
10:11 --> 10:13those are pretty rare.
10:13 --> 10:16So when it comes to risk factors that
10:16 --> 10:19affect a good amount of people,
10:19 --> 10:20those are pretty much the main
10:20 --> 10:22ones that we've talked about,
10:22 --> 10:27smoking, drinking and increased
10:27 --> 10:28number of oral sex partners.
10:29 --> 10:31So when we think about smoking,
10:31 --> 10:34one of the other questions that often
10:34 --> 10:39comes up is whether it is the actual
10:39 --> 10:43vapors or whether it is the nicotine content.
10:43 --> 10:46So to get to the whole point of are
10:46 --> 10:49e-cigarettes safe, is vaping safe?
10:49 --> 10:52Does this reduce your risk of
10:52 --> 10:54cancer versus
10:54 --> 10:57traditional smoking or is there a
10:57 --> 11:01risk associated with these as well?
11:01 --> 11:03You know those products I don't
11:03 --> 11:05think have been around long enough
11:05 --> 11:08for us to really know if they
11:08 --> 11:10have the same impact on cancer
11:10 --> 11:15predisposition as the smoked tobacco.
11:15 --> 11:17So we're just not at that point yet.
11:17 --> 11:21The kind of general
11:21 --> 11:23recommendation though is that it
11:23 --> 11:26very well could be associated with it,
11:26 --> 11:28one of the concerns about smokeless tobacco
11:28 --> 11:32is that it's getting people exposed early
11:32 --> 11:34and there's a concern that
11:34 --> 11:38also it's so much easier to do,
11:38 --> 11:39you could do it indoors,
11:39 --> 11:40you could do a little bit here,
11:40 --> 11:42a little bit there throughout the day.
11:42 --> 11:44There's a concern that the exposure
11:44 --> 11:47over time is higher because it's so
11:47 --> 11:49easy and relatively discreet.
11:49 --> 11:54So in terms of head and neck cancer,
11:54 --> 11:58I don't think enough time has passed
12:00 --> 12:04to be able to say
12:04 --> 12:08it is as associated or as
12:08 --> 12:10dangerous in terms of a risk factor
12:10 --> 12:11as smoked tobacco.
12:11 --> 12:12So the jury is still out,
12:12 --> 12:14but we anticipate it's probably
12:14 --> 12:16going to be about the same.
12:17 --> 12:18What about for people who already
12:18 --> 12:21have had a history of smoking,
12:21 --> 12:23have had a history of alcohol,
12:23 --> 12:28may have had exposure to HPV over time?
12:28 --> 12:31You quit smoking, you quit drinking,
12:31 --> 12:37don't have oral sex,
12:37 --> 12:40does that reduce your risk or is it
12:40 --> 12:43more that if you've had a single exposure,
12:43 --> 12:45that single exposure is kind
12:45 --> 12:47of like a mark on your record
12:47 --> 12:49that still increases your risk?
12:51 --> 12:55We talked about it mostly with smoking.
12:55 --> 12:58And it has to do with sort of
12:58 --> 12:59cumulative exposure over time
12:59 --> 13:03and typically we use the
13:03 --> 13:0710 pack year as a bit of a benchmark.
13:07 --> 13:12So below which your risk is lower
13:13 --> 13:15than it is if you've smoked
13:15 --> 13:17more than 10 packs per year.
13:17 --> 13:19Pack year just refers to
13:19 --> 13:21on average how many packs of
13:21 --> 13:23cigarettes do you smoke per year.
13:24 --> 13:27So there's hope for
13:27 --> 13:30people who want to quit smoking
13:30 --> 13:34and reduce their risk of
13:34 --> 13:36getting oropharyngeal cancer.
13:36 --> 13:38When we come back after taking a
13:38 --> 13:40short break for a medical minute,
13:40 --> 13:43we'll dive into a little bit more
13:43 --> 13:44about oropharyngeal cancers and
13:44 --> 13:46other cancers of the head and neck,
13:46 --> 13:47how they present,
13:47 --> 13:49how they're treated and what's
13:49 --> 13:51new on the horizon.
13:51 --> 13:53Please stay tuned to learn more
13:53 --> 13:54about the care of patients with
13:54 --> 13:56head and neck cancers in honor of
13:56 --> 13:58Head and Neck Cancer Awareness
13:58 --> 14:00Month with my guest, Dr.
