Head and Neck Cancers
October 19, 2020Information
October 18, 2020
Yale Cancer Center
visit: http://www.yalecancercenter.org
email: canceranswers@yale.edu
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- 00:00Support for Yale Cancer Answers comes from
- 00:03AstraZeneca, committed to researching
- 00:06innovative treatments to address
- 00:08unmet needs in head and neck cancer.
- 00:11Learn more at astrazeneca-us.com.
- 00:14Welcome to Yale Cancer
- 00:16Answers with your host
- 00:17Doctor Anees Chagpar.
- 00:19Yale Cancer Answers features the
- 00:21latest information on cancer care by
- 00:23welcoming oncologists and specialists
- 00:24who are on the forefront of the
- 00:27battle to fight cancer. This week
- 00:29it's a conversation about head and neck
- 00:31cancers with Doctor Benjamin Judson.
- 00:33Doctor Judson is a professor of
- 00:35surgery in Otolaryngology and the chief
- 00:37of the division of Otolaryngology
- 00:38at the Yale School of Medicine,
- 00:41where doctor Chagpar is a
- 00:43professor of surgical oncology.
- 00:47I always think about head
- 00:49and neck cancers as this
- 00:52very large bucket
- 00:54of heterogeneous diseases.
- 00:55Can you talk a little bit
- 00:57about how you classify them,
- 00:59how you think about them?
- 01:02Well your impression is actually on target. Head
- 01:05and neck cancers make up about four to
- 01:085% of cancers in the United States,
- 01:11but when you really zone in on them,
- 01:14they are not common,
- 01:17but they're not rare either.
- 01:19And then when you really begin
- 01:21to look more closely, they
- 01:23are made up of a lot of different
- 01:25cancers in the mouth throat area.
- 01:28One of the phrases we use to describe
- 01:30it in the medical lingo is it's
- 01:32between the dura and the pleura, so
- 01:34any cancer that's not brain cancer,
- 01:36but it's above the lung
- 01:39falls into that bucket of being a head and neck cancer.
- 01:44Are there things that
- 01:46kind of make these similar?
- 01:48So when we think about risk factors for
- 01:51example of getting head neck cancers,
- 01:53granted that all of these cancers
- 01:56are a little bit different,
- 01:58but do they share some of
- 02:00the same risk factors?
- 02:01Some of them do and some of them don't.
- 02:05Some of the cancers we see in this area
- 02:07just don't have strong risk factors,
- 02:11They are uncommon,
- 02:13but they they can happen out of the
- 02:15blue without any sort of exposure.
- 02:18That's probably a minority
- 02:19of the cancers in this area.
- 02:21Historically,
- 02:21the biggest risk factor has been smoking,
- 02:23and you know,
- 02:24with the decrease in smoking rates
- 02:26in the United States since World War
- 02:28Two we're beginning to see some slight
- 02:31decrease in smoking related cancers.
- 02:33But the big sort of change or
- 02:35the big story in this area
- 02:38is the rise of cancers in the throat
- 02:40that are a result of infection
- 02:43with the human papilloma virus.
- 02:45I want to dig into HPV in a minute,
- 02:49but I want to talk about
- 02:51a couple of other things before we get there.
- 02:55One is a little bit about alcohol.
- 02:58Is alcohol a major risk factor
- 03:01for head and neck cancers, and if so,
- 03:04is there a quote safe amount of alcohol?
- 03:08It's a great question and I'm
- 03:10saying a little because we don't
- 03:13know some of this,
- 03:16but what we do know about
- 03:19the role of alcohol is that it has a
- 03:22synergistic role with tobacco so that
- 03:24if alcohol is a risk factor,
- 03:28a low risk factor for developing
- 03:30head neck cancer,
- 03:31smoking is a larger risk factor,
- 03:34but if someone smokes and drinks
- 03:36it isn't an additive effect,
- 03:39it's a multiplicative effect.
- 03:43So if you smoke and drink,
- 03:44your risk is significantly higher.
- 03:46So I guess the biggest role of alcohol
- 03:48is in people who smoke because it
- 03:51amplifies that risk of smoking.
