In recognition of Head and Neck Cancer Awareness Month, Manju Prasad, MD, MBBS, Professor of Pathology; Director, Endocrine Head and Neck Pathology Fellowship Program; Director, Endocrine Head and Neck Pathology
During Head and Neck Cancer Awareness Month, what do you feel is the most important message to share with our community?
Public awareness is our best tool as, unfortunately, there are no population-based screening programs for head and neck cancers as there are for colon, breast, or cervical cancers.
Are there any risk factors for head and neck cancers – such as lifestyle, age, family history – and are there specific symptoms that we should be aware of?
Head and neck cancers are caused by environmental carcinogens, like smoking and alcohol. Quitting smoking reduces the risk of cancer but does not eliminate it. In the last few decades, the Human Papilloma Virus (HPV), a sexually transmitted virus, has emerged in association with a substantial number of tonsillar cancers. Thus, lifestyle has a major association with head and neck cancers. The deleterious effects of carcinogens on the DNA accumulate, causing cancer in adults, usually late middle aged and older. Head and neck tumors may remain painless and without symptoms for years. Once they involve nerves and become painful, they usually are quite advanced. Please consult an ear, nose, and throat specialist if you develop hoarseness of voice or a mass in the head and neck.
How have diagnosis and treatment of head and neck cancers improved in the last several years and do you expect these improvements will continue in the coming years?
Fine needle aspiration cytology of a mass can be very informative and often diagnostic. Tumor cells are pulled into a syringe with a fine needle and can be used for microscopic and for molecular analyses to confirm or rule out cancer. We can do HPV testing on a few cells or the aspirated fluid. A small biopsy provides more tissue for examination and is almost always diagnostic. Given the complexities of head and neck cancers, a need for special training in head and neck pathology is recognized in the last few years. The Yale Department of Pathology has trained head and neck pathologists, a fellowship program to train the next generation of pathologists and offers cutting-edge tests for clinical trials and new therapies.
How do you collaborate with the oncologists at Smilow Cancer Hospital to treat patient with head and neck cancer?
The Medical Oncology Division at Yale has experienced oncologists with national eminence who are dedicated to treating head and neck cancers. Treatment includes immunotherapy and anti-PD-L1 therapy in addition to radiation. Yale has a SPORE grant in head and neck cancers which promotes cutting edge research.
How can we prioritize cancer prevention in our daily lives?
Quitting smoking and alcohol in moderation are a few of the lifestyle changes one may be able to implement. Another important point to remember is offering the HPV vaccine to older children, boys, and girls, before the commencement of sexual activity. A large number of head and neck cancers are preventable.