14:00 --> 14:01Ansley Roche.
14:01 --> 14:02Funding
14:02 --> 14:04for Yale Cancer Answers comes
14:04 --> 14:05from Smilow Cancer Hospital,
14:05 --> 14:08where their Prostate and Urologic Cancers
14:08 --> 14:11program comprises a multispecialty team
14:11 --> 14:13dedicated to managing the diagnosis,
14:13 --> 14:16evaluation, and treatment of urologic cancer.
14:18 --> 14:18Smilowcancerhospital.org
14:20 --> 14:22Breast cancer is one of the
14:22 --> 14:24most common cancers in women.
14:24 --> 14:25In Connecticut alone,
14:25 --> 14:27approximately 3500 women will be
14:27 --> 14:30diagnosed with breast cancer this year.
14:30 --> 14:31But there is hope thanks
14:31 --> 14:32to earlier detection,
14:32 --> 14:33non invasive treatments,
14:33 --> 14:35and the development of novel
14:35 --> 14:37therapies to fight breast cancer,
14:37 --> 14:39women should schedule a baseline
14:39 --> 14:41mammogram beginning at age 40 or
14:41 --> 14:43earlier if they have risk factors
14:43 --> 14:45associated with the disease.
14:45 --> 14:46With screening,
14:46 --> 14:48early detection,and a healthy lifestyle,
14:48 --> 14:50breast cancer can be defeated.
14:50 --> 14:52Clinical trials are currently
14:52 --> 14:54underway at federally designated
14:54 --> 14:56comprehensive cancer centers such
14:56 --> 14:58as Yale Cancer Center and Smilow
14:58 --> 15:00Cancer Hospital to make innovative
15:00 --> 15:03new treatments available to patients.
15:03 --> 15:05Digital breast tomosynthesis or 3D
15:05 --> 15:08mammography is also transforming breast
15:08 --> 15:10cancer screening by significantly
15:10 --> 15:12reducing unnecessary procedures
15:12 --> 15:14while picking up more cancers.
15:14 --> 15:16More information is available
15:16 --> 15:17at yalecancercenter.org.
15:17 --> 15:20You're listening to Connecticut Public Radio.
15:21 --> 15:23Welcome back to Yale Cancer Answers.
15:23 --> 15:25This is Dr. Anees Chagpar
15:25 --> 15:27and I'm joined tonight by my guest,
15:27 --> 15:28Dr. Ansley Roche.
15:28 --> 15:30We're discussing the care of patients
15:30 --> 15:32with head and neck cancers in honor of
15:32 --> 15:34Head and Neck Cancer Awareness Month.
15:34 --> 15:36Now, before the break,
15:36 --> 15:39we were talking about risk factors
15:39 --> 15:41and things that people can do to reduce
15:41 --> 15:44their risk of getting head and neck cancers,
15:44 --> 15:46and particularly those of
15:46 --> 15:48the oropharyngeal tract.
15:48 --> 15:51So Ansley, let's suppose that somebody
15:51 --> 15:55does get an oropharyngeal cancer,
15:55 --> 15:57tell us a little bit more
15:57 --> 15:58about how those are found.
15:58 --> 16:01Are these routinely things that are
16:01 --> 16:03screened for that are asymptomatic
16:03 --> 16:05or do patients present with
16:05 --> 16:07symptoms and if so what are those?
16:07 --> 16:10It's highly variable how these
16:10 --> 16:12present, we often see patients
16:12 --> 16:14and this depends on the location,
16:14 --> 16:16we often are referred patients that
16:16 --> 16:18have been evaluated by their dentist
16:18 --> 16:21who notices a lesion within the mouth,
16:21 --> 16:22a spot, something that
16:22 --> 16:23doesn't look quite right.
16:23 --> 16:26So they get a biopsy and they would
16:26 --> 16:29get the diagnosis of cancer.
16:29 --> 16:31Again typically this would
16:31 --> 16:32be squamous cell carcinoma.
16:32 --> 16:35So that can occur just by getting
16:35 --> 16:36seen by a dentist regularly.
16:36 --> 16:39So we do strongly encourage regular
16:39 --> 16:42dental visits every six months.
16:42 --> 16:44That's one way these are diagnosed.