- 03:53I think that although we say that
- 03:56alcohol is a risk factor for
- 03:58developing a head neck cancer
- 04:00A low level of alcohol.
- 04:02The risk of developing head
- 04:04neck cancer with that
- 04:06is quite low. OK, an my next question.
- 04:09It has to do with race and ethnicity.
- 04:12Are there particular racial and
- 04:14ethnic groups that are more at risk?
- 04:16I know that I have sent you in the last year.
- 04:21At least a number of people that I
- 04:24can think of off the top of my head
- 04:27who are of South Asian descent,
- 04:30which is which is a racial and ethnic group
- 04:33that we rarely think about in this country.
- 04:36We usually think about race in
- 04:39terms of African Americans,
- 04:40and we think about ethnicity
- 04:42in terms of Hispanic people,
- 04:44but if we think globally,
- 04:46are there particular racial and
- 04:48ethnic groups that are more at risk?
- 05:03Head and neck cancer is significantly
- 05:05more common in the rest of the world,
- 05:08and that probably has to do
- 05:10with tobacco and alcohol
- 05:12and betel nut exposure,
- 05:13which are higher elsewhere,
- 05:15especially in Asia.
- 05:16The other thing that's at play
- 05:18is that there is a particular
- 05:20type of head neck cancer
- 05:22called nasopharyngeal cancer that
- 05:24is much more prevalent in parts of
- 05:27Asia and it's related to Epstein
- 05:29Barr virus infection and
- 05:30we see when individuals from that part
- 05:33of the world move to the United States,
- 05:36their risk of developing those
- 05:38cancers goes down significantly,
- 05:39but not to the same level,
- 05:41and so we're sort of figuring out why that is.
- 05:44It is unclear exactly how
- 05:46the risk factors work,
- 05:48but we do see different types of
- 05:50head neck cancer more frequently
- 05:52in other parts of the world, like in
- 05:55Asia.
- 05:57And that brings me to this whole virus phenomenon,
- 05:59because now you've mentioned two viruses,
- 06:02both of which are risk factors for
- 06:04various head and neck cancers.
- 06:06One being HPV and one
- 06:09being Epstein Barr virus,
- 06:10and certainly right now,
- 06:12in the midst of a global pandemic,
- 06:15a lot of us have got viruses on the brain.
- 06:19Talk a little bit about the differences
- 06:24between different viruses and
- 06:27how exactly these viruses cause
- 06:30cancer and what we can do about it.
- 06:36I think what we're seeing the
- 06:38most in the United States by far
- 06:41is the rise in throat cancers
- 06:43that are caused by exposure
- 06:45to the human papilloma virus,
- 06:47and it's been happening
- 06:49over the last 15 or 20 years,
- 06:52and it's still an emerging story.
- 06:54We're still learning more about
- 06:56what's happening and how this works,
- 06:59but we certainly know a lot,
- 07:01and one of the key takeaways
- 07:03is that these are preventable
- 07:05cancers, and they're preventable
- 07:06if an individual is vaccinated against the
- 07:09human papilloma virus when they were younger.
- 07:11It's going to take 10
- 07:14to 20 years for that to play out.
- 07:16Teens today are
- 07:18getting vaccinated many of them,
- 07:20but not probably as many as we'd
- 07:22like in the United States,
- 07:24and that's going to prevent these
- 07:26cancers in those individuals
- 07:2715-20-30 years down the road.
- 07:31When we think about HPV,
- 07:35I think that many of our listeners may
- 07:38think about HPV and think about it being
- 07:42really primarily for women for cervical
- 07:45cancer being sexually transmitted.
- 07:48They don't think about it as much or
- 07:51perhaps at all for people of both
- 07:54genders in throat cancer.
- 07:55Talk a little bit about that.
- 07:59I mean, is this the same virus?
- 08:02Is it a different virus?
- 08:04Is it spread through sexual
- 08:07means or other means?
