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VOL. 5 • NO. 4
© February 2011
Head and neck
CANCER
Though the combination of smoking tobacco and drinking alcohol accounts for nearly three-fourths of all cases, race and gender remain factors Head and neck cancer is typically defined as cancers that occur in a slew of sites — the nasal cavity, the oral cavity, throat and larynx (voice box). It is often referred to as oral cancer. Susan L. Curry stands Of all the cancers, none are as least in front of the commupublicized as cancer of the head and neck. But nity center that bears her if left unchecked, it is just as deadly. name. Curry underwent The American Cancer Society (ACS) minimally invasive surgery estimated that in 2010 there were almost to treat her head and neck 37,000 new cases of cancers of the oral cavity and 8,000 deaths. If cancer of the larynx is cancer four years ago at included, the incidence jumps to 50,000 and Boston Medical Center. more than 11,000 deaths. (Ernesto Arroyo photo) The list of luminaries who are victims of head and neck cancer is long — Sammy Davis Jr., Yul Brynner, movie critic Roger Ebert, Beatle George Harrison and singer Mary Wells. Actor Michael Douglas has recently been added to the list. o her credit, Susan Curry didn’t scream when Gender and race matter. Head and neck she learned she had cancer. cancer is twice as common in men as in women. According to She became very quiet, almost bewildered, the ACS, oral cancers are the eighth most common cancer in all as the doctor described how the disease had men and the sixth most common in black men. Although the invaded her gums, the roof of her mouth and sinuses. It even crept incidence is comparable in black and white men, the death rates into the base of her skull where countless delicate nerves and tell a different story. Black men die of oral cancer at roughly blood vessels travel to the brain. twice the rate of whites, American Indians and Asians and On one level, Curry said she couldn’t help respecting what almost three times the rate of Hispanics. her doctor described as cancer of the head and neck. “Wow!” So significant is the problem in black males that the National Curry recalled thinking to herself. “That bad boy goes anywhere.” Institute of Dental and Craniofacial Research, an arm of the But on a deeper level, she admits that she was confused. “I National Institutes of Health, has developed a campaign — Oral had no idea that you could get cancer of the mouth,” she said. Cancer: What African American Men Need to Know — to
T
increase awareness. Dr. Scharukh Jalisi is the director of the Division of Head and Neck Surgery and Skull Base Surgery at Boston Medical Center. He attributes the gender differences in part to lifestyles. “Men smoke more,” he said, “and indulge in worse habits.” Age is also a factor. The median age at diagnosis is 62; the median age at death is 67 years. The tricky thing about head and neck cancer is that symptoms may occur but are not readily recognized. And there are many, according to the Head and Neck Cancer Alliance — sores in the mouth that do not heal; difficulty swallowing or chewing; prolonged hoarseness or other change in the voice; unusual white or red patches in the mouth and bleeding in the mouth, to name a few. Jalisi stresses to be aware of the symptoms and do a simple self-check. “Feel your neck for lumps,” he says. “Look in your mouth for sores or spots that should not be there. Be alert for pain on swallowing, especially if you’re not sick.” Jalisi cautions if these symptoms do not resolve within a few weeks, they require medical attention. The key is not to delay treatment. “The earlier you detect cancer,” he says, “the less invasive the treatment and the better the outcome.” If caught early, survival and cure rates are high. When localized — meaning it has not spread — 5-year survival rates exceed 82 percent. Once it spreads to the lungs or other sites, survival drops to 32 percent. Tobacco of all kinds — including cigarettes, cigars, pipes and smokeless tobacco — is the biggest risk factor for head and neck cancer. The longer a person smokes, the higher the risk. And it’s not necessary to light up. Contrary to an oft-repeated myth, smokeless tobacco is not safer than cigarettes or cigars, Curry, continued to page 4
Incidence rates by race 15.7
A funny thing happened after Goins’ surgery. She was not able to speak, but that didn’t stop her from communicating. Her daughter walked into her hospital room with a chalk board. “From day one I was ‘talking,’ ” she said. “After that I carried a notebook with me.” It was a year before Goins could talk again Goins, continued to page 4
16.1
10.5 9.6 8.7
Hispanic American Indian
Willia Goins, right, shown with her daughter, Tracy, says that with the help of a prosthesis, she is able to speak after the removal of her larynx due to cancer. (Daryl Goins photo)
DISPARITIES
Although the incidence rates of oral cancer are comparable in black and white men, the death rates are more than 70 percent higher in blacks than whites.
Rates are per 100,000 men per year 2003 to 2007
Willia Goins, 70, now speaks in a whisper. She had her larynx, or voice box, removed about 14 years ago, and the whisper is as loud as it gets. Goins might speak quietly, but her message comes through loud and clear. “I always had problems with my throat,” she explained. “Even when I was young.” Back then she said she paid no attention to the intermittent pain she had when swallowing and attributed it to the cold weather or perhaps a cold. But as she grew older, the pain continued and got worse with time. Goins finally gave in and visited a doctor. “Something is terribly wrong,” she told her physician. She underwent weeks of testing until the diagnosis was confirmed. “It [cancer] was in my throat,” she said. The doctors warned her that it was possible that her larynx might have to be removed if her throat cancer was extensive. When her initial treatment of chemotherapy failed to solve the problem, she welcomed the surgery. She was 56 at the time. “Maybe I’ve talked enough,” she said. Treatment for oral cancer varies by its location and extent, according to Dr. Scharukh Jalisi, the director of the Division of Head and Neck Surgery and Skull Base Surgery at Boston Medical Center, and may include surgery, radiation and in some cases, chemotherapy. A diverse team of professionals is involved, including oncologists (cancer specialists), dentists, reconstructive surgeons and speech therapists. The team is extensive because of the potential losses suffered from oral cancer. The disease can compromise the ability to speak, swallow and eat, and result in irreversible damage to the area impacted.
DISTURBING
Rates are per 100,000 men per year 2003 to 2007
EFFECTIVE TREATMENTS REQUIRE EARLY DIAGNOSIS
Asian
Whites
Black
6.3
Death rates by race 3.1
3.5
3.7
2.5
Hispanic
Asian
American Indian
Whites
Black
Source: Surveillance Epidemiology and End Results Program National Cancer Institute