16:44 --> 16:46You can imagine that
16:46 --> 16:47cancer within the
16:47 --> 16:49upper digestive tract
16:49 --> 16:52you know can be associated with
16:52 --> 16:53things like difficulty eating,
16:53 --> 16:56painful eating, painful chewing,
16:56 --> 16:58painful swallowing, difficulty swallowing.
16:58 --> 17:03So those are some also things like ear pain.
17:03 --> 17:06Even if it's not an ear cancer,
17:06 --> 17:07there are some nerves in the back
17:07 --> 17:10of the mouth, back of the throat,
17:10 --> 17:12that if those nerves are
17:12 --> 17:14irritated, they can actually cause what is
17:14 --> 17:15called referred pain,
17:15 --> 17:17where you get pain somewhere else.
17:17 --> 17:18So if some patients have ear pain
17:18 --> 17:20even though they have a
17:20 --> 17:22cancer within their throat
17:22 --> 17:24or their voice box,
17:24 --> 17:26their larynx,
17:26 --> 17:28another symptom would be a neck
17:28 --> 17:31mass and that implies that the
17:31 --> 17:33cancer has spread to a lymph node
17:33 --> 17:35within the head and neck.
17:35 --> 17:37So cancers that arise within the
17:37 --> 17:38oral cavity or even the skin,
17:38 --> 17:39the back of the mouth,
17:39 --> 17:42the oral pharynx or the voice box,
17:42 --> 17:43once they arise there,
17:43 --> 17:44they have a tendency or the
17:44 --> 17:46potential to spread to surrounding
17:46 --> 17:47lymph nodes within the neck.
17:47 --> 17:49So at times people don't really
17:49 --> 17:51notice that anything's going on
17:51 --> 17:53except they might feel a mass or
17:53 --> 17:55a lump on the side of their neck.
17:55 --> 17:56So if those are
17:58 --> 17:59symptoms that you have,
17:59 --> 18:02then you should definitely seek
18:02 --> 18:04an appointment with your doctor.
18:04 --> 18:08A neck mass in an adult,
18:08 --> 18:10without being an alarmist, is
18:10 --> 18:12concerning until proven otherwise.
18:12 --> 18:16Neck masses in children typically are
18:16 --> 18:18infectious and so it's not uncommon for
18:18 --> 18:20them to get a course of antibiotics
18:20 --> 18:22and then the neck mass goes away.
18:22 --> 18:25Adults that have a neck mass,
18:25 --> 18:26again,
18:26 --> 18:28it's more concerning than it is in
18:28 --> 18:30the pediatric population and it
18:30 --> 18:32really should be evaluated seriously.
18:34 --> 18:37And so let's say you find a neck
18:37 --> 18:40mass or you have some ear pain,
18:40 --> 18:44or a dentist finds a spot in your
18:44 --> 18:46mouth and refers you to your
18:46 --> 18:50family doctor or a specialist,
18:50 --> 18:51what happens then?
18:51 --> 18:54So if you've gotten the biopsy and you've
18:54 --> 18:56gotten the diagnosis then the next
18:56 --> 18:58place to go is a specialist
18:58 --> 19:00that is trained
19:00 --> 19:02to take care of these sorts of
19:02 --> 19:04problems day in and day out.
19:04 --> 19:06And there are some general ENT's
19:06 --> 19:09that are comfortable and very
19:09 --> 19:11facile and proficient with taking care
19:11 --> 19:13of head and neck cancer patients.
19:13 --> 19:16But typically head and neck cancer patients
19:16 --> 19:19are managed by a cancer specialist,
19:19 --> 19:21surgical oncologist of the head and neck,
19:21 --> 19:24just like if you have colon cancer,
19:24 --> 19:25you would want a surgical
19:25 --> 19:27oncologist to be managing that.
19:27 --> 19:30That also helps with facilitating
19:30 --> 19:32other sorts of treatment.
19:32 --> 19:33Let's say surgery is not
19:33 --> 19:35the best option for you.
19:35 --> 19:37Chemotherapy or radiation may be better
19:37 --> 19:40options and being involved with the
19:40 --> 19:42head and neck cancer specialist you
19:42 --> 19:44automatically are involved with all
19:44 --> 19:46of these other specialists.
19:48 --> 19:50We deliver all of our care within
19:50 --> 19:52the context of a multidisciplinary
19:52 --> 19:54team and we make decisions about the
19:54 --> 19:57best way to treat patients as a team.
