Frequently Asked Questions About Head and Neck Cancer
Cancer. A single word that can turn a patient's world inside out. Knowledge is power. For free cancer-related explanations from an oncology nurse or for physician referral information, please call The James Line 24 hours a day, seven days a week at: (614) 293-5066 or toll-free at 1-800-293-5066.
Following are some of the most frequently asked questions about head and neck cancers.
Q. What are the major contributing factors for head and neck cancers?
A. The major causes (etiologic factors) for head and neck cancers are tobacco and alcohol use, including cigarettes, cigars, snuff, chewing tobacco, betel leaf, lime, catchu and areca nut, and marijuana. Combining tobacco and alcohol use poses an even greater risk. Learn how to kick the tobacco habit. Other causes include:
§ Viruses (herpes simplex virus and the human papilloma viruses)
§ Genetic predisposition (further study on this issue is being conducted)
§ Occupation (workers in nickel refining and wood- and leather-working industries)
§ Radiation exposure (radium watch dial painting and thorotrast ingestion)
A possible association is diet, particularly Vitamin A and beta-carotene deficiencies.
Q. What are the risk factors for head and neck cancers?
A. There are many risk factors for head and neck cancers. Age and lifestyle factors, such as alcohol and tobacco use, are the biggest. But risk factors vary, depending on the type of cancer. Select any of the links below to read more about the risk factors for:
§ Laryngeal cancer
§ Lip and oral cancer
§ Oropharyngeal cancer
It's important to note that having any or all of the known risk factors does not necessarily mean that a person will develop a head and neck cancer. On the other hand, having no risk factors does not mean that a person cannot develop a head and neck cancer, either. Smokers and drinkers who don't quit these lifestyle behaviors during and after treatment for a primary head and neck cancer are at a higher risk of developing another cancer.
Q. What are the warning signs of head and neck cancers?
A. Warning signs of head and neck cancers depend on the location of the cancer. Sometimes there are no warning signs. That's why men and women over 40 may wish to get an annual cancer-related health checkup, especially if they use tobacco or alcohol. Having any of the following symptoms for more than two weeks warrants a visit to a physician:
§ A sore on the lip or in the mouth that does not heal
§ A lump on the lip or in the mouth or throat
§ A white (leukoplakia) or red patch on the gums, tongue or lining of the mouth
§ Unusual bleeding, pain or numbness in the mouth
§ A sore throat that does not go away or a feeling that something is caught in the throat
§ Difficulty or pain with chewing or swallowing
§ Swelling of the jaw that causes dentures to fit poorly or become uncomfortable
§ A change in the voice or hoarseness
§ Pain in the ear
§ Slurred speech
§ Loose teeth
§ Unintended weight loss
§ Involvement of skin and face
Q. How will a physician make a diagnosis of head and neck cancer?
A. If a physician suspects a head and neck cancer, he or she will order specific diagnostic tests, depending upon the location of the cancer. These tests may include:
§ Physical examination
§ Inspection of oral and nasal cavities using mirrors and fiber-optic scopes
§ Examination of suspicious lesions
§ Examination of the back of the tongue
§ Blood tests, including a complete blood count and liver function test
§ A blood draw to check for the Epstein-Barr virus (EBV) antibody measurement
§ CT, PET, MRI imaging or X-rays
Q. What is the likelihood that a benign head and neck lesion like an irritation fibroma caused from chronically biting or sucking the cheek will turn into cancer?
A. Treatment of a benign lesion usually involves excising (surgically removing) the lesion. It also means having to break the habit and/or have the cusps of the teeth reduced. Typically, having a benign lesion excised completes the treatment and eliminates the chance for it to become malignant.
Q. How are head and neck cancers staged and what, exactly, does that mean?
A. A staging system is a clinical evaluation, based on the best possible estimate of the extent of the disease prior to treatment. Head and neck cancers are commonly staged using the TNM system. T describes the size of the tumor. N describes the extent of the spreading to the lymph nodes. M is an indicator of metastasis or spreading of the cancer to other organs. The physician needs to know the extent, or stage, of the disease so he or she can determine the best course of treatment. Understanding staging helps both patient and physician make an appropriate treatment decision. Patients should ask their physicians to explain staging in a way that they can easily understand.
