The recent media attention to Michael Douglas' battle with head and neck cancer has cast a light on a devastating disease that attacks the very center of our humanity.
These tumors affect speech, hindering the ability to communicate. They impair the ability to swallow, preventing the afflicted from sharing a meal with those they love. In advanced stages, and through many forms of therapy, there can be disfigurement of the face and neck, which may result in patients shutting themselves away from others when the need for companionship is greatest.
Head and neck cancer arises from the linings of the mouth throat and upper airway. Tumors silently grow and spread through fluid-containing channels called lymph vessels into the lymph nodes of the neck. In many cases, the only symptoms might be a neck mass, a subtle sore throat, voice change, ear pain or change in the quality of speech.
The symptoms mimic many far more common maladies and therefore go undetected until the tumor becomes more advanced. An otolaryngologist (also called an ENT) is the specialist trained to examine these areas of the lower throat and voice box. Symptoms persisting more than a month may warrant a thorough exam by an otolaryngologist.
There are several known risk factors for head and neck cancer. Tobacco and alcohol use are factors in 70 to 90 percent of patients. A substantial number of head and neck tumors are in part caused by viral infection with human papilloma virus (HPV) through oral sex. This same viral infection causes cancer in the cervix and has given rise to recommendations of vaccination of young women against this virus prior to sexual activity.
I am troubled by the 80 percent cure rate discussed for Douglas’ stage IV head and neck cancer. It implies an exaggerated success rate that cannot be translated to most head and neck cancer patients. Although stage I head and neck cancer has a cure rate of about 80 percent, the five-year survival rate for stage IV head and neck cancer in the United States is between 25 and 50 percent, depending upon the location of the tumor.
In certain subsets of patients in excellent health, with very favorable tumor location, the cure rates are better. Those who never smoke are more frequently cured than those that quit at the time of diagnosis, and those patients do better than those who never cease to smoke. Other factors, such as access to care and income, also correlate with better outcomes.
The therapy for advanced head and neck cancer is difficult to undergo and to recover from. Patients are never “back to normal,” and must learn to adapt to their “new normal.” Support groups, such as our UK head and neck cancer survivor’s group, help patients and families cope with their altered abilities. We are privileged to help hundreds of people with head and neck cancer at the University of Kentucky and the UK Markey Cancer Center. These patients are remarkable men and women who never cease to impress us with their courage.
Dr. Joseph Valentino is a head-neck surgeon and professor of surgery in the Division of Otolaryngology at the UK College of Medicine and Markey Cancer Center.