Update on Head and Neck Cancers

Transcript

00:00 --> 00:03Support for Yale Cancer Answers comes from
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00:07 --> 00:10unmet needs in head and neck cancer.
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00:14 --> 00:15Welcome to Yale Cancer
00:15 --> 00:17Answers with your host
00:17 --> 00:18Doctor Anees Chagpar.
00:18 --> 00:20Yale Cancer Answers features the
00:20 --> 00:22latest information on cancer care by
00:22 --> 00:24welcoming oncologists and specialists
00:24 --> 00:26who are on the forefront of the
00:26 --> 00:28battle to fight cancer. This week
00:28 --> 00:30it's a conversation about head and neck
00:30 --> 00:32cancers with Doctor Benjamin Judson.
00:32 --> 00:34Doctor Judson is a professor of
00:34 --> 00:36surgery in Otolaryngology and the chief
00:36 --> 00:38of the division of Otolaryngology
00:38 --> 00:40at the Yale School of Medicine,
00:40 --> 00:43where doctor Chagpar is a
00:43 --> 00:45professor of surgical oncology.
00:46 --> 00:49I always think about head
00:49 --> 00:51and neck cancers as this
00:51 --> 00:53very large bucket
00:53 --> 00:54of heterogeneous diseases.
00:54 --> 00:57Can you talk a little bit
00:57 --> 00:59about how you classify them,
00:59 --> 01:01how you think about them?
01:02 --> 01:04Well your impression is actually on target. Head
01:04 --> 01:08and neck cancers make up about four to
01:08 --> 01:105% of cancers in the United States,
01:10 --> 01:13but when you really zone in on them,
01:13 --> 01:16they are not common,
01:16 --> 01:18but they're not rare either.
01:18 --> 01:20And then when you really begin
01:20 --> 01:22to look more closely, they
01:22 --> 01:25are made up of a lot of different
01:25 --> 01:27cancers in the mouth throat area.
01:27 --> 01:29One of the phrases we use to describe
01:29 --> 01:32it in the medical lingo is it's
01:32 --> 01:34between the dura and the pleura, so
01:34 --> 01:36any cancer that's not brain cancer,
01:36 --> 01:38but it's above the lung
01:39 --> 01:42falls into that bucket of being a head and neck cancer.
01:44 --> 01:46Are there things that
01:46 --> 01:48kind of make these similar?
01:48 --> 01:50So when we think about risk factors for
01:50 --> 01:53example of getting head neck cancers,
01:53 --> 01:55granted that all of these cancers
01:55 --> 01:57are a little bit different,
01:57 --> 02:00but do they share some of
02:00 --> 02:01the same risk factors?
02:01 --> 02:04Some of them do and some of them don't.
02:04 --> 02:07Some of the cancers we see in this area
02:07 --> 02:09just don't have strong risk factors,
02:11 --> 02:12They are uncommon,
02:12 --> 02:15but they they can happen out of the
02:15 --> 02:17blue without any sort of exposure.
02:17 --> 02:18That's probably a minority
02:18 --> 02:20of the cancers in this area.
02:20 --> 02:21Historically,
02:21 --> 02:23the biggest risk factor has been smoking,
02:23 --> 02:24and you know,
02:24 --> 02:26with the decrease in smoking rates
02:26 --> 02:28in the United States since World War
02:28 --> 02:30Two we're beginning to see some slight
02:30 --> 02:32decrease in smoking related cancers.
02:32 --> 02:35But the big sort of change or
02:35 --> 02:37the big story in this area
02:37 --> 02:40is the rise of cancers in the throat
02:40 --> 02:42that are a result of infection
02:42 --> 02:44with the human papilloma virus.
02:45 --> 02:49I want to dig into HPV in a minute,
02:49 --> 02:51but I want to talk about
02:51 --> 02:54a couple of other things before we get there.
02:54 --> 02:57One is a little bit about alcohol.
02:57 --> 03:00Is alcohol a major risk factor
03:00 --> 03:04for head and neck cancers, and if so,
03:04 --> 03:07is there a quote safe amount of alcohol?
03:07 --> 03:10It's a great question and I'm
03:10 --> 03:12saying a little because we don't
03:12 --> 03:15know some of this,
03:15 --> 03:18but what we do know about
03:18 --> 03:21the role of alcohol is that it has a
03:21 --> 03:24synergistic role with tobacco so that
03:24 --> 03:27if alcohol is a risk factor,
03:27 --> 03:29a low risk factor for developing
03:30 --> 03:31head neck cancer,
03:31 --> 03:34smoking is a larger risk factor,
03:34 --> 03:36but if someone smokes and drinks
03:36 --> 03:38it isn't an additive effect,
03:38 --> 03:39it's a multiplicative effect.