- 08:09And what do you say to the people
- 08:13who say, my child won't
- 08:17engage in oral sex and therefore
- 08:20will not be at risk of HPV in their
- 08:24throat and therefore if not female,
- 08:27does not need to be
- 08:30vaccinated?
- 08:32That is a question that people ask for sure
- 08:35and what we know is
- 08:38that human papilloma virus,
- 08:39the type of HPV that causes
- 08:43throat cancer is the same type that
- 08:46can cause cervical cancer in women.
- 08:49And in the throat
- 08:51it predominantly causes cancer in men
- 08:53and we don't know why that's the case.
- 08:56What we've learned is that the
- 08:58vast majority of Americans are
- 09:00exposed to this virus at some point.
- 09:03Estimates put it in the 80 to 90% range.
- 09:06So almost all of us get exposed
- 09:09to the virus at some point.
- 09:11Usually our bodies clear the virus.
- 09:14For some people,
- 09:15the virus hides out in the
- 09:17back of the throat.
- 09:19And it's it's there,
- 09:20sort of evading our immune
- 09:22system for decades.
- 09:23And it's that exposure of sitting
- 09:25there that is a risk factor for
- 09:28developing a cancer later on.
- 09:33There is some evidence that suggests
- 09:35that people who are more active,
- 09:37more sexually active are at higher
- 09:39risk for developing these cancers.
- 09:41But I think anyone just the vast majority,
- 09:44almost all Americans are
- 09:45exposed at some point,
- 09:47and so we do see these cancers in
- 09:50everyone.
- 09:51And so this opens the
- 09:55question of vaccination and as
- 09:58we sit here in 2020,
- 10:02the remarkable year that it has been,
- 10:06it really does bring to light
- 10:09the question of vaccination.
- 10:10And historically there have been
- 10:14people in this country who have been what
- 10:18have been called anti-vaxers who have
- 10:22concerns about autism due to vaccination and
- 10:25perhaps there are more people who worry
- 10:28about how vaccines actually get approved
- 10:31in this country and whether they are safe.
- 10:37Can you speak to that and really
- 10:40allay our listeners fears?
- 10:42Because right now people might have
- 10:45all kinds of concerns with regards
- 10:48to not just the Covid vaccine,
- 10:50but vaccines in general.
- 10:53I think with
- 10:55HPV we have the benefit of this
- 10:58not being a new vaccine.
- 11:01Over 120 million doses have been
- 11:03given in the United States and I
- 11:06think it's now over 300 million doses
- 11:09across the world over the last decade.
- 11:12and this is a safe vaccine.
- 11:15It also is an effective vaccine.
- 11:18It eliminates 90 to 100%
- 11:21of the infections and cancers
- 11:23that this virus can cause down the road.
- 11:34It's safe and
- 11:36it's effective and you know,
- 11:38in the past the rationale for
- 11:40getting the vaccine was sometimes
- 11:42it was described as to avoid
- 11:44genital warts or things like that,
- 11:47and I think that there's not as great a
- 11:49perception or understanding that this
- 11:51is really a cancer prevention vaccine,
- 11:54and so there's new survey
- 11:56data and studies going on that
- 11:58really shows that if more
- 12:01people appreciate that this
- 12:02vaccine has the potential
- 12:05and the ability to prevent cancers,
- 12:07those people are more likely to
- 12:10have their children vaccinated,
- 12:11so I think that there is some
- 12:14work to do in this area to explain
- 12:17the benefits of
- 12:18the vaccine.
- 12:21The other point that comes up is
- 12:24the fact that this cancer
- 12:27is not terribly common.
- 12:28As you said, it's not terribly rare,
- 12:31but it's not terribly common,
- 12:33and so I'm playing Devil's advocate
- 12:36here for the benefit of our listeners,
- 12:39who may have similar concerns.
- 12:42To really think about the risks of
- 12:45the vaccine versus the benefit in
- 12:47preventing a cancer that occurs
- 12:49in 4 to 5% of the population,
- 12:52can you speak to the data
- 12:54with regards to autism,
- 12:56which is something that
- 12:59Jenny McCarthy and other
- 13:01figures active in the anti vax
- 13:03movement have really promulgated.
