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Head and neck cancers: risk, diagnosis and treatment

A cancer diagnosis is never welcome. But cancers of the head and neck can be particularly difficult to diagnose and treat. This week on WRVO's health and wellness show "Take Care," hosts Lorraine Rapp and Linda Lowen, speak with Dr. David Pfister, the chief of the head and neck oncology service at Memorial Sloan Kettering Cancer Center about the risk factors for these types of cancer.

Lorraine Rapp:  What are the most common forms of cancer that appear in the head and neck regions?

Dr. David Pfister: Generally when folks think about head and neck cancer they think of tumors of what we call the upper area digestive track, which is the upper areas in your mouth, your throat, when you go “ah” in the mirror, your voicebox and so forth. So that is the most common sites. The other common site that is common is thyroid cancer is quite common.

Lorraine Rapp: So are the causes the same for most of these?

Dr. Pfister: Well historically, when you look at tumors of the head and neck, upper area digestive track, the main risk factors for these tumors have been tobacco and/or alcohol use. And there seems to be kind of a synergistic  risk with the interaction between tobacco and alcohol. And so this is one of the sites in the body where those behaviors were clearly associated with the cancer.

Lorraine Rapp: How is this usually found? Does the patient find it or is it screened for?

Dr. Pfister: There’s not a – unlike, let’s say for breast cancer or colon cancer or cervix cancer with the pap smear – we’re still trying to find a good screening test for head and neck cancers. It’s really, so you go to the dentist, you look in the mirror yourself. Moving on there to symptoms, what do patients typically present with? In my experience, generally it’s the patient comes in with a complaint, and then when I examine, I look around and find something. But history is extremely important.

Linda Lowen: How is this treated, because we are talking about sensitive areas. Does treatment always compromise function?

Dr. Pfister: Historically, these tumors, the approach would have mainly been with surgery and if it didn’t lend itself to surgery, it would be some sort of radiation, or radiation as an adjunct to surgery. And really, when we approach head and neck cancer, we of course want to cure the patient, we want the patient to live, we are obviously very focused on survival. But integrated with that, is how do we design a treatment plan that leads to the best possible cure rate, but at the same time optimizes quality of life, cosmeses and function for the patient.

Linda Lowen: HPV-related head and neck cancers – the human papillomavirus. Could you talk about it, because it is on the rise and it’s one of those cancers that’s a little tricky to talk about.

Dr. Pfister: When you look at head and neck cancers and you look over couple decades, as tobacco behaviors in our country with people decreasing the amount of smoking, overall you see these tumors tracking downward. However the subgroup that’s related to HPV is clearly tracking upward. What we find is the patients tend to not necessarily have any tobacco or significant alcohol history, that they tend to be younger , they tend to have less other medical problems, because they haven’t been smokers. They actually have a cure rate, even when they have stage 3 and 4 disease, that is actually, we cure most of these patients. To the extent that these HPV-related cancers are related with certain lifestyle factors, obviously, you know generally, when you look epidemiologically it’s potentially associated with oral sex and increased number of sexual partners. That’s another lifestyle factor that potentially could be considered in terms of decreasing risk.

More of this interview can be heard on "Take Care," WRVO's health and wellness show Sunday evenings at 6:30 p.m.  Support for this story comes from the Health
Foundation for Western and Central New York.