03:42 --> 03:44So if you smoke and drink,
03:44 --> 03:45your risk is significantly higher.
03:45 --> 03:48So I guess the biggest role of alcohol
03:48 --> 03:50is in people who smoke because it
03:50 --> 03:52amplifies that risk of smoking.
03:53 --> 03:56I think that although we say that
03:56 --> 03:58alcohol is a risk factor for
03:58 --> 04:00developing a head neck cancer
04:00 --> 04:02A low level of alcohol.
04:02 --> 04:04The risk of developing head
04:04 --> 04:05neck cancer with that
04:05 --> 04:08is quite low. OK, an my next question.
04:08 --> 04:11It has to do with race and ethnicity.
04:11 --> 04:13Are there particular racial and
04:13 --> 04:16ethnic groups that are more at risk?
04:16 --> 04:21I know that I have sent you in the last year.
04:21 --> 04:24At least a number of people that I
04:24 --> 04:27can think of off the top of my head
04:27 --> 04:29who are of South Asian descent,
04:29 --> 04:33which is which is a racial and ethnic group
04:33 --> 04:36that we rarely think about in this country.
04:36 --> 04:38We usually think about race in
04:38 --> 04:40terms of African Americans,
04:40 --> 04:41and we think about ethnicity
04:41 --> 04:43in terms of Hispanic people,
04:43 --> 04:45but if we think globally,
04:45 --> 04:47are there particular racial and
04:47 --> 04:50ethnic groups that are more at risk?
05:03 --> 05:05Head and neck cancer is significantly
05:05 --> 05:08more common in the rest of the world,
05:08 --> 05:10and that probably has to do
05:10 --> 05:11with tobacco and alcohol
05:11 --> 05:13and betel nut exposure,
05:13 --> 05:14which are higher elsewhere,
05:14 --> 05:15especially in Asia.
05:15 --> 05:18The other thing that's at play
05:18 --> 05:20is that there is a particular
05:20 --> 05:22type of head neck cancer
05:22 --> 05:23called nasopharyngeal cancer that
05:23 --> 05:26is much more prevalent in parts of
05:26 --> 05:28Asia and it's related to Epstein
05:28 --> 05:30Barr virus infection and
05:30 --> 05:32we see when individuals from that part
05:32 --> 05:35of the world move to the United States,
05:35 --> 05:37their risk of developing those
05:37 --> 05:39cancers goes down significantly,
05:39 --> 05:41but not to the same level,
05:41 --> 05:44and so we're sort of figuring out why that is.
05:44 --> 05:46It is unclear exactly how
05:46 --> 05:47the risk factors work,
05:47 --> 05:49but we do see different types of
05:49 --> 05:51head neck cancer more frequently
05:51 --> 05:53in other parts of the world, like in
05:54 --> 05:57Asia.
05:57 --> 05:59And that brings me to this whole virus phenomenon,
05:59 --> 06:01because now you've mentioned two viruses,
06:01 --> 06:04both of which are risk factors for
06:04 --> 06:06various head and neck cancers.
06:06 --> 06:08One being HPV and one
06:08 --> 06:10being Epstein Barr virus,
06:10 --> 06:12and certainly right now,
06:12 --> 06:15in the midst of a global pandemic,
06:15 --> 06:19a lot of us have got viruses on the brain.
06:19 --> 06:23Talk a little bit about the differences
06:23 --> 06:26between different viruses and
06:26 --> 06:29how exactly these viruses cause
06:29 --> 06:33cancer and what we can do about it.
06:35 --> 06:38I think what we're seeing the
06:38 --> 06:40most in the United States by far
06:40 --> 06:42is the rise in throat cancers
06:42 --> 06:44that are caused by exposure
06:44 --> 06:46to the human papilloma virus,
06:46 --> 06:49and it's been happening
06:49 --> 06:51over the last 15 or 20 years,
06:51 --> 06:53and it's still an emerging story.
06:53 --> 06:56We're still learning more about
06:56 --> 06:58what's happening and how this works,
06:58 --> 07:00but we certainly know a lot,
07:00 --> 07:02and one of the key takeaways
07:02 --> 07:05is that these are preventable
07:05 --> 07:06cancers, and they're preventable
07:06 --> 07:08if an individual is vaccinated against the
07:08 --> 07:11human papilloma virus when they were younger.
07:11 --> 07:13It's going to take 10
07:13 --> 07:16to 20 years for that to play out.
07:16 --> 07:18Teens today are
07:18 --> 07:20getting vaccinated many of them,
07:20 --> 07:22but not probably as many as we'd
07:22 --> 07:24like in the United States,
07:24 --> 07:26and that's going to prevent these
07:26 --> 07:27cancers in those individuals
07:27 --> 07:3015-20-30 years down the road.