- 13:05Is there any truth to that?
- 13:08I know certainly not with the HPV vaccine.
- 13:11There's really been no
- 13:14signs whatsoever over hundreds
- 13:15of millions of people that
- 13:17there is any association like that.
- 13:19The data that
- 13:22led to some of those claims has
- 13:24really been debunked as false data
- 13:26at this point for other vaccines.
- 13:29So I think that that's
- 13:31not really\ up-to-date
- 13:33with where we are in terms of
- 13:35understanding the side effects.
- 13:38I think that given its safety and
- 13:40the fact that it's been around for
- 13:43a long time and seems to almost
- 13:45completely eliminate cancer,
- 13:46whether it's cervical cancer
- 13:48for girls, head and neck cancers
- 13:50for both genders, it reduces the risk.
- 13:53general towards for what that's worth.
- 13:58Vaccine is really important.
- 14:00We're going to take a short
- 14:02break for a medical minute,
- 14:04and when we return,
- 14:06we'll talk more about treatment
- 14:08and diagnosis for head and neck
- 14:10cancers with my guest doctor Ben
- 14:12Judson.
- 14:14Support for Yale Cancer Answers comes from AstraZeneca,
- 14:16a biopharmaceutical business
- 14:18with a deep rooted heritage in
- 14:21oncology and a commitment to
- 14:24developing cancer medicines for
- 14:27patients. Learn more at astrazeneca-us.com.
- 14:30This is a medical minute about survivorship.
- 14:34Completing treatment for cancer
- 14:35is a very exciting milestone,
- 14:38but cancer and its treatment can be a life
- 14:41changing experience for cancer survivors.
- 14:43The return to normal activities and
- 14:46relationships can be difficult and
- 14:48some survivors face long term side
- 14:50effects resulting from their treatment,
- 14:53including heart problems,
- 14:54osteoporosis, fertility issues,
- 14:55and an increased risk of 2nd cancers.
- 14:58Resources are available to help
- 15:00keep cancer survivors well and
- 15:02focused on healthy living.
- 15:04More information is available
- 15:06at yalecancercenter.org.
- 15:07You're listening to Connecticut public radio.
- 15:11Welcome back to Yale Cancer Answers.
- 15:13This is doctor Anees Chagpar and I am
- 15:16joined tonight by my guest doctor Ben Judson.
- 15:20We're talking about patients with
- 15:22head and neck cancer and right before
- 15:25the break we were talking about the
- 15:27fact that HPV is actually
- 15:30causing a lot of throat cancers
- 15:32that we see and this is entirely
- 15:34preventable with the HPV vaccine now.
- 15:37We talked a little bit about risks
- 15:39and benefits and it seems to me that
- 15:42with millions and millions
- 15:45of doses being given over many,
- 15:48many years, we really do have
- 15:50the data that suggests that this
- 15:53vaccine is safe and effective.
- 15:55But I wanted to
- 15:59ask who should be
- 16:02vaccinated and when?
- 16:03Terrific question, so the guidelines
- 16:06now for males and females who are
- 16:09under the age of 26 to be vaccinated.
- 16:12Usually the recommendation is
- 16:14for the first dose to be given
- 16:17when someone is around 11 or 12
- 16:19years old with one second dose.
- 16:22And the thought for that timing is that
- 16:24the vaccination then has
- 16:27time to work before
- 16:29they are potentially exposed,
- 16:31likely years down the road.
- 16:33The change in this area has
- 16:35been that the CDC
- 16:37broadened the recommendation
- 16:38to consider vaccination for
- 16:40anyone up to 45 years old.
- 16:43I think that that's so important,
- 16:46but one of the
- 16:49issues that I always ask is,
- 16:51many of our listeners
- 16:54who may be hearing this show,
- 16:56may be saying, I'm 47,
- 16:59I'm 48, I'm 52.
- 17:00I'm outside that window,
- 17:02but I really want to
- 17:05get vaccinated because I'm not
- 17:07particularly keen on getting cancer.
- 17:09What do you do in that older population?
