On Thursday evening, April 27, Congregation Etz Chaim hosted a virtual lecture on head and neck cancer basics with Dr. Baoqing Li, Clinical Director of Radiology Oncology at NewYork-Presbyterian Queens Hospital. Dr. Li shared that the most common site for head and neck cancer is the skin on the cheeks, lips, or chin.
Nasopharynx cancer is uncommon in the Caucasian population, he taught. It is very common in Southeast Asia and Southeast China. The Yangtze River divides China. There are few patients from the Northern China area with nasopharynx cancer. The Southern part has a high incidence because of the Epstein-Barr virus, which is prevalent in that area in the water, air, and food. He noted that 60 percent of infants in that area have the virus, and it is one of the most important causes of nasopharynx cancer.
Another cause is eating salted fish and another cause is genetics. In the United States, it is common in San Francisco where there are a lot of immigrants from that part of China. Manhattan and Flushing are other endemic areas. Symptoms include congestion, nose bleeding, postnasal discharge, neck lymph nodes that grow rapidly, and some people experience ear pressure.
He explained that diagnosis involves first determining where the patient is from and then referring him or her to an ENT surgeon for testing. If the surgeon sees something, then a biopsy is performed. If it is an aggressive cancer, there is no surgery for it because it is inaccessible. Treatment is chemo and radiation. This is followed by surveillance. It tends to recur in the same area, or it moves to the liver, bone, or lung. Virus titer [viral infectivity] will come back if the cancer returns.
Next, he spoke about oropharynx cancer, which is located in the tonsil area and the deeper part of the tongue or the base of the tongue. He noted that they have seen more of this type of cancer in the past ten years. Twenty or 30 years ago, the cause was mainly smoking. Today, the cause is HPV virus, which occurs in the cervical or anal area. Treatment is chemo and radiation. The most common symptoms are a sore throat and a very deep voice. Sometimes, there is pain in swallowing and the patient could have enlarged neck lymph nodes. To test for this, the ENT surgeon puts the scope in all the way down. If he sees something suspicious, then a biopsy is performed. The majority of cases have HPV virus along with this type of cancer. If the patient has HPV virus, then there is a better chance for getting cured. Treatment of HPV is robotic surgery through the mouth to get to the part of the tongue and clean the neck lymph nodes. Radiation and chemo are done post-operative. The second approach is just to give radiation, if the cancer is strong; then radiation and chemo is performed with the nonsurgical approach. There is an 85-percent chance that it will be cured for five years. Follow-up is with a PET or CT scan three months after treatment. If the PET is equivocal, then on the third month, it is repeated.
Larynx cancer is located in the vocal cords, and supraglottic cancer is above the vocal cords. Vocal cord cancer occurs in smokers and people who abuse their voice like singers, bar tenders, salesmen, and teachers. Symptoms include hoarseness and inability to speak out loud. It is easy to identify. Most cases are identified at a very early stage.
Supraglottic cancer symptoms include a sore throat and painful swallowing. For cancer of the vocal cords, the first approach is just radiation. For supraglottic cancer you don’t need surgery. You need chemo and radiation. If you do surgery, then the voice box will be gone. Physicians try to use the nonsurgical approach in order to preserve the ability to talk and to eat. There is 90-percent tumor control over ten years with this nonsurgical treatment in the vocal cords.
Next, Dr. Li spoke about oral cancer in the tongue, floor of the mouth, upper and lower gum area, and lips. The treatment is to perform surgery first because it is very accessible. The cause is smoking, and from India the cause is the habit of chewing the betel nut. Also, tobacco chewing can cause it. Treatment is surgery first and afterwards radiation and sometimes chemo. Dr. Li said to prevent this type of cancer you should stop drinking alcohol and stop smoking.
Following this, there was a Q&A session. One question was what progress has been made in irradicating the Epstein-Barr virus that causes cancer. He responded that it is impossible to irradicate as it is in the water, food, and air in Sothern China but today it is better than in the1970s and 1980s. For the HPV virus, we now have a vaccine for teenagers. Data for 2023 show that cervical cancer incidence has dropped to 30 percent, compared to ten years ago, because of the vaccine.
By Susie Garber