19:57 --> 19:59We have weekly meetings and I
19:59 --> 20:01think this is pretty universal within
20:01 --> 20:03the head and neck cancer field,
20:03 --> 20:04weekly meetings,
20:04 --> 20:07tumor boards or tumor discussions
20:07 --> 20:09where we talk about new patients
20:09 --> 20:12or any patient really,
20:12 --> 20:14where we're trying to figure out the
20:14 --> 20:16best way to manage where we meet
20:16 --> 20:18and discuss the best treatment plan
20:18 --> 20:20taking into account that individual
20:20 --> 20:21person looking at their scans,
20:21 --> 20:23looking at their pathology,
20:23 --> 20:25talking about their symptoms and then
20:25 --> 20:26coming up with the best treatment
20:26 --> 20:27plan for them.
20:27 --> 20:29So it's very patient specific,
20:29 --> 20:30patient centered,
20:30 --> 20:32tailored towards each patient
20:32 --> 20:34taking into account a variety
20:34 --> 20:36of things about that person.
20:37 --> 20:39Even before the biopsy though,
20:39 --> 20:41when you just go to
20:41 --> 20:43your doctor and you have some ear
20:43 --> 20:47pain or a neck mass or something,
20:47 --> 20:48should patients anticipate
20:48 --> 20:50that there are scans done?
20:50 --> 20:53I mean, because especially in the cases
20:53 --> 20:55like you were mentioning of ear pain,
20:55 --> 20:57it may be that you have an earache,
20:57 --> 20:59but it may be referred pain
20:59 --> 20:59from somewhere else.
20:59 --> 21:03So how do people know what to biopsy and how?
21:04 --> 21:05Yes, great question.
21:05 --> 21:07I mean the vast majority of the time
21:07 --> 21:09ear pain would will probably be related
21:09 --> 21:10to something going on in the ear.
21:11 --> 21:12Ear infections are much more
21:12 --> 21:14common than head and neck cancer.
21:14 --> 21:16So the odds are if you have ear
21:16 --> 21:18pain you probably don't have cancer,
21:18 --> 21:20but it's probably a good idea to see
21:20 --> 21:21somebody especially if it doesn't
21:21 --> 21:23go away after a couple of weeks,
21:23 --> 21:25a month or two.
21:25 --> 21:27In terms of what to biopsy,
21:29 --> 21:31maybe a better question is,
21:31 --> 21:33when do you start scanning?
21:33 --> 21:35I would say if there's
21:35 --> 21:37a bump that you can feel,
21:37 --> 21:39if you're having swallowing problems,
21:39 --> 21:40it's sort of all of a sudden.
21:40 --> 21:42If your voice has changed,
21:42 --> 21:43sort of all of a sudden,
21:43 --> 21:45and it's persistent over weeks,
21:45 --> 21:47that's something to bring to the attention
21:47 --> 21:49of your primary care doctor.
21:49 --> 21:50And honestly,
21:50 --> 21:52if your primary care doctor
21:53 --> 21:55reassures you that everything looks great,
21:56 --> 21:57if you're still concerned
21:57 --> 21:57about your symptoms,
21:57 --> 21:58you could certainly make
21:58 --> 21:59another appointment or honestly
21:59 --> 22:01get a second opinion.
22:01 --> 22:04And when you talk about
22:04 --> 22:06multidisciplinary team in the
22:06 --> 22:08management of head and neck cancers,
22:08 --> 22:11in that context is there kind of
22:11 --> 22:14an algorithm for which
22:14 --> 22:16patients need chemotherapy,
22:16 --> 22:18which patients need radiation,
22:18 --> 22:20which patients need surgery, which
22:20 --> 22:22patients need a combination of the above?
22:23 --> 22:26Yes, it has mostly to do with the
22:26 --> 22:30anatomic location and also the type of tumor.
22:30 --> 22:32So within the oral cavity,
22:32 --> 22:34that's the mouth, the gums,
22:34 --> 22:35the lips, the tongue,
22:35 --> 22:40those are managed with surgery up front,
22:40 --> 22:42unless in very
22:42 --> 22:43extenuating circumstances,
22:43 --> 22:46if it's a very advanced tumor
22:46 --> 22:47that's involving multiple sites,
22:47 --> 22:50if it's involving the jaw,
22:50 --> 22:51the tongue, the skin,
22:51 --> 22:53if it's a very advanced tumor,
22:53 --> 22:56we may try other things
22:56 --> 22:57first like chemotherapy,
22:57 --> 22:59but in general oral cavity is
22:59 --> 23:01managed with surgery upfront
23:01 --> 23:02and then based on what things
23:02 --> 23:04look like under the microscope.
