Head and neck cancer is changing its plan of attack. When Dr. Alex Lin told me that tobacco use is the main risk factor for cancers of the throat, tongue, tonsils, pharynx and salivary glands, it made sense. Smoking and chewing tobacco puts carcinogens right in contact with those areas, so why wouldn’t it increase risk of cancer in the surrounding tissues? Everything seemed logical enough.
But we know that instances of head and neck cancer are becoming more common. With the national and municipal crusade against tobacco use, wouldn’t it make more sense if the cancers caused by it were also being curtailed? Maybe, but that’s not the case. So what is the case?
Dr. Lin discusses head and neck cancer treatment, the potential side effects and the importance of being prepared and treated for them.
“I definitely think it’s because of HPV,” briskly stated Dr. Lin, as if it were an established medical consensus.
This caught my attention.
“The subset of patients who have head and neck cancer that’s induced by smoking is on the decline,” he told me. “The subset who got it from HPV is rising, and I think will continue to rise.” HPV, a common virus whose strains affect nearly three quarters of the human race, has become a main channel through which head and neck cancer claims its victims. We’ve learned about HPV from the commercials for Gardasil, the vaccination that protects against the strains that carry the highest risk for inducing cervical cancer. The media marketed the vaccination as something that girls should be getting.
Though the effort was noble, the ads ignored what Dr. Lin told me in the interview. “There are several sub-types of HPV that carry the highest risks for cervical cancer AND head and neck cancer.” They’re the same strains. So while we were all busy worrying about vaccinating people with cervixes, we should have been worrying about vaccinating everybody. Oops.
When Dr. Lin sees a new patient, he tries hard to make them understand that the side effects of treatment for head and neck cancer will be fairly vicious. All too commonly, he told me, “It doesn’t really set in.” Head and neck cancers affect small, tight areas of the body with lots of different types of cell tissue. For a radiation oncologist like Dr. Lin, it can be hard to spare the parts unaffected by cancer. For example, if a patient has cancer of the pharynx, but not of the tongue or tonsils, the radiation dose they receive might affect the healthy areas anyway.
Receiving radiation for head and neck cancer is a bit of a negative feedback cycle. It is often the best option to stop the cancer, but because of the area affected it also makes eating incredibly painful (and sometimes unfeasible.) So many patients tend to lose weight. But a patient who loses weight during treatment is a patient who “does worse,” according to Dr. Lin. So it’s very important to maintain weight while going through the treatments, even though the treatments tend to make that goal a battle.
“We know, in general, that for most people with head and neck cancer, they’re going to be very symptomatic during treatment,” said Dr. Lin. Making people understand the high likelihood that the “side effects” of treatment for these particular cancers are really more like “practical inevitabilities” is a part of the medical process that Dr. Lin thinks is undeveloped. His solution is that there needs to be more time spent before treatment begins to set up proper expectations. If people don’t understand what to expect coming in, even if they’re told what to expect, they are worse off against the cancer. The medical community needs a change in rhetoric if people are to know what they’re up against.