07:31 --> 07:35When we think about HPV,
07:35 --> 07:38I think that many of our listeners may
07:38 --> 07:42think about HPV and think about it being
07:42 --> 07:45really primarily for women for cervical
07:45 --> 07:47cancer being sexually transmitted.
07:47 --> 07:50They don't think about it as much or
07:50 --> 07:53perhaps at all for people of both
07:53 --> 07:55genders in throat cancer.
07:55 --> 07:58Talk a little bit about that.
07:58 --> 08:01I mean, is this the same virus?
08:01 --> 08:04Is it a different virus?
08:04 --> 08:06Is it spread through sexual
08:06 --> 08:09means or other means?
08:09 --> 08:12And what do you say to the people
08:12 --> 08:16who say, my child won't
08:16 --> 08:20engage in oral sex and therefore
08:20 --> 08:24will not be at risk of HPV in their
08:24 --> 08:27throat and therefore if not female,
08:27 --> 08:29does not need to be
08:29 --> 08:32vaccinated?
08:32 --> 08:34That is a question that people ask for sure
08:34 --> 08:37and what we know is
08:37 --> 08:39that human papilloma virus,
08:39 --> 08:42the type of HPV that causes
08:42 --> 08:45throat cancer is the same type that
08:45 --> 08:49can cause cervical cancer in women.
08:49 --> 08:50And in the throat
08:50 --> 08:53it predominantly causes cancer in men
08:53 --> 08:55and we don't know why that's the case.
08:55 --> 08:58What we've learned is that the
08:58 --> 09:00vast majority of Americans are
09:00 --> 09:02exposed to this virus at some point.
09:02 --> 09:06Estimates put it in the 80 to 90% range.
09:06 --> 09:08So almost all of us get exposed
09:08 --> 09:11to the virus at some point.
09:11 --> 09:13Usually our bodies clear the virus.
09:13 --> 09:15For some people,
09:15 --> 09:17the virus hides out in the
09:17 --> 09:19back of the throat.
09:19 --> 09:20And it's it's there,
09:20 --> 09:22sort of evading our immune
09:22 --> 09:23system for decades.
09:23 --> 09:25And it's that exposure of sitting
09:25 --> 09:28there that is a risk factor for
09:28 --> 09:30developing a cancer later on.
09:32 --> 09:34There is some evidence that suggests
09:34 --> 09:36that people who are more active,
09:37 --> 09:39more sexually active are at higher
09:39 --> 09:41risk for developing these cancers.
09:41 --> 09:43But I think anyone just the vast majority,
09:43 --> 09:45almost all Americans are
09:45 --> 09:46exposed at some point,
09:46 --> 09:49and so we do see these cancers in
09:49 --> 09:50everyone.
09:51 --> 09:54And so this opens the
09:54 --> 09:57question of vaccination and as
09:57 --> 10:02we sit here in 2020,
10:02 --> 10:05the remarkable year that it has been,
10:05 --> 10:08it really does bring to light
10:08 --> 10:10the question of vaccination.
10:10 --> 10:14And historically there have been
10:14 --> 10:18people in this country who have been what
10:18 --> 10:21have been called anti-vaxers who have
10:21 --> 10:24concerns about autism due to vaccination and
10:24 --> 10:28perhaps there are more people who worry
10:28 --> 10:30about how vaccines actually get approved
10:30 --> 10:34in this country and whether they are safe.
10:37 --> 10:40Can you speak to that and really
10:40 --> 10:42allay our listeners fears?
10:42 --> 10:44Because right now people might have
10:44 --> 10:47all kinds of concerns with regards
10:47 --> 10:50to not just the Covid vaccine,
10:50 --> 10:52but vaccines in general.
10:52 --> 10:54I think with
10:54 --> 10:58HPV we have the benefit of this
10:58 --> 11:00not being a new vaccine.
11:00 --> 11:03Over 120 million doses have been
11:03 --> 11:06given in the United States and I
11:06 --> 11:08think it's now over 300 million doses
11:08 --> 11:11across the world over the last decade.
11:11 --> 11:15and this is a safe vaccine.
11:15 --> 11:17It also is an effective vaccine.
11:17 --> 11:20It eliminates 90 to 100%
11:20 --> 11:22of the infections and cancers
11:22 --> 11:24that this virus can cause down the road.
