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Oral and Head and Neck Cancers Rising: What You Need to Know

Baptist Health Miami Cancer Institute

Most people know that tobacco use is a major risk factor for oral and head and neck cancers. Some even understand that excessive alcohol consumption also ups the odds. Human papillomavirus (HPV), however, is responsible for the majority of oropharyngeal cancers. The HPV vaccine is highly effective in preventing HPV-related head and neck cancers and is routinely recommended for children starting at age 9 through 26. Adults up to age 45 may also benefit from the vaccine, especially if at risk of HPV exposure.

 

April is Oral, Head & Neck Cancer Awareness Month. Approximately 71,100 cases of head and neck cancer are diagnosed in the U.S. each year, according to the National Cancer Institute. Unfortunately, over the past decade the incidence has increased significantly, particularly among younger adults.

 

 

(Watch now: Geoffrey Young, M.D., chief of head and neck surgery at Baptist Health Miami Cancer Institute, and Alessandro Villa, DDS, MPH, Ph.D., chief of oral medicine, oral oncology and dentistry at the Institute and Baptist Health, recently teamed up for a Baptist Health Talk podcast as part of April’s Oral, Head & Neck Cancer Awareness Month.)

 

Experts Geoffrey Young, M.D., chief of head and neck surgery at Baptist Health Miami Cancer Institute, and Alessandro Villa, DDS, MPH, Ph.D., chief of oral medicine, oral oncology and dentistry at the Institute and Baptist Health, recently teamed up for a Baptist Health Talk podcast to provide updates on the subject.

 

It’s important, they agree, to define oral and head and neck cancer. “I tell everyone it’s pretty much anything above the collarbone, but outside of the brain,” Dr. Young says. “These would be cancers of the thyroid and salivary glands, some skin cancers of the head and neck and what we call mucosal cancers that come from the lining of the upper aerodigestive tract, such as the throat, mouth and tongue.”

 

Common Symptoms of Oral and Head and Neck Cancers

Symptoms of oral and head and neck cancer can include:

 

·      A lesion or sore in the mouth that won’t heal.

·      Pain in the mouth or at the back of the throat.

·      A lump, often not painful, in the neck.

·      Difficulty swallowing or chewing.

·      A change in the voice, typically hoarseness.

·      A change in hearing or pain behind the ears.

 

Some Types of Oral Cancer Develop from Leukoplakia

Of particular concern, Dr. Villa says, is a disorder present in up to 4 percent of the population called leukoplakia. “Leukoplakia is defined as a wide plaque (often white patches in the mouth, gums, tongue and inside of the cheeks) that doesn’t go away. Several lesions can be white, but typically leukoplakia has certain clinical characteristics that include demarcation of the margins. The tongue is the most commonly affected site,” he says. Leukoplakia is a potentially malignant disorder. Several oral cancers develop from leukoplakia.

 

Patients with leukoplakia may undergo a biopsy and, depending on the findings and the size of the lesions, they may have surgery or CO2 laser ablation. Some patients may be given a topical chemotherapeutic agent and others may be under active surveillance, where they are seen every four to six months and undergo surveillance biopsies to make sure the lesion has not progressed.

 

An annual oral examination by your dentist can help detect precancerous and cancerous lesions, but if you have any persistent symptom or a lesion of the mouth that does not go away in two weeks, don’t wait to see your dentist. Or, ask to be referred to an oral medicine specialist. Dr. Villa is the only cancer center-based, board-certified oral medicine specialist in South Florida.

 

Treatment Options for Oral or Head or Neck Cancer

If you are diagnosed with oral or head or neck cancer, it’s critical to be treated at an experienced, comprehensive cancer center like Miami Cancer Institute, the doctors say. “There are many different treatment options in the head and neck landscape,” says Dr. Young. “That’s one of the reasons why a multidisciplinary team is very important. You’re talking about critical areas of anatomy that involve speaking, communication, eating, tasting and breathing. We want to preserve as much of that as we possibly can when treating these diseases.”

 

Treatments may involve surgery, chemotherapy, radiation or a combination of approaches. The evolution of treatment for oral and head and neck surgeries has changed significantly in the past decade and the Institute has a sophisticated single-port robotic system — the only one of its kind that is FDA-approved for transoral robotic surgery.

 

“We’re lucky to have that. They get small tools into a hard-to-reach area and provide better visualization,” Dr. Young says. “The new technologies really allow individualized approaches to treatment.”

 

The Institute also offers proton therapy for certain patients, which provides very targeted radiation, sparing nearby healthy tissues. Additionally, immunotherapy, which uses medications to boost the body’s own immune system to help kill cancer cells, is being studied for its ability to treat head and neck cancers.

 

How Radiation Therapy Can Affect Your Oral Health

Good oral health is essential for all cancer patients, the doctors stress. The Institute follows American Society of Clinical Oncology guidelines that all patients who are scheduled to have radiation therapy see their dentist for an evaluation. “The goal is to minimize any sources of dental infection,” Dr. Villa says. “Teeth with a poor prognosis should be extracted before starting chemoradiation because radiation specifically can cause problems to the jawbone. It’s a complication called osteoradionecrosis.”

 

Alessandro Villa, DDS, MPH, Ph.D., chief of oral medicine, oral oncology and dentistry at Baptist Health and Baptist Health Miami Cancer Institute

 

Cancer treatment can cause a number of other oral side effects, including painful mouth sores (mucositis), difficulty swallowing, changes in taste, speech problems and dry mouth.

 

A large study that looked at 4,000 cancer patients who received immunotherapy, found that about 8 percent developed some toxicity affecting the mouth, including xerostomia (subjective feeling of dry mouth), hyposalivation (reduced saliva production), dysgeusia (altered taste) and oral mucosal lesions.

 

Maintaining Oral Health During Cancer Treatment

There are a variety of treatments and recommendations for maintaining optimal oral health during cancer treatment. The Institute also has skilled speech-language pathologists, nutritionists, nurse navigators and other specialists to help patients with specific challenges.

 

Geoffrey Young, M.D., chief of head and neck surgery at Baptist Health Miami Cancer Institute

 

“As research progresses, combination therapies and novel drug development offer hope for better survival and quality of life. We are getting closer to more effective and less toxic solutions,” Dr. Young says.

 

Even better, the doctors agree, is prevention. “We have a cancer prevention vaccine,” Dr. Villa says. “It’s safe, it’s effective. It not only prevents HPV-associated oropharyngeal cancer, it also prevents many others caused by HPV persistent infections.”

 

Dr. Young adds, “If you look at Australia, where they have 95 percent vaccination rates, there are HPV-related diseases that haven’t been seen for five years now. If you eliminate the cancer, we have a win for the world.”

 

Speak to your dentist, your primary care physician or your child’s pediatrician for more information about the HPV vaccine.

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With internationally renowned centers of excellence, 12 hospitals, more than 28,000 employees, 4,500 physicians and 200 outpatient centers, urgent care facilities and physician practices spanning Miami-Dade, Monroe, Broward and Palm Beach counties, Baptist Health is an anchor institution of the South Florida communities we serve.

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