23:04 --> 23:06So the final pathology that will
23:06 --> 23:08determine whether somebody also
23:08 --> 23:10needs radiation or chemotherapy.
23:10 --> 23:11And then you know,
23:11 --> 23:12if you talk about areas like
23:12 --> 23:13the oropharynx that we were
23:13 --> 23:14talking about before many,
23:14 --> 23:15many years ago,
23:15 --> 23:19it was treated with a very invasive,
23:19 --> 23:21somewhat highly morbid surgery to
23:21 --> 23:22if you can imagine,
23:22 --> 23:24to try to access the back of the throat,
23:24 --> 23:25the back of the tongue.
23:25 --> 23:26It's kind of operating around the
23:26 --> 23:28corner and you'd have to do some
23:29 --> 23:31pretty invasive surgery to get
23:31 --> 23:32access back there.
23:32 --> 23:34So the trend was to actually
23:34 --> 23:35begin treating these patients with
23:35 --> 23:37chemotherapy and radiation and
23:37 --> 23:39they've responded very well and
23:39 --> 23:41cure rates have been very high with
23:41 --> 23:43that over the past 20 or so years
23:43 --> 23:46with the advent of literally a robot
23:46 --> 23:49which helps us access the back of the mouth,
23:49 --> 23:50the back of the throat,
23:50 --> 23:53it's actually used quite a bit in
23:53 --> 23:54gynecologic surgeries,
23:54 --> 23:55urologic surgeries, abdominal surgeries.
23:55 --> 23:57We've actually been able to fashion
23:57 --> 24:00it and get FDA approval, not we,
24:00 --> 24:02but some very smart people have
24:02 --> 24:04been able to get FDA approval for
24:04 --> 24:06this to operate in the oropharynx.
24:06 --> 24:08So surgery has become another way
24:08 --> 24:10that we treat oropharynx cancers
24:10 --> 24:12again with also excellent cure rates.
24:12 --> 24:14And so now we're just trying to
24:14 --> 24:15figure out well is surgery better
24:15 --> 24:17than chemo and radiation and we
24:17 --> 24:18often do surgery plus radiation
24:18 --> 24:20can we get rid of the chemotherapy.
24:20 --> 24:23So all along the way
24:23 --> 24:24it's a constant
24:24 --> 24:28struggle or a constant ambition
24:28 --> 24:31to treat without overtreating,
24:31 --> 24:33but treat such that we cure the
24:33 --> 24:35cancer but without
24:35 --> 24:36causing significant
24:36 --> 24:38functional deficits or significant
24:38 --> 24:41side effects from that treatment.
24:41 --> 24:42Things like salivary gland tumors,
24:42 --> 24:45those are primarily treated surgically,
24:45 --> 24:47followed again by radiation
24:47 --> 24:48or possibly chemotherapy,
24:48 --> 24:50and then cancers of
24:50 --> 24:52the voice box or the larynx,it
24:52 --> 24:54depends on how advanced the disease is.
24:54 --> 24:57If it's a small tumor,
24:57 --> 24:59we would love to be able to
24:59 --> 25:00preserve somebody's voice box.
25:00 --> 25:03And so if there are nonsurgical
25:03 --> 25:05options for larynx cancer,
25:05 --> 25:08then that's what we typically try to do.
25:08 --> 25:09If the cancer has already
25:09 --> 25:11rendered that patient to the point
25:11 --> 25:12where they can't really eat,
25:12 --> 25:14they cannot breathe without a
25:14 --> 25:16tracheostomy tube and they can't
25:16 --> 25:18eat without a feeding tube,
25:18 --> 25:20then we have to ask
25:20 --> 25:20well is this organ, and
25:20 --> 25:22the larynx is an organ,
25:22 --> 25:24is this organ worth preserving if
25:24 --> 25:27it's not working that well and if
25:27 --> 25:29if it's already not working well,
25:29 --> 25:31then the highest chance for
25:31 --> 25:33cure in those cases is surgery.
25:33 --> 25:35So again it depends really on
25:35 --> 25:37the location of the cancer as well
25:37 --> 25:38as how advanced the cancer is.
