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cancer

New treatments show promise for throat cancer
New treatments show promise for throat cancer A persistent cough, unexpected voice changes, problems with persistent earaches, and an often painless enlargement in the neck region are often associated with the development of head and neck and throat cancer.

Throat cancer is a term often used synonymously with head and neck cancer because the various forms of cancer encompassed within the head, neck, and throat are pathologically similar. They are all known as squamous cell cancer types and are therefore managed in a similar fashion.

There are approximately 25,000 new cases of throat cancer in the US each year, half of which involve the pharynx and half that are in proximity to the larynx. The most definitive and significant risk factors for throat and head and neck cancers are tobacco use, excessive alcohol use, poor oral hygiene, and exposure to a virus known as the Human Papilloma Virus, or HPV. In fact, the HPV virus not only increases one’s risk of head and neck cancer but also of cervical and anal cancers. When the HPV causes various forms of head and neck cancer, it usually involves areas in the mouth, such as the tongue and the back of the throat.

When a person is diagnosed with head and neck cancer, it is necessary for him/her to undergo procedures to determine the particular stage of the cancer. This staging is done by both physical examination and imaging studies such as x-rays, CT scans, and MRIs. Today, a special scan known as a PET (Positron Emission Tomography) has proven very useful. In addition to informing the doctor of the cancer stage at the start of treatment, a PET scan is useful in following patients after treatment to help determine whether the cancer has remained in remission. Once the staging has been completed, the next step is to determine what form of intervention will result in the best chance for a cure. Typically, with Stages I and II the disease is fairly localized in the area where it started in the head and neck, including the throat region, either surgery or radiation alone is used as intervention. However, in cases where lymph nodes or surrounding organs are involved and possibly even metastatic disease where the cancer has spread to distant sites beyond where it started, a combined modality approach is necessary.
Symptoms
There are some typical signs and/or symptoms associated with the development of throat cancer. A persistent cough, unexpected voice changes, problems with persistent earaches, and an often painless enlargement in the neck region are often associated with the development of head and neck and throat cancer. When these signs and/or symptoms develop, individuals should seek prompt medical advice. Initially, when these signs or symptoms appear, a physician will perform an examination of the head and neck region. This examination will often involve an otolaryngologist also known as an ear, nose, and throat specialist (ENT). Eventually, a piece of abnormal tissue or mass, known as a biopsy, will be obtained.

Treatment
As with most other solid tumors, surgical excision is the treatment of choice for head and neck cancers, including the subtype throat cancers. Recently, however, there has been a change in this philosophy because surgeries, if indeed they could be performed in order to remove the entire cancer, often resulted in extreme disabilities, including the inability to talk and possibly even eat normally. Patients were often left with a permanent hole in their throat known as a tracheostomy. An alternative form of intervention has been popular over the last couple of decades and is referred to as “organ preservation” therapy. This therapy typically involves the use of radiation with or without chemotherapy, with the goal of requiring little, if any, surgery in order to minimize changes to a patient’s body image. The chemotherapy is often given in conjunction with radiation to try to destroy more cancer cells than would be possible using radiation alone. This form of therapy can still result in many side effects, including extreme irritation or burning of the tissue treated and difficulties with swallowing for a fairly long time period if not indefinitely.

Over the past few years, a new form of cancer therapy called “targeted” and occasionally, “biologic” therapy has been used. This therapy takes many forms but in regard to head and neck including throat cancer, it typically involves medications that “target” the epidermal growth factor receptor also known as EGFR. This receptor is expressed or located on up to 90 percent of the squamous cancer cells involved in head and neck and throat cancer. When this receptor is activated, it results in further growth and spread of these cancers. As a result, medications known as EGRF receptor inhibitors have been developed. The only one currently commercially available for treatment of head and neck cancer is known as Erbitux® (cetuximab). This medication has demonstrated the ability as a single agent to cause head and neck cancer cells, including throat cancer cells, to stop growing and possibly even die. While it seems to be effective when used alone, when combined with radiation the effect is much more profound.
Recent developments in the treatment of head and neck including throat cancers, have involved two issues. The first is how to combine the new biologic therapies such as Erbitux®, which is likely to be joined by additional biologic therapies in the future, with other past therapies such as radiation and chemotherapy. One recent attempt has resulted in an improved outcome in patients when chemotherapy, Erbitux, and radiation are all combined but at the risk of increased toxicity. Nevertheless, future advanced head and neck cancer treatment will take this likely direction.

Managing Your Cancer Experience
Sometimes you just need to talk to someone about your disease. The American Cancer Society has a great section on their website called Managing Your Cancer Experience at http://www.cancer.org/docroot/home/. The Radius website also contains a variety of articles on the topic of cancer: www.radthemag.com written by renowned oncologists. Sometimes help is only a “click” away.
The second issue involves the previously mentioned association of the Human Papilloma Virus (HPV) with various forms of head and neck cancer. As stated earlier, multiple malignancies have been attributed to this virus. Recently, a vaccine against the HPV has been commercially available for females to prevent cervical cancer. In all likelihood, this same vaccine will also prevent this virus from causing head and neck cancer as well as anal and penile cancer. Therefore, both males and females could benefit from the HPV vaccine. In addition, when a patient does have HPV associated head and neck cancer, it has been established that treatment with higher doses of chemotherapy may not be necessary, because this form of cancer seems to have a high sensitivity to past developed treatments and many patients can avoid side effects and still result in cure of their disease.

With new interventions, including both biologic therapy to treat and immunologic therapy to prevent the cancer, it is possible that positive outcomes can result in the near future. As with all cancers, prevention by avoiding risk factors is the best defense against throat cancer.

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"New treatments show promise for throat cancer"
   authored by:
ONCOLOGY
Dr. Fleming earned his MD degree from the University of Louisville, Kentucky, and completed his fellowship at the University of Kentucky which included an externship at the National Cancer Institute.He became a tenured professor in hematology/oncolog...



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