Twitter Chat Transcript
Robert Haddad, MD
The chat took place on September 16, 2010. This transcript has been edited for clarity and style.
Welcome to our chat on head and neck cancer with Dr. Robert Haddad, medical oncologist at Dana-Farber/Brigham and Women's Cancer Center. Dr. Haddad is also Associate Professor of Medicine at Harvard Medical School.
Dr. Haddad's colleagues Dr. Sewanti Limaye and nurse practitioner Dan Gorman are also contributing their expertise today.
Robert Haddad, MD:
Welcome everyone. Head and neck cancer affects more than half a million individuals worldwide every year. Major risk factors are tobacco use, excessive alcohol use and HPV infection.
Presenting symptoms are a sore throat, change in voice, difficulty eating, chewing or pain when eating. Other signs are a lump in the neck, an ulcer on tongue, or a lip ulcer.
Treatment often involves the use of chemotherapy, radiation therapy, and surgery.
HPV infection is a major cause of tonsil cancer in the U.S. Close to 70 percent of tonsil cancer in the U.S. is linked to HPV. The outcome is excellent in this cancer.
Question: How much does alcohol lead to head and neck cancer? Should a moderate drinker be worried?
Heavy alcohol use is linked to developing head and neck cancer. It is not clear from the literature how to define "heavy." That being said, a patient who has already developed this cancer should not be using alcohol at all.
Smoking and drinking are highly synergistic and significantly increase the risk of head and neck cancer.
Question: Does Gardasil protect against some strains of head and neck cancer? Should men also get the vaccine?
Yes, Gardasil does protect against HPV 16, which is the major cause of oropharynx cancer in the U.S. I believe men should get vaccinated too. We at Dana-Farber are looking closely at the epidemiology of HPV-related cancer and are studying both patients and their spouses.
Question: We know the survival rate goes up with HPV oral cancer. How is the recurrence statistic affected?
Survival is excellent in HPV-related cancer and the recurrence rates are much lower. It is expected that the vast majority of HPV-related cancer is curable with chemotherapy and radiation.
Question: What happens if one doesn't take all three HPV shots? I'm rethinking it after the second.
The vaccine is less effective if you don't take all three shots, and the body might not mount an adequate immune response.
Question: For those who tested positive for the HPV virus, is there anything to be concerned about?
This really depends on where the positive test came from. Please consult your physician. There could be an intervention for you.
Our recent data presented in our national meeting shows close to 90 percent cure in HPV-related head and neck cancer.
Keep in mind that HPV is a cause of head and neck cancer, cervical cancer, anal cancer, vaginal and vulvar cancer.
Vaccination can be instrumental in the fight against these cancers.
Question: Why was it so difficult to diagnose Michael Douglas?
Symptoms can be subtle. A sore throat can be due to many reasons. Physicians should be careful not to ignore a sore throat in a smoker or ex-smoker. Early referral to a head and neck surgeon or ENT is key to establishing an early diagnosis.
Dentists and dental hygienists can be instrumental in identifying early signs and symptoms of cancer. A good head and neck exam can identify these cancers easily. A CAT scan can also be helpful.
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