11:33 --> 11:36It's safe and
11:36 --> 11:37it's effective and you know,
11:37 --> 11:40in the past the rationale for
11:40 --> 11:42getting the vaccine was sometimes
11:42 --> 11:44it was described as to avoid
11:44 --> 11:46genital warts or things like that,
11:46 --> 11:49and I think that there's not as great a
11:49 --> 11:51perception or understanding that this
11:51 --> 11:53is really a cancer prevention vaccine,
11:53 --> 11:56and so there's new survey
11:56 --> 11:58data and studies going on that
11:58 --> 12:00really shows that if more
12:00 --> 12:02people appreciate that this
12:02 --> 12:04vaccine has the potential
12:04 --> 12:07and the ability to prevent cancers,
12:07 --> 12:09those people are more likely to
12:09 --> 12:11have their children vaccinated,
12:11 --> 12:13so I think that there is some
12:13 --> 12:17work to do in this area to explain
12:17 --> 12:18the benefits of
12:18 --> 12:21the vaccine.
12:21 --> 12:23The other point that comes up is
12:24 --> 12:26the fact that this cancer
12:26 --> 12:28is not terribly common.
12:28 --> 12:31As you said, it's not terribly rare,
12:31 --> 12:33but it's not terribly common,
12:33 --> 12:36and so I'm playing Devil's advocate
12:36 --> 12:39here for the benefit of our listeners,
12:39 --> 12:41who may have similar concerns.
12:41 --> 12:44To really think about the risks of
12:44 --> 12:47the vaccine versus the benefit in
12:47 --> 12:49preventing a cancer that occurs
12:49 --> 12:51in 4 to 5% of the population,
12:51 --> 12:54can you speak to the data
12:54 --> 12:56with regards to autism,
12:56 --> 12:58which is something that
12:58 --> 13:00Jenny McCarthy and other
13:00 --> 13:02figures active in the anti vax
13:02 --> 13:05movement have really promulgated.
13:05 --> 13:07Is there any truth to that?
13:07 --> 13:10I know certainly not with the HPV vaccine.
13:10 --> 13:13There's really been no
13:13 --> 13:15signs whatsoever over hundreds
13:15 --> 13:17of millions of people that
13:17 --> 13:19there is any association like that.
13:19 --> 13:21The data that
13:21 --> 13:24led to some of those claims has
13:24 --> 13:26really been debunked as false data
13:26 --> 13:28at this point for other vaccines.
13:28 --> 13:30So I think that that's
13:30 --> 13:32not really\ up-to-date
13:32 --> 13:34with where we are in terms of
13:35 --> 13:36understanding the side effects.
13:38 --> 13:40I think that given its safety and
13:40 --> 13:42the fact that it's been around for
13:42 --> 13:45a long time and seems to almost
13:45 --> 13:46completely eliminate cancer,
13:46 --> 13:48whether it's cervical cancer
13:48 --> 13:50for girls, head and neck cancers
13:50 --> 13:52for both genders, it reduces the risk.
13:52 --> 13:55general towards for what that's worth.
13:58 --> 14:00Vaccine is really important.
14:00 --> 14:02We're going to take a short
14:02 --> 14:04break for a medical minute,
14:04 --> 14:05and when we return,
14:05 --> 14:07we'll talk more about treatment
14:07 --> 14:10and diagnosis for head and neck
14:10 --> 14:12cancers with my guest doctor Ben
14:12 --> 14:14Judson.
14:14 --> 14:16Support for Yale Cancer Answers comes from AstraZeneca,
14:16 --> 14:17a biopharmaceutical business
14:17 --> 14:20with a deep rooted heritage in
14:20 --> 14:24oncology and a commitment to
14:24 --> 14:27developing cancer medicines for
14:27 --> 14:27patients. Learn more at astrazeneca-us.com.
14:29 --> 14:33This is a medical minute about survivorship.
14:33 --> 14:35Completing treatment for cancer
14:35 --> 14:37is a very exciting milestone,
14:37 --> 14:40but cancer and its treatment can be a life
14:40 --> 14:43changing experience for cancer survivors.
14:43 --> 14:45The return to normal activities and
14:45 --> 14:48relationships can be difficult and
14:48 --> 14:50some survivors face long term side
14:50 --> 14:52effects resulting from their treatment,
14:52 --> 14:54including heart problems,
14:54 --> 14:55osteoporosis, fertility issues,
14:55 --> 14:58and an increased risk of 2nd cancers.
14:58 --> 15:00Resources are available to help
15:00 --> 15:02keep cancer survivors well and
15:02 --> 15:03focused on healthy living.
15:03 --> 15:05More information is available
15:05 --> 15:06at yalecancercenter.org.
15:06 --> 15:10You're listening to Connecticut public radio.
15:11 --> 15:13Welcome back to Yale Cancer Answers.
15:13 --> 15:16This is doctor Anees Chagpar and I am
15:16 --> 15:19joined tonight by my guest doctor Ben Judson.