25:39 --> 25:41On this
25:41 --> 25:44show we talk about a variety of
25:44 --> 25:46cancers and our listeners are
25:46 --> 25:48very familiar with this concept of
25:48 --> 25:51treating patients with chemotherapy
25:51 --> 25:54upfront sometimes and some cancers having
25:54 --> 25:57extraordinarily high rates of what we
25:57 --> 25:59call a pathologic complete response
25:59 --> 26:02where essentially there's no
26:02 --> 26:05cancer left when the surgeon goes in
26:05 --> 26:08and in some cases there are clinical
26:08 --> 26:11trials and various other tumor types
26:11 --> 26:14not necessarily in the head and neck,
26:14 --> 26:17but looking at non operative approaches,
26:17 --> 26:18when we think about the head and neck,
26:18 --> 26:21I can only imagine that as you
26:21 --> 26:23kind of mentioned operating in the
26:23 --> 26:26head and neck can be very morbid.
26:26 --> 26:29There are important structures in there
26:30 --> 26:32that are important for function and so on.
26:32 --> 26:37Has that neo adjuvant approach been
26:37 --> 26:39tried in the head and neck?
26:39 --> 26:41For example, in oral cancers you mentioned
26:41 --> 26:44that the mainstay is treating
26:44 --> 26:46with surgery upfront.
26:46 --> 26:49Have people tried using chemotherapy as the
26:49 --> 26:52primary modality and has that not worked?
26:53 --> 26:57We have.
26:59 --> 27:01We have done it for a handful of patients here.
27:01 --> 27:06We know that in general oral cavity
27:06 --> 27:09cancers will, not all of them,
27:09 --> 27:11but some of them, will respond
27:11 --> 27:13to chemotherapy or induction chemotherapy
27:13 --> 27:16or neoadjuvant as you said.
27:16 --> 27:20But in general it's not a durable,
27:20 --> 27:25curable way of treating this cancer.
27:25 --> 27:28It's just something about the
27:28 --> 27:31oral cavity that it's just not as
27:31 --> 27:33chemosensitive in that regards for it
27:33 --> 27:36to completely eliminate the tumor.
27:36 --> 27:39That's why surgery is,
27:39 --> 27:40for the vast majority of cases,
27:40 --> 27:42the initial treatment modality.
27:42 --> 27:46We have been using the new adjuvant
27:46 --> 27:48model for very advanced tumors
27:48 --> 27:51where surgery would be highly,
27:51 --> 27:56highly morbid and we've seen quite a
27:56 --> 27:58response is the surgery the same and a
27:58 --> 28:01lot of the cases it ends up being the same,
28:01 --> 28:05but honestly the control
28:05 --> 28:06of the cancer is,
28:06 --> 28:08it seems, to be better if they've
28:08 --> 28:10received the neoadjuvant treatment.
28:10 --> 28:11It's actually an active area
28:11 --> 28:12of research for us,
28:12 --> 28:15this neoadjuvant concept and there
28:15 --> 28:19are some trials within the head
28:19 --> 28:21and neck section here at Yale
28:21 --> 28:23looking at neoadjuvant treatments
28:23 --> 28:26for oropharynx cancers.
28:26 --> 28:27So it's very,
28:27 --> 28:29very exciting area of research
28:29 --> 28:31and does have a lot of potential.
28:32 --> 28:34Doctor Ansley Roche is an assistant
28:34 --> 28:36professor of surgery and otolaryngology
28:36 --> 28:38at the Yale School of Medicine.
28:38 --> 28:40If you have questions, the address
28:40 --> 28:43is Cancer Answers at Yale dot Edu,
28:43 --> 28:45and past editions of the program
28:45 --> 28:47are available in audio and written
28:47 --> 28:48form at yalecancercenter.org.
28:48 --> 28:51We hope you'll join us next week to
28:51 --> 28:53learn more about the fight against
28:53 --> 28:55cancer here on Connecticut Public Radio.
28:55 --> 28:57Funding for Yale Cancer Answers is
28:57 --> 29:00provided by Smilow Cancer Hospital.

Information

Head and Neck Cancer Awareness Month with guest Dr. Ansley Roche April 30, 2023 Yale Cancer Center visit: http://www.yalecancercenter.org email: canceranswers@yale.edu call: 203-785-4095