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The Changing Face of Head and Neck Cancers

By August 12, 2014 - 3:07pm
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It used to be that head and neck cancers were an older man’s illness, spurred on by decades of smoking and drinking, but that’s not true anymore.

“We’re seeing many more young and middle-aged men -- and some women-- with these cancers,” said Dr. Rex Hoffman, a radiation oncologist practicing at the Disney Family Cancer Center in Burbank, California, and affiliated with Providence Saint Joseph Medical Center in Los Angeles.

Since the late 1980s, when the United States heightened its public awareness for smoking cessation, the number of new cancers in the larynx (voice box), hypopharynx (sometimes called the gullet) and oral cavity (lips, front of tongue, cheek, upper and lower gum lines) lessened, Hoffman said.

But as those cancers decreased, the incidence of new cancers in the oropharynx (the back or base of tongue and tonsils) rose sharply.

The head and neck cancers most frequently seen now appear to be sexually transmitted, linked to the human papillomavirus, especially HPV-16, rather than smoking and drinking. Recent National Cancer Institute studies show that these cancers are more common than once believed.

mesh mask

HPV-16 is the same strain of the virus that causes cervical cancer in women. However, HPV-related head and neck cancer is nearly twice as common among men as in women, according to the American Cancer Society’s 2012 Cancer Facts & Figures.

“The incidence of these HPV-related oropharynx cancers now outnumber the incidence of head and neck cancer that is not HPV related,” Hoffman said. “In general, patients with HPV-positive oropharyngeal cancer are approximately 10 years younger than those with HPV-negative cancer.”

In fact, these cancers are being diagnosed as young as age 30 in nonsmokers and nondrinkers. Conventional knowledge suggests that HPV-related cancers actually start forming years before they are diagnosed, said Hoffman.

General symptoms may include:

  • Lump on the side of one's neck
  • Persistent sore throat and ear pain
  • Non-healing sore in one's mouth on tongue, under tongue or on side of mouth
  • Progressive hoarseness
  • Chronic sinus infections or persistent sinus infection despite several courses of antibiotics
  • Persistent pain with swallowing 

If you or your dentist identify any of the above symptoms, it is important to see your doctor.

Treating head and neck cancers can be pretty tricky. For starters they are in a region where normal critical structures, such as the ears, eyes, brain and spinal cord are located. How do you get the right amount of radiation to the cancerous site without also radiating normal skin and organs around it?

A customized mesh mask is the answer. It’s molded from a soft, pliable, white or clear plastic to form-fit each cancer patient’s entire face. The mask, which sort of looks like a hockey face mask, will be used throughout the treatment process to not only protect the patient from receiving unnecessary radiation exposure to noncancerous areas, but also helps to keep the patient motionless during treatment.

mesh mask

Using mesh masks, also called radiotherapy moulds, for head and neck cancer treatments is the standard of care and is currently being widely used throughout the United States, Hoffman said.

Before a head and neck cancer patient starts a course of radiation, the mask is created for him or her during a procedure called CT simulation. The process only takes a few minutes and is accomplished during the phase when the oncology team devises your treatment plan.

The mask is snug, but should be comfortable, Hoffman said. When treatment starts, the mask is placed on the patient and then bolted to the table ensuring the radiated area is consistent. Most radiation treatments last for 5-20 minutes depending on the location, type and stage of cancer.

Typically radiotherapy masks are created to cover the patient’s head, or it may extend to also cover the neck, even the shoulders.

Some researchers are currently examining ways to allow head and neck cancer patients to use less than an entire mask during treatments, Hoffman said. However these masks are several years away from being routinely used in patient care.

Lynette Summerill is an award-winning writer and watersports junkie living in San Jose, Calif. In addition to writing about cancer for EmpowHER, her work has been seen in publications internationally.

Sources: Interview with Dr. Rex Hoffman. 11 August 2014.

Head and Neck Cancers. NCI Fact Sheet. Accessed 12 August 2014. http://www.cancer.gov/cancertopics/factsheet/Sites-Types/head-and-neck

What are oral cavity and oropharyngeal cancers? American Cancer Society. 5 August 2014. Online: http://www.cancer.org/cancer/oralcavityandoropharyngealcancer

ACS Cancer Facts and Figures 2012. http://www.cancer.org/research/cancerfactsfigures/cancerfactsfigures/can...

Reviewed August 13, 2014

by Michele Blacksberg RN

Edited by Jody Smith

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EmpowHER Guest

Very helpful article. Thank you for sharing!!! I knew nothing about radiotherapy masks. Good to know.

April 9, 2015 - 9:18am
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