15:19 --> 15:21We're talking about patients with
15:21 --> 15:24head and neck cancer and right before
15:24 --> 15:27the break we were talking about the
15:27 --> 15:29fact that HPV is actually
15:29 --> 15:31causing a lot of throat cancers
15:31 --> 15:34that we see and this is entirely
15:34 --> 15:36preventable with the HPV vaccine now.
15:36 --> 15:39We talked a little bit about risks
15:39 --> 15:42and benefits and it seems to me that
15:42 --> 15:44with millions and millions
15:44 --> 15:47of doses being given over many,
15:47 --> 15:50many years, we really do have
15:50 --> 15:52the data that suggests that this
15:52 --> 15:55vaccine is safe and effective.
15:55 --> 15:58But I wanted to
15:58 --> 16:02ask who should be
16:02 --> 16:03vaccinated and when?
16:03 --> 16:05Terrific question, so the guidelines
16:05 --> 16:08now for males and females who are
16:08 --> 16:12under the age of 26 to be vaccinated.
16:12 --> 16:13Usually the recommendation is
16:13 --> 16:16for the first dose to be given
16:16 --> 16:19when someone is around 11 or 12
16:19 --> 16:21years old with one second dose.
16:21 --> 16:24And the thought for that timing is that
16:24 --> 16:26the vaccination then has
16:26 --> 16:28time to work before
16:28 --> 16:30they are potentially exposed,
16:30 --> 16:32likely years down the road.
16:32 --> 16:35The change in this area has
16:35 --> 16:36been that the CDC
16:36 --> 16:38broadened the recommendation
16:38 --> 16:40to consider vaccination for
16:40 --> 16:42anyone up to 45 years old.
16:43 --> 16:46I think that that's so important,
16:46 --> 16:48but one of the
16:48 --> 16:51issues that I always ask is,
16:51 --> 16:53many of our listeners
16:53 --> 16:55who may be hearing this show,
16:55 --> 16:58may be saying, I'm 47,
16:58 --> 17:00I'm 48, I'm 52.
17:00 --> 17:01I'm outside that window,
17:01 --> 17:04but I really want to
17:04 --> 17:06get vaccinated because I'm not
17:06 --> 17:09particularly keen on getting cancer.
17:09 --> 17:12What do you do in that older population?
17:15 --> 17:17We don't know for sure the benefit,
17:19 --> 17:21I mean the benefit is
17:21 --> 17:23overwhelming for those that are under
17:23 --> 17:2626 in terms of preventing
17:26 --> 17:28cancers and the issues
17:28 --> 17:30or side effects from
17:30 --> 17:32treatment as well as the risk of death.
17:32 --> 17:34So that is for sure.
17:34 --> 17:37I think in that group that are 27 to 45,
17:37 --> 17:39there is a suggestion that
17:39 --> 17:41there's a real benefit there.
17:41 --> 17:43That's where we have this
17:43 --> 17:44sort of soft recommendation
17:44 --> 17:46to consider vaccination in that
17:46 --> 17:49age group and we just don't know
17:49 --> 17:52beyond that whether the size
17:52 --> 17:54of the benefit to getting vaccination
17:54 --> 17:58and is the reason why we've kind of
17:58 --> 18:01looked at those particular age ranges
18:01 --> 18:04as being the age ranges
18:04 --> 18:06where people are most likely to
18:06 --> 18:09be sexually active.
18:09 --> 18:12So you would imagine that people
18:12 --> 18:15who are in their 50s may have
18:15 --> 18:17already come in contact with
18:17 --> 18:18the virus and therefore
18:18 --> 18:20vaccination may be less effective.
18:20 --> 18:21That is absolutely
18:21 --> 18:23right. The idea is to vaccinate
18:23 --> 18:25people before they could possibly
18:25 --> 18:26be exposed to the virus.
18:26 --> 18:29That's why it's as young as the
18:29 --> 18:31recommendations are
18:31 --> 18:33for the initial vaccination and
18:33 --> 18:35it's less known as we get
18:35 --> 18:37older and we're more likely,
18:37 --> 18:40as I mentioned, 80 to 90% of us
18:40 --> 18:42have been exposed to the virus.
18:42 --> 18:44The potential benefit of the
18:44 --> 18:45vaccination later on is less
18:45 --> 18:47understood or less known.
18:49 --> 18:52I mean if you have people who have
18:52 --> 18:55not been sexually active until their 50s
18:55 --> 18:58for example, maybe they were
18:58 --> 19:00for religious reasons or other reasons
19:00 --> 19:03really did not engage but wanted to
19:03 --> 19:05be vaccinated before they started.
19:05 --> 19:07Whether that's something to consider.
