Kristie L. Kahl: To start, why is it important for individuals to be conducting self exams, especially for head and neck cancer?
Dr. Michael Moore: Yeah, I think it's a great point. You know, many mouth and throat cancers, in particular, oftentimes don't cause symptoms early on in the disease. And so, especially for people who may be at higher risk than others, if you are able to pick something up on yourself, it may end up saving your life or at a minimum would bring it to your doctor's attention much earlier on and hopefully allow you to have a more successful treatment and one that may have fewer side effects. The challenge of mouth and throat cancers are they don't have other good screening tests, if you will.
So there's not a blood test or an easy test that can be done that's an approved screening test for mouth or throat cancer. There's no pap smear of the throat, for example. And so the best means we have is just to be in tune with your body and do a regular exam. And to do that, obviously, there's only certain areas that can be examined well, but the mouth is certainly one of them. And I think performing a regular oral exam and good skin examination, and a good feeling of the lymph nodes within your neck and the salivary glands is one good way of potentially finding something early.
Kristie L. Kahl: How does early detection, in particular, affect survival rates in head and neck cancer?
Dr. Michael Moore: Yeah, so obviously depends a little bit on where the cancer is and what type of cancer it is as far as the prognosis, but as a general rule, stage 1 or 2 cancers or early stage cancers are going to do much better oftentimes have survival rates well over 50%, and in some cases, 70%, 80%, even 90%, just depending on the type of cancer, whereas stage 3 or 4 cancers are going to have a much more guarded prognosis. Depending on the type of cancer, it can be as low as 20% to 30%. For diseases still contained within the head neck, or potentially a bit higher, you know, 50% or 60%, if it's in an area that's very amenable to treatment still. But even for those ones, where you could cure it for the more advanced disease, the treatment is going to be that much more challenging to endure, whether it's a big surgery and following that with radiation therapy, or radiation therapy and chemotherapy, the more advanced diseases are almost always going to require a much more significant and aggressive treatment, and often it's going to result in more long term side effects.
Kristie L. Kahl: Can you walk us through how to conduct a self exam?
Dr. Michael Moore: Essentially, you're going to want to start by just feeling your scalp and your skin of your head and neck. So just get a sense on where that is. And if you feel anything that feels like a persistent or growing lump, or an area that bleeds easily, those would all be things that would be concerning.
In particular, for skin lesions, the pigmented ones are the ones that are brown. Think of the ABCDE’s. So, A for asymmetry: Is it a perfectly round circle, or does it have an area that is shooting off to the side. B the border: so they have a well-defined border, or is it actually irregular on the border. C is the color: so if it has just one brown color, that's better than if it has multiple shades or some parts are darker than others are, and some parts are lighter. And then D: if its diameters greater than 6 millimeters or a little bit bigger than the eraser on a pencil, that would be big. And then E is elevations: if it starts to grow up those would be concerning for pigmented lesions.
When you feel also on the inside of the mouth and the throat, usually getting a flashlight and in the mirror, you can hold out one cheek and just start by looking at the top, the bottom of the cheek on one side and the other, hold your lip out and looking on the inside of the lips and on the gums. Same as on the top. And then raising your tongue up and shining the light there sticking your tongue out on one side. And then the other, you'll be able to look there and then straight out in the middle. And then looking at the roof of the mouth. And then if you can get a look straight back in the back of your throat, get a sense on what you look like. The idea is you want to see some symmetry looking similar on one side or the other. There are many lumps and bumps within all of our mouths that are normal. And so once you get to know those, then you'll have a much better sense on what abnormal is.
And then the feeling down on the lymph nodes underneath the chin and down in the neck. And if you feel one side has a lump or a bump that shouldn't be there, it's not comparable on the other side. You want to bring that to the attention of your doctor. We have a normal saliva gland tucked under the chin and then also a normal one here, but if you have a lump within them would be something that should be investigated.
Kristie L. Kahl: If an individual thinks they see or feel something that's not right, what's the next step they should take?
Dr. Michael Moore: Yeah, so usually I'd just bring it up to your doctor. You know, it's one thing to have a cold and have a gland that comes and goes, but anything that's long there longer than two weeks shouldn't be there. And so we usually recommend bringing it up to your primary doctor. And if they have any concern, they'll usually have it assessed by an ear, nose and throat doctor or head and neck surgeon. It doesn't mean you need surgery, it just means you need to be assessed to see if there's anything to worry about. And they may do a mouth and throat exam, for example, a lump within the neck. They may do either a CAT scan or an ultrasound. And if they're wanting to get a biopsy of it, they'll consider doing what's called an ultrasound guided fine needle aspiration where they actually draw out some cells guiding the tip of the needle with an ultrasound. And the pathologist can really definitively say what is it that's going on in that lump that you're feeling.