Regional Lymph Nodes
N0—No regional lymph node metastasis
N1—Metastasis in a single ipsilaterial lymph node, three centimeters or less in greatest dimension
N2a—Metastasis in a single ipsilateral lymph node, more than three centimeters, but not more than six centimeters, in greatest dimension
N2b—Metastasis in multiple ipsilateral lymph nodes, none more than six centimeters in greatest dimension
N2c—Metastasis in bilateral or contralateral lymph nodes, none more than six centimeters in greatest dimension
N3—Metastasis in a lymph node, more than six centimeters in greatest dimension
M0—No (known) distant metastasis
M1—Distant metastasis is present
Stage I =
T1, NO, MO
Stage II =
T2, NO, MO
Stage III =
T3, NO, MO
T1 or T2 or T3, N1, MO
Stage IV =
T4, NO or N1, MO
Any T, N2 or N3, MO
Any T, Any N, M1
Q. Since surgery is a frequently used in treating head and neck cancers, is there a risk of disfigurement?
A. It's true that surgery often is a treatment for head and neck cancers. That's because surgery is a good way to remove the disease, especially when the cancer has been diagnosed early. Reconstruction may be part of the treatment plan. The physician will discuss treatment options, including reconstruction, with the patient before any surgery takes place. Reconstructive surgical innovations in the past 15 years have created a positive impact on quality of life after treatment. At The James, surgeons have an international reputation for their reconstruction innovations, work to minimize the loss of bone, tissue and muscle, and are fully equipped to reconstruct when necessary.
Q. Besides surgery, how else are head and neck cancers treated?
A. Head and neck cancers are complex. Therefore, treatment options are specific to the patient and the kind and stage of cancer. Treatment often involves surgery, radiation (internal and/or external), chemotherapy or a combination of these. It's important for patients to understand the treatment options available to them, including what impact each option has on quality of life.
Q. What is a clinical trial and how is it decided who will participate?
A. Clinical trials are studies that help evaluate a new treatment. Clinical trials do two things: they attempt to answer scientific questions and they find new and better ways to help cancer patients. An institutional review board (IRB) carefully reviews each clinical trial before patients begin participating. Also, some studies are reviewed by government agencies, such as the National Cancer Institute (NCI) and the National Institutes of Health (NIH).
A patient may or may not wish to participate in a clinical trial. Patients should speak with their physician about all their treatment options, including eligibility to participate in a clinical trial. Most clinical trial participants participate because they hope to benefit in some way from the study or they hope their participation will help researchers develop improved diagnostic and therapeutic approaches.
Q. What advice can you offer to help me live with the effects of head and neck cancer?
A. After treatment for laryngeal or hypopharyngeal cancer, special help may be needed to adjust to the effects of treatment. The type and duration of side effects depends on the type and extent of treatment. Some side effects are temporary, and some are permanent. We're here to assist patients and their families in successfully managing any side effects. Doctors, nurses, dietitians and speech therapists can suggest ways to deal with side effects. It may help to talk with another patient, too. In many instances, social workers can arrange a visit with someone who has had the same treatment.
The following list is a generalization of what side effects could occur, not necessarily what side effects will occur:
- Tender mouth sores
- Dry mouth due to reduction of saliva
- Less saliva and more tooth decay
- Change in the way the voice sounds, weak voice
- Feeling of a lump in the throat
- Extreme fatigue
- Red or dry skin (at the site of radiation therapy)
- Sensitive tongue
- Bitter taste in mouth
- Loss of taste or smell
- Difficulty in swallowing
- Numbness in parts of the neck and throat
- Weak and stiff shoulder and neck (if lymph nodes were also removed)
- Lowered resistance to infection
- Loss of appetite
- Nausea and vomiting
- Hair loss
Remember, each situation is unique and no two people react alike to treatment. In fact, side effects may vary from one treatment to the next. Patients should talk with their physician and nurse about the side effects of treatment. They can help explain more about what's happening, as well as suggest ways of managing any side effects patients might experience.
Living with cancer involves more than the physical aspects of dealing with the disease. At The James, there are numerous support groups and services offered by JamesCare for Life. These programs, such as the Head and Neck Cancer Support Group, provide information and inspiration to head and neck cancer survivors.
Here are some additional resources for the patient, family, friends and co-workers:
An essential portion of head and neck cancer treatment is the need for rehabilitation after aggressive treatment regimes have been employed. For rehabilitation to be successful, it takes a team. Here at The James, speech pathologists, social workers, physical therapists, prosthodontists, occupational therapists, dieticians and nurses all contribute to the patients' return to a comfortable life.
Cosmetic appearance, swallowing, speech, chewing and psychosocial functioning are all considered part of the rehabilitation package. Family, too, plays a critical role in supporting and encouraging the patient. Some functions and appearances become different with this disease, but the cancer patient is still the same person. For more information on patient, caregiver and other support programs, contact JamesCare for Life at (614) 293-6428.