19:07 --> 19:10But it sounds like we're not there
19:10 --> 19:13yet in terms of the data,
19:13 --> 19:15it sounds very reasonable,
19:15 --> 19:17but we just don't know yet
19:17 --> 19:19based on the data.
19:24 --> 19:26Let's suppose you weren't vaccinated.
19:26 --> 19:28What are the signs and symptoms
19:28 --> 19:31that you should look out for in
19:31 --> 19:33terms of head and neck cancers?
19:33 --> 19:36And I mean we talked at the
19:36 --> 19:39top of the show about this being
19:39 --> 19:42a basket of really heterogeneous
19:42 --> 19:45diseases right?
19:45 --> 19:49I would
19:49 --> 19:52imagine that there are so many
19:52 --> 19:55varied symptoms that could
19:55 --> 19:59be signs of head and neck cancer.
19:59 --> 20:01I think that's right.
20:03 --> 20:05In some ways,
20:05 --> 20:07one of the pitfalls that we've
20:07 --> 20:09seen is that with HPV related
20:09 --> 20:11cancers these cancers are arising
20:11 --> 20:14in younger otherwise very healthy
20:14 --> 20:16individuals without real risk factors.
20:16 --> 20:18The vast majority of patients
20:18 --> 20:20with an HPV related cancer
20:20 --> 20:23present with a painless neck mass,
20:23 --> 20:26a physical lump in the neck that they can
20:26 --> 20:30see and feel and they otherwise feel fine,
20:30 --> 20:34and so there's a little bit of a tendency to
20:34 --> 20:35put that off like
20:35 --> 20:37I feel fine and
20:41 --> 20:42living my life and
20:42 --> 20:44so they might not seek
20:45 --> 20:46medical care early,
20:46 --> 20:48but that is the
20:48 --> 20:50leading presentation of this cancer.
20:50 --> 20:52And so one of the
20:52 --> 20:54recommendations is that
20:54 --> 20:56someone who has a mass in the neck,
20:56 --> 20:58even if you otherwise feel great
20:58 --> 20:59and have no other symptoms,
20:59 --> 21:02and if it's there for more than four weeks,
21:02 --> 21:04you should see your
21:04 --> 21:05physician about it.
21:05 --> 21:06See someone about it.
21:06 --> 21:09And what's the age range that
21:09 --> 21:11we typically see these cancers in?
21:11 --> 21:14You mentioned if you're
21:14 --> 21:16an otherwise healthy young person,
21:16 --> 21:18are young people really the
21:18 --> 21:19ones getting this disease,
21:19 --> 21:21or are they at lower risk and this
21:21 --> 21:23is really something that people
21:23 --> 21:26should worry about when they're
21:26 --> 21:28pushing into their 70s and 80s?
21:28 --> 21:30I think that the smoking drinking
21:30 --> 21:32related head neck cancers that
21:32 --> 21:34we saee happen most frequently
21:34 --> 21:37in people who are in their 60s,
21:37 --> 21:39somewhat later in life,
21:41 --> 21:43having a longer time
21:43 --> 21:46of exposure to
21:46 --> 21:48the risky effects of tobacco
21:48 --> 21:50and alcohol. With HPV we're seeing
21:50 --> 21:52these cancers younger and younger,
21:52 --> 21:55and so the peak age of these cancers is
21:55 --> 21:58actually in their 40s and we see it
21:58 --> 22:01at all ages we can see younger and older,
22:01 --> 22:02but it definitely isn't
22:02 --> 22:03happening in younger patients,
22:03 --> 22:05and I think that that's so critical for
22:05 --> 22:08people to really understand because,
22:08 --> 22:11being in my 40s, I can tell you that
22:11 --> 22:15you do kind of feel invincible, right?
22:15 --> 22:17You're healthy, you don't
22:17 --> 22:20really need to go to the doctor.
22:20 --> 22:21Everything is good.
22:21 --> 22:23And you certainly don't think you're
22:23 --> 22:25gonna get cancer, but it can occur.
22:25 --> 22:26That's so true.
22:26 --> 22:28And so often peoples in their
22:28 --> 22:3040s are busy with life.
22:30 --> 22:32You know they've got jobs and whatever it is,
22:32 --> 22:34and so their time for cancer,
22:34 --> 22:36they don't have time for this and
22:36 --> 22:38they are less likely to go get it
22:38 --> 22:40checked out 'cause they're just too busy.
22:47 --> 22:49What are the other other symptoms
22:49 --> 22:50that people should look for?