- 17:15We don't know for sure the benefit,
- 17:20I mean the benefit is
- 17:22overwhelming for those that are under
- 17:2426 in terms of preventing
- 17:26cancers and the issues
- 17:28or side effects from
- 17:30treatment as well as the risk of death.
- 17:33So that is for sure.
- 17:34I think in that group that are 27 to 45,
- 17:38there is a suggestion that
- 17:40there's a real benefit there.
- 17:41That's where we have this
- 17:43sort of soft recommendation
- 17:45to consider vaccination in that
- 17:47age group and we just don't know
- 17:50beyond that whether the size
- 17:52of the benefit to getting vaccination
- 17:55and is the reason why we've kind of
- 17:58looked at those particular age ranges
- 18:01as being the age ranges
- 18:04where people are most likely to
- 18:07be sexually active.
- 18:10So you would imagine that people
- 18:12who are in their 50s may have
- 18:15already come in contact with
- 18:17the virus and therefore
- 18:19vaccination may be less effective.
- 18:20That is absolutely
- 18:21right. The idea is to vaccinate
- 18:23people before they could possibly
- 18:25be exposed to the virus.
- 18:27That's why it's as young as the
- 18:29recommendations are
- 18:31for the initial vaccination and
- 18:33it's less known as we get
- 18:36older and we're more likely,
- 18:38as I mentioned, 80 to 90% of us
- 18:41have been exposed to the virus.
- 18:43The potential benefit of the
- 18:44vaccination later on is less
- 18:46understood or less known.
- 18:49I mean if you have people who have
- 18:53not been sexually active until their 50s
- 18:56for example, maybe they were
- 18:59for religious reasons or other reasons
- 19:01really did not engage but wanted to
- 19:04be vaccinated before they started.
- 19:06Whether that's something to consider.
- 19:08But it sounds like we're not there
- 19:11yet in terms of the data,
- 19:13it sounds very reasonable,
- 19:15but we just don't know yet
- 19:18based on the data.
- 19:24Let's suppose you weren't vaccinated.
- 19:26What are the signs and symptoms
- 19:29that you should look out for in
- 19:32terms of head and neck cancers?
- 19:34And I mean we talked at the
- 19:37top of the show about this being
- 19:40a basket of really heterogeneous
- 19:43diseases right?
- 19:46I would
- 19:49imagine that there are so many
- 19:53varied symptoms that could
- 19:56be signs of head and neck cancer.
- 20:00I think that's right.
- 20:04In some ways,
- 20:05one of the pitfalls that we've
- 20:07seen is that with HPV related
- 20:10cancers these cancers are arising
- 20:12in younger otherwise very healthy
- 20:14individuals without real risk factors.
- 20:17The vast majority of patients
- 20:18with an HPV related cancer
- 20:21present with a painless neck mass,
- 20:24a physical lump in the neck that they can
- 20:27see and feel and they otherwise feel fine,
- 20:30and so there's a little bit of a tendency to
- 20:35put that off like
- 20:36I feel fine and
- 20:41living my life and
- 20:43so they might not seek
- 20:45medical care early,
- 20:47but that is the
- 20:49leading presentation of this cancer.
- 20:50And so one of the
- 20:52recommendations is that
- 20:54someone who has a mass in the neck,
- 20:57even if you otherwise feel great
- 20:58and have no other symptoms,
- 21:00and if it's there for more than four weeks,
- 21:02you should see your
- 21:04physician about it.
- 21:05See someone about it.
- 21:07And what's the age range that
- 21:09we typically see these cancers in?
- 21:12You mentioned if you're
- 21:14an otherwise healthy young person,
- 21:16are young people really the
- 21:18ones getting this disease,
- 21:20or are they at lower risk and this
- 21:22is really something that people
- 21:24should worry about when they're
- 21:26pushing into their 70s and 80s?
