Head & Neck Cancer

Head&Neck Cancer

by, Noel C. Estopinal, MD

A sore throat is usually a sign of a relatively minor problem like spring allergies or the common cold. But if you have a sore throat that lasts for more than two weeks, you should make an appointment to go see your family physician.

That’s because persistent sore throat can also be a sign of head and neck cancer, according to Dr. Noel C. Estopinal, a radiation oncologist with Alliance Cancer Care in Huntsville.

Head and neck cancer, which includes cancers of the mouth, throat (pharynx), voicebox (larynx), sinuses, nasal cavity and salivary glands, accounts for about 5-7 percent of cancer cases nationally.

But Dr. Estopinal said it’s more common in states with the highest rates of smoking, smokeless tobacco and alcohol use – including Alabama.

“It weighs more heavily in the South than in other parts of the country,” he said. Tobacco smoke contains more than 70 chemicals that have been shown to cause or promote cancer. Meanwhile, alcohol irritates the mucous-covered surfaces of the mouth and throat, making them more vulnerable to those carcinogens.

Not all head and neck cancers are linked to cigarette and alcohol use. Dr. Estopinal said human papillomavirus (HPV) is now a leading cause of oropharyngeal cancer affecting the base of the tongue, soft palate, tonsils and side and back walls of the throat. HPV can be spread through sexual contact, including oral sex.

In addition to persistent sore throat, head and neck cancer warning signs include persistent difficulty swallowing, a growing lump in the neck, chronic hoarseness, sores in the mouth that won’t heal, changes in how your voice sounds, and unexplained weight loss. Early detection is the key to successful treatment of head and neck cancers, so get to your doctor if you have any of the above symptoms that last for more than a couple of weeks. “When the disease is caught in the earliest stages, we can often achieve excellent long-term control with less aggressive therapy,” said Dr. Estopinal. “For patients with very small lesions on the vocal cords, a short course of radiation alone can result in a cure rate of better than 90 percent. Other patients may only need to have the tumor surgically removed with no further treatment.

If your doctor suspects you have head and neck cancer, the first step is usually a tissue biopsy of the affected area.

Once the diagnosis is confirmed, the radiation oncologists at Alliance Cancer Care can develop a customized treatment plan. In addition to Dr. Estopinal, the Alliance physician team includes Drs. Harry James McCarty III, Elizabeth Falkenberg, Hoyt A. “Tres”

Childs III, John F. “Jack” Gleason Jr., Traci McCormick and Stanley Clarke.

Depending on the stage and location of the disease, the treatment plan for head and neck cancer may include surgical removal of the tumor by an ear, nose and throat specialist, targeted radiation therapy at one of Alliance’s six locations across North Alabama, and chemotherapy overseen by a medical oncologist.

“Head and neck cancer is one of the most intensive multi-disciplinary cancers that we treat,” said Dr. Estopinal. “We’re fortunate in Huntsville to be staffed with many experienced surgeons, radiation and medical oncologists who have successfully treated head and neck cancer.”

If radiation is recommended, Alliance Cancer Care uses Intensity Modulated Radiation Therapy (IMRT) and Image Guided Radiation Therapy (IGRT) to deliver the treatment. A CT scan of the patient is taken before and during treatment to make sure the radiation beam hits only the tumor and not the surrounding healthy tissue.

The standard regimen for head and neck cancer is 25-35 radiation therapy treatments over a period of five to seven weeks. Side effects may include fatigue, dry mouth, skin irritation in the treated area, pain or difficulty swallowing, and loss of appetite due to changes in the way food tastes. “With IMRT and IGRT, we’re able to steer the radiation dose around the salivary glands, jaw bone, spinal cord and other sensitive organs while targeting the tumor,” said Dr. Estopinal. “That helps to minimize any side effects from treatment and improves the opportunity for cure.”