22:50 --> 22:53I mean a painless lump in the neck
22:53 --> 22:55is certainly something that
22:55 --> 22:57should be a red flag for people,
22:57 --> 22:58even though it's painless,
22:58 --> 23:00and I think that's the other
23:01 --> 23:03thing is that people say
23:03 --> 23:05if it's not causing me pain,
23:05 --> 23:06it can't be bad,
23:06 --> 23:08but we know that with so many
23:08 --> 23:10cancers that simply is not the case.
23:11 --> 23:13That's right, and
23:21 --> 23:23one of the symptoms, potential
23:23 --> 23:26symptoms, is a sore throat or pain
23:26 --> 23:28or difficulty with swallowing.
23:28 --> 23:30Obviously this happens to
23:30 --> 23:33all of us as a result of an infection
23:33 --> 23:35or tonsillitis or something like that,
23:36 --> 23:38but if that persists for more
23:38 --> 23:39than three to four weeks,
23:39 --> 23:42that is another reason to
23:42 --> 23:44seek medical attention.
23:44 --> 23:46Similarly, hoarseness of voice again,
23:46 --> 23:47usually not cancer.
23:47 --> 23:50We all get that at one point or another,
23:50 --> 23:53but if it persists for more than four weeks
23:53 --> 23:55that probably makes sense to seek
23:55 --> 23:57medical attention for that as well.
23:57 --> 23:58Yeah, it seems
23:58 --> 24:00like that four week mark is really
24:00 --> 24:02when people should start saying,
24:02 --> 24:03you know, something
24:03 --> 24:06that you get out of the blue if
24:06 --> 24:07it's been persistent, it's really
24:07 --> 24:09something that you need to look for.
24:16 --> 24:19I had a
24:19 --> 24:21friend who had a nosebleed,
24:21 --> 24:24really young guy, 20-22 years old.
24:24 --> 24:28I think you may have heard about him
24:28 --> 24:32because I sent him to you who
24:32 --> 24:34presented with a nosebleed.
24:34 --> 24:37So simple things like that,
24:37 --> 24:39you think
24:39 --> 24:42it's a nosebleed but
24:42 --> 24:44things like that can happen.
24:47 --> 24:48It goes back to what we
24:48 --> 24:50were talking about before.
24:50 --> 24:51It's the patients who are
24:51 --> 24:53young and healthy and feel fine.
24:53 --> 24:55They're more likely to
24:55 --> 24:56blow off these things.
24:56 --> 24:58And most likely
24:59 --> 25:0199% of the time,
25:01 --> 25:01it's nothing.
25:03 --> 25:04But sometimes it's something,
25:04 --> 25:06and so it is just a reminder,
25:06 --> 25:07if something is not going
25:07 --> 25:09away or not getting better,
25:09 --> 25:10it's ertainly worth
25:10 --> 25:11having someone take a look.
25:11 --> 25:12And sometimes
25:12 --> 25:14there's some things that are really bad
25:14 --> 25:15like what happened
25:15 --> 25:17to my friend. so can you talk
25:17 --> 25:19a little bit about the
25:19 --> 25:23prognosis for head and neck cancers,
25:23 --> 25:26and I realized that again it's a
25:26 --> 25:28heterogeneous bucket of diseases,
25:28 --> 25:30but in general, how
25:30 --> 25:31do people fair?
25:31 --> 25:32You mentioned it varies.
25:32 --> 25:34You know it varies on the type,
25:34 --> 25:36the specific type and the
25:36 --> 25:37stage at which they present.
25:37 --> 25:39So all the more reason to come in
25:39 --> 25:42and get it checked out and found earlier.
25:43 --> 25:44Interestingly
25:44 --> 25:47the prognosis with HPV related cancers
25:47 --> 25:49is much better than with the other
25:49 --> 25:52types of head neck cancers that we see.
25:52 --> 25:53Like for example,
25:53 --> 25:55the smoking drinking related cancer.
25:55 --> 25:57So the vast majority of patients
25:57 --> 25:59with HPV related cancers are cured.
25:59 --> 26:02Cure rates are in the 70 to 90% range.
26:02 --> 26:04There are certainly side
26:04 --> 26:06effects from treatment and so
26:06 --> 26:08our goal is really
26:08 --> 26:10to maximize that cure,
26:10 --> 26:12but also try to
26:12 --> 26:14minimize the side effects of any
26:14 --> 26:17treatment.
26:17 --> 26:21And the prognosis can be
26:21 --> 26:24across the board, it can be varied.
26:24 --> 26:26It can be very good.
26:26 --> 26:29It can be not so good.
26:29 --> 26:32Talk a little bit about treatments.
26:32 --> 26:34Now, granted, treatments are going
26:34 --> 26:37to vary based on whether this is
26:37 --> 26:40found at an early stage or whether
26:40 --> 26:43it is spread and metastatic.