- 21:29I think that the smoking drinking
- 21:31related head neck cancers that
- 21:32we saee happen most frequently
- 21:34in people who are in their 60s,
- 21:38somewhat later in life,
- 21:42having a longer time
- 21:44of exposure to
- 21:46the risky effects of tobacco
- 21:48and alcohol. With HPV we're seeing
- 21:51these cancers younger and younger,
- 21:52and so the peak age of these cancers is
- 21:55actually in their 40s and we see it
- 21:58at all ages we can see younger and older,
- 22:01but it definitely isn't
- 22:02happening in younger patients,
- 22:04and I think that that's so critical for
- 22:06people to really understand because,
- 22:08being in my 40s, I can tell you that
- 22:12you do kind of feel invincible, right?
- 22:16You're healthy, you don't
- 22:17really need to go to the doctor.
- 22:21Everything is good.
- 22:22And you certainly don't think you're
- 22:24gonna get cancer, but it can occur.
- 22:26That's so true.
- 22:26And so often peoples in their
- 22:2840s are busy with life.
- 22:30You know they've got jobs and whatever it is,
- 22:33and so their time for cancer,
- 22:34they don't have time for this and
- 22:36they are less likely to go get it
- 22:38checked out 'cause they're just too busy.
- 22:47What are the other other symptoms
- 22:49that people should look for?
- 22:51I mean a painless lump in the neck
- 22:53is certainly something that
- 22:55should be a red flag for people,
- 22:57even though it's painless,
- 22:59and I think that's the other
- 23:01thing is that people say
- 23:03if it's not causing me pain,
- 23:05it can't be bad,
- 23:06but we know that with so many
- 23:09cancers that simply is not the case.
- 23:11That's right, and
- 23:22one of the symptoms, potential
- 23:24symptoms, is a sore throat or pain
- 23:26or difficulty with swallowing.
- 23:28Obviously this happens to
- 23:30all of us as a result of an infection
- 23:34or tonsillitis or something like that,
- 23:36but if that persists for more
- 23:38than three to four weeks,
- 23:40that is another reason to
- 23:42seek medical attention.
- 23:44Similarly, hoarseness of voice again,
- 23:46usually not cancer.
- 23:47We all get that at one point or another,
- 23:50but if it persists for more than four weeks
- 23:54that probably makes sense to seek
- 23:56medical attention for that as well.
- 23:57Yeah, it seems
- 23:58like that four week mark is really
- 24:00when people should start saying,
- 24:02you know, something
- 24:04that you get out of the blue if
- 24:06it's been persistent, it's really
- 24:08something that you need to look for.
- 24:16I had a
- 24:19friend who had a nosebleed,
- 24:22really young guy, 20-22 years old.
- 24:25I think you may have heard about him
- 24:29because I sent him to you who
- 24:32presented with a nosebleed.
- 24:35So simple things like that,
- 24:37you think
- 24:40it's a nosebleed but
- 24:42things like that can happen.
- 24:47It goes back to what we
- 24:49were talking about before.
- 24:50It's the patients who are
- 24:52young and healthy and feel fine.
- 24:54They're more likely to
- 24:55blow off these things.
- 24:56And most likely
- 25:0099% of the time,
- 25:01it's nothing.
- 25:03But sometimes it's something,
- 25:04and so it is just a reminder,
- 25:06if something is not going
- 25:08away or not getting better,
- 25:10it's ertainly worth
- 25:10having someone take a look.
- 25:12And sometimes
- 25:12there's some things that are really bad
- 25:14like what happened
- 25:15to my friend. so can you talk
- 25:17a little bit about the
- 25:20prognosis for head and neck cancers,
- 25:23and I realized that again it's a
- 25:26heterogeneous bucket of diseases,
- 25:28but in general, how
- 25:30do people fair?
- 25:31You mentioned it varies.
- 25:33You know it varies on the type,
- 25:35the specific type and the
- 25:36stage at which they present.
- 25:37So all the more reason to come in
- 25:40and get it checked out and found earlier.
- 25:44Interestingly
- 25:44the prognosis with HPV related cancers
- 25:47is much better than with the other
- 25:50types of head neck cancers that we see.
- 25:52Like for example,
- 25:53the smoking drinking related cancer.
- 25:55So the vast majority of patients
- 25:57with HPV related cancers are cured.
