July 27th is World Head & Neck Cancer Day.
What is a Head & Neck Cancer? Head & Neck Cancer is a diverse group of cancers that can arise from anywhere above the collar bones and outside the brain. They can occur from the skin, glands, soft tissue or the aerodigestive tract of the head & neck. What kind of cancers are included in this group? Many types including, throat cancer, tongue cancer, thyroid cancer, voice box cancer, tonsil cancer, melanoma, parotid cancer, etc. Over time, the morbidity and mortality rates have improved only very slightly.
Based on Canadian data, in males thyroid cancer is the 7th and oral cancer is the 9th most common cancer; whereas in females, thyroid cancer is the fifth most common type of cancer. My days are spent treating these unfortunate patients. Depending on the type, location and stage of tumour, treatment may involve surgery, radiation, chemotherapy or a combination of them. As a Head & Neck Surgeon I often have to perform radical and disfiguring surgeries to remove the cancer. We split the jaw, the cheekbone, or the skull base to get to whatever tumour that needs to be removed. We peel the face, drill the skull, chisel the nose, laser the throat, slice the neck, and gouge the eyes. It’s a cut-throat matter, literally. We take parts of the leg, the thigh or the arm to reconstruct the jaw, the tongue or the voice box. We leave some patients breathing permanently through a hole in the neck. We do 12-18 hour long resection and reconstruction cases with knife, drill, saw, chisel, laser, microscope, and even the robot. You would not believe some of the horrific things that patients have to go through to get their cancer resected. This is sometimes done in combination with, or in addition to, 6 weeks of chemoradiation. It’s a really rough time for our patients who would never be the same after what we do for them.
So why don’t Head and Neck Cancers get more attention? Unfortunately, the typical patient is usually, but not always, the elderly cachectic male who has been a smoker and drinker all his life. They often sound hoarse, cough a lot, and have poor socioeconomic support. Their cancer is a horrible sight to behold. Can you imagine a face with a fungating tumour or a tongue that is swollen with cancer? These are not emotionally inviting images. In my experience, most people’s initial reaction to a Head and Neck Cancer patient is not pity or compassion, but repulsion and disgust. They are so deformed that society looks away from them.
The one specific cancer subgroup that is experiencing an epidemic is Human Papilloma Virus (HPV) induced oropharyngeal carcinoma, a tonsil or tongue base cancer that is triggered by latent viral infection. This cancer strikes the young, non-smoker, non-drinker and is rapidly increasing in incidence. I still have in my mind the image of my first patient diagnosed with this tumour. She’s a 30-year-old gorgeous young chic graphic designer who came in with a sore throat and a lump in her neck. The next thing we knew, she went under the knife and we cut open her beautiful neck and throat. She subsequently had chemotherapy and radiotherapy. She could not stop her tears from smearing her designer mascara and dripping onto her branded clothes. I cried with her when we discussed her treatments.
Think of a patient with tongue cancer and consider if the taste of her food include the taste of her cancer. Think of a patient with parotid cancer with a facial paralysis and consider how that changes all of his facial expression. Think of a patient with nasal cancer that has eaten into the eyeball and consider how difficult it would be to see through a painful cancer-ridden eye. Think of a patient with laryngeal cancer and consider how difficult it would be for them to speak or even take a breath. Can you imagine breathing permanently through a hole in the neck? Can you imagine having a piece of your leg sitting in the mouth to replace your jaw and tongue? Can you imagine having a permanent voice and swallowing difficulty due to the treatment? Can you imagine having a thyroid cancer so big we have to split open your chest? Can you imagine having your eye and ear removed and having half your face covered by a thick piece of muscle?
I want them to do better. I want us to find better ways of treating thyroid cancer and laryngeal cancer. I want us to find better ways of cutting out cancers so they don’t suffer terrible side effects. I want us to deliver better chemotherapy and better radiation treatment. I want us to find ways of diagnosing these cancers earlier so their survival improves. I want us to improve the care we give to these patients. I want better multidisciplinary teamwork. I want every Head & Neck specialty (surgical, medical, radiology, pathology, nursing, speech therapy, physiotherapy, dietetics, nutrition, social work, palliative care, audiology, administration, etc) upskilled so we can do better for our patients.
Don’t look away from them. I look at them everyday and I know that they desperately need our attention. I want your support. Not for me, but for them because they need any practical support that they can get.
Find your local Head & Neck Cancer unit or support network and see what you can do to support them. It doesn’t have to be extensive or expensive. Your support makes a difference.