New risk factor for head, neck cancers and how it could impact screening and diagnosis

May 11, 2014

Any diagnosis of cancer can be scary. But cancers of the head and neck bring unique challenges because of the importance of this region to the body. These cancers can impact a patient’s ability to speak, swallow or breathe.

This week on “Take Care,” Dr. David Pfister talks about the risk factors for head and neck cancers and how they are diagnosed and treated. Dr. Pfister is the chief of the head and neck oncology service at Memorial Sloan Kettering Cancer Center, and treats patients with a broad spectrum of head and neck malignancies including tumors of the mouth, throat, thyroid, salivary glands and skin.

The category of head and neck cancers includes malignancies that appear in what’s called the upper area digestive track.

“The upper areas in your mouth, your throat, when you go ‘ah’ in the mirror, your voicebox and so forth,” said Dr. Pfister.

Historically, the biggest risk factor for this kind of cancer is tobacco and alcohol use. The link between smoking or chewing tobacco and getting cancer in your mouth, throat or on your tongue is clear and more commonly known. But Dr. Pfister says the danger with alcohol is often when it is consumed, or over-consumed, in conjunction with tobacco.

“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,” said Dr. Pfister.

But, in recent years, Dr. Pfister says it has become clear that head and neck cancers can because by a viral infection, specifically the human papillomavirus, or HPV. In fact, as fewer American are smoking, the number of head and neck cancers due to tobacco use have gone down. But, meanwhile, cases of cancer in this region that can be traced to HPV are tracking up. And Dr. Pfister says these patients fit a different profile.

"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,” said Dr. Pfister.

“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,” said Dr. Pfister.

The fact that these cancers are associated with HPV, is actually causing some hope among researchers that a screening test could be developed for these kind of head and neck cancers. Cervical cancer, which is associated with the HPV virus as well, can be screened using a pap smear test.

Regardless of the cause, Dr. Pfister says currently there are no standard screening tests. Patients generally notice that something is wrong, they have problems swallowing or discomfort of some kind. Or their dentist may detect a problem.

Treatment for head and neck cancers is generally surgery, sometimes followed by radiation. But if the location of the cancer makes surgery impossible, the cancer may be treated by radiation alone. Dr. Pfister says that advances in robotics are making surgery possible in locations in the head and neck that were either too difficult for human hands to perform, or would have caused too much damage.

Whatever the treatment, Dr. Pfister says that the first priority is curing the cancer and saving the patient’s life. But, Dr. Pfister says the treatment team also needs to consider maintaining the function of the mouth and throat, and how it will impact the way a patient looks.

“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.”