- 26:00Cure rates are in the 70 to 90% range.
- 26:03There are certainly side
- 26:04effects from treatment and so
- 26:06our goal is really
- 26:08to maximize that cure,
- 26:10but also try to
- 26:12minimize the side effects of any
- 26:15treatment.
- 26:18And the prognosis can be
- 26:21across the board, it can be varied.
- 26:24It can be very good.
- 26:27It can be not so good.
- 26:30Talk a little bit about treatments.
- 26:32Now, granted, treatments are going
- 26:35to vary based on whether this is
- 26:38found at an early stage or whether
- 26:41it is spread and metastatic.
- 26:43But on this show we frequently talk about
- 26:47personalized medicine about a
- 26:49multidisciplinary approach about
- 26:50all of the things that have
- 26:53evolved overtime that can improve
- 26:55treatment and patients outlooks.
- 26:57So how do you approach patients
- 26:59who have had neck cancer?
- 27:01Well, one part of this
- 27:03that I'm just passionate about is that
- 27:06it's so apparent to me working in this
- 27:10field that how patients do
- 27:13depends on the team that surround them.
- 27:16And so you know, I'm a surgeon and
- 27:19that's one potential treatment for a patient.
- 27:22Other treatments are chemotherapy
- 27:23or immunotherapy, or radiation.
- 27:24But it's critical
- 27:26to have a nutritionist, a
- 27:28speech language pathologist,
- 27:29physical therapists,
- 27:30a social worker,
- 27:32all part of the team and really
- 27:35how people do depends on
- 27:38having that whole team around the
- 27:40patient to help get them through it and
- 27:44having the team is key and then as you said,
- 27:48just carefully tailoring
- 27:49treatments for each patient
- 27:51based on the specifics of what's going on
- 27:53with them in their situation is just key.
- 27:56Talk a little bit about that.
- 27:59I mean we talk on this show
- 28:01a lot about how there have been
- 28:04advances in various tumor types.
- 28:09So in some cancers you
- 28:11know they they look at,
- 28:13panels of hundreds of
- 28:15of genetic and genomic mutations,
- 28:18and have targeted therapies
- 28:20for each of these.
- 28:21In others it's not quite so advanced
- 28:24in terms of tailoring therapies.
- 28:26The idea of course being that you
- 28:29know with a more targeted therapy
- 28:31you can potentially reduce some
- 28:34of the side effects of treatment.
- 28:37So given what you had said earlier
- 28:39about the side effects of therapy,
- 28:42where are we in terms of personalized
- 28:44medicine in head and neck cancer?
- 28:47It's so interesting
- 28:49and one of the areas where personalized
- 28:52medicine, really
- 28:53is common day-to-day in treating patients
- 28:55in this area is that patients with head
- 28:58with HPV related cancers are now being
- 29:01treated differently than the other cancers.
- 29:03We know that their responses and
- 29:06the prognosis is different and
- 29:08so now the
- 29:09treatments are different as well.
- 29:12And like so much in
- 29:14medicine there are constant advances.
- 29:16We're doing transoral
- 29:18robotic surgery and now patients
- 29:20have the potential to get immunotherapy,
- 29:22potentially as part of their treatment,
- 29:24and so there's
- 29:27more targeted radiation treatment,
- 29:29so it's constantly evolving
- 29:31and we're seeing
- 29:33an overall gradual improvement.
- 29:35Slow, but gradual improvement in prognosis,
- 29:38and I think it's a result of
- 29:40all these little incremental
- 29:41steps and improvements.
- 29:44Dr. Benjamin Judson is a professor
- 29:46of surgery in Otolaryngology,
- 29:47and the chief of the division
- 29:50of otolaryngology at the
- 29:51Yale School of Medicine.
- 29:53If you have questions,
- 29:54the address is canceranswers@yale.edu
- 29:56and past editions of the program
- 29:58are available in audio and written
- 30:00form at Yalecancercenter.org.
- 30:01We hope you'll join us next week to
- 30:04learn more about the fight against
- 30:07cancer here on Connecticut public radio.