Kristie L. Kahl: To start, can you explain the different types of head and neck cancer?
Dr. Michael Moore: Head neck cancers are essentially any type of malignancy that happens within the head and neck, essentially excluding tumors that involve the brain that originate from the brain or the eyes or the spinal cord. The main ones we think of are ones that develop from the lining of the nose and mouth or the throat. And those have the common risk factors such as tobacco or alcohol use, or in some cases, the HPV virus. But other cancers such as skin cancer of the head and neck or melanoma that arise from the skin or the lining of the nose, also are considered head neck cancers, as are salivary cancers or tumors that develop in the saliva glands within the head, neck and thyroid cancer.
Kristie L. Kahl: What are some of the signs and symptoms of the various types of disease?
Dr. Michael Moore: That really depends on where it starts. So (head and neck cancers) on the mouth or the throat typically would be a persistent sore within a mouth or throat that won't go away. A lot of times, for example, like a sore throat on one side or the other, that doesn't get better. You can have difficulty swallowing or changes in your voice that can develop or more advanced stage tumors, you can actually get changes in the articulation of your speech or even difficulty in opening your mouth. Coughing up blood can be a sign, but that can also be related to a number of other things. Loosening of teeth that aren't related just to dental disease is obviously a big red flag. And then one thing that we're seeing a lot more of, especially in HPV-related cancers are actually just a painless neck mass. A lot of times that can be the first sign or symptom of head neck cancer.
Kristie L. Kahl: Are there risk factors that are associated with the disease? And if so, what are they?
Dr. Michael Moore: With regards to tumors of the mouth and the throat, typically tobacco and alcohol use are thought of as the primary risk factors for many. But the HPV virus, or the human papilloma virus, has now been linked to over 70% of cancers developing in what's called the oropharynx, or the back of the throat. And those tumors typically arise within the tonsils or the tonsil tissue on the back of the tongue called the base of the tongue.
Kristie L. Kahl: Are there screenings for head and neck cancer available?
Dr. Michael Moore: That's a great question. There actually aren't any great screening tests that are widely used, unlike things like the pap smear for cervical cancer or a blood test that can be used for many other types of cancers. Currently, there are no approved screening studies or tests that can be used for head neck cancer. For certain high-risk individuals, when they're going to see their dentist, we do usually recommend that they at least talk to their dentists to do a look in the mouth and the throat during their exam. But in reality, there's no effective screening test at present. In particular, for the HPV-related cancers, these often happen in areas that you really wouldn't be able to see them on a routine physical exam, unless, of course, it's developing something that's more significant. And so oftentimes, these tumors may be found at a later stage. I think the big thing is, if you have anything that's going on, that really seems out of place to let your doctor know about it, and they can investigate it further.
Kristie L. Kahl: How is head neck cancer typically diagnosed then?
Dr. Michael Moore: So I would say it really depends on which type it is. So, the most common presenting sign or symptom of the HPV-related throat cancers are actually a neck mass within the neck and so it's often referred to as the shaving cancer because people will often find it just when they're shaving and they feel it on themselves. But many other cancers actually start causing symptoms where they originate. So, for mouth cancer is a lot of times a non-healing sore on either the mouth or the tongue. Skin cancers are obviously a non-healing sore on the skin, throat cancers, as you know, somebody's looking to investigate a persistent sore throat or change in their voice or their swallowing. But to ultimately make the diagnosis, you need to actually take a biopsy or a small piece of tissue and have the pathologists look at it under the microscope to truly confirm that cancer is present.
Kristie L. Kahl: And once a patient receives a diagnosis, can you discuss the types of staging for head and neck cancer?
Dr. Michael Moore: The staging systems really depend on where they are, as far as how they're staged. There's a big range. So cancers are usually staged in three different components. The T is a primary tumor, meaning the main tumor that starts the cancer itself, the N is the lymph nodes within the neck. So has it spread to any lymph nodes? And if so, how many? And are they all just a side of the main tumor or on both sides. And then M is if it's gone to other parts of the body.
Based on the extent of the primary tumor, whether or not any lymph nodes are involved and then any distant metastatic disease, it's usually stages either 1 through 4, whereas 1 or 2 are considered more early stage and 3 or 4 are more advanced stage and the staging systems are really meant to kind of help grouping people into different prognostic groups, meaning how well you'll do from the treatment of your cancer. And then also to sometimes help guide therapies, as many of the clinical trials that have been used to develop treatment approaches, kind of stratify people based on their stage.