26:43 --> 26:46But on this show we frequently talk about
26:46 --> 26:48personalized medicine about a
26:48 --> 26:50multidisciplinary approach about
26:50 --> 26:52all of the things that have
26:52 --> 26:54evolved overtime that can improve
26:54 --> 26:56treatment and patients outlooks.
26:56 --> 26:58So how do you approach patients
26:58 --> 27:01who have had neck cancer?
27:01 --> 27:03Well, one part of this
27:03 --> 27:06that I'm just passionate about is that
27:06 --> 27:10it's so apparent to me working in this
27:10 --> 27:12field that how patients do
27:12 --> 27:15depends on the team that surround them.
27:15 --> 27:19And so you know, I'm a surgeon and
27:19 --> 27:21that's one potential treatment for a patient.
27:21 --> 27:23Other treatments are chemotherapy
27:23 --> 27:24or immunotherapy, or radiation.
27:24 --> 27:26But it's critical
27:26 --> 27:27to have a nutritionist, a
27:27 --> 27:29speech language pathologist,
27:29 --> 27:30physical therapists,
27:30 --> 27:32a social worker,
27:32 --> 27:34all part of the team and really
27:34 --> 27:37how people do depends on
27:37 --> 27:40having that whole team around the
27:40 --> 27:42patient to help get them through it and
27:44 --> 27:47having the team is key and then as you said,
27:47 --> 27:48just carefully tailoring
27:48 --> 27:50treatments for each patient
27:50 --> 27:52based on the specifics of what's going on
27:52 --> 27:55with them in their situation is just key.
27:55 --> 27:58Talk a little bit about that.
27:58 --> 28:01I mean we talk on this show
28:01 --> 28:04a lot about how there have been
28:04 --> 28:06advances in various tumor types.
28:08 --> 28:10So in some cancers you
28:10 --> 28:12know they they look at,
28:12 --> 28:15panels of hundreds of
28:15 --> 28:17of genetic and genomic mutations,
28:17 --> 28:19and have targeted therapies
28:19 --> 28:21for each of these.
28:21 --> 28:23In others it's not quite so advanced
28:23 --> 28:26in terms of tailoring therapies.
28:26 --> 28:28The idea of course being that you
28:28 --> 28:31know with a more targeted therapy
28:31 --> 28:33you can potentially reduce some
28:33 --> 28:36of the side effects of treatment.
28:36 --> 28:39So given what you had said earlier
28:39 --> 28:41about the side effects of therapy,
28:41 --> 28:44where are we in terms of personalized
28:44 --> 28:46medicine in head and neck cancer?
28:47 --> 28:48It's so interesting
28:48 --> 28:51and one of the areas where personalized
28:51 --> 28:53medicine, really
28:53 --> 28:55is common day-to-day in treating patients
28:55 --> 28:57in this area is that patients with head
28:57 --> 29:00with HPV related cancers are now being
29:00 --> 29:03treated differently than the other cancers.
29:03 --> 29:05We know that their responses and
29:05 --> 29:07the prognosis is different and
29:07 --> 29:09so now the
29:09 --> 29:11treatments are different as well.
29:11 --> 29:14And like so much in
29:14 --> 29:16medicine there are constant advances.
29:16 --> 29:18We're doing transoral
29:18 --> 29:20robotic surgery and now patients
29:20 --> 29:22have the potential to get immunotherapy,
29:22 --> 29:24potentially as part of their treatment,
29:24 --> 29:25and so there's
29:27 --> 29:29more targeted radiation treatment,
29:29 --> 29:31so it's constantly evolving
29:31 --> 29:33and we're seeing
29:33 --> 29:35an overall gradual improvement.
29:35 --> 29:37Slow, but gradual improvement in prognosis,
29:37 --> 29:39and I think it's a result of
29:39 --> 29:41all these little incremental
29:41 --> 29:42steps and improvements.
29:43 --> 29:45Dr. Benjamin Judson is a professor
29:45 --> 29:47of surgery in Otolaryngology,
29:47 --> 29:49and the chief of the division
29:49 --> 29:51of otolaryngology at the
29:51 --> 29:52Yale School of Medicine.
29:52 --> 29:54If you have questions,
29:54 --> 29:55the address is canceranswers@yale.edu
29:55 --> 29:57and past editions of the program
29:57 --> 29:59are available in audio and written
29:59 --> 30:01form at Yalecancercenter.org.
30:01 --> 30:04We hope you'll join us next week to
30:04 --> 30:06learn more about the fight against
30:06 --> 30:09cancer here on Connecticut public radio.

Information

Update on Head and Neck Cancers with guest Dr. Ben Judson October 18, 2020 Yale Cancer Center visit: http://www.yalecancercenter.org email: canceranswers@yale.edu call: 203-785-4095