Your nose, tongue, face, and throat. You may not think of cancer lurking in these places, yet many head and neck cancers originate here. Luckily, there are signs and symptoms related to the disease that you can look for. In this episode, Jason Newman, MD, director of the Division of Head and Neck Oncology in the Department of Otolaryngology, talks about  the warning signs of head and neck cancer and the latest treatments offered to patients at MUSC Health.

Topics covered in this show

• Newman says the common symptoms of head and neck cancer can include a lump in the throat or neck, a sore throat that does not heal, changes in voice, difficulty swallowing and ear pain.
• This type of cancer can affect any part of the head and neck, including the throat, voice box, sinuses, tongue and face. Typically, head and neck cancer is detected by primary care doctors, dentists or otolaryngologists.
• Risk factors include smoking and drinking alcohol, sun exposure and viral exposures such as having the human papillomavirus or the Epstein-Barr virus.
• There are different types of treatment for head and neck cancer, which can include surgery, radiation therapy, chemotherapy or a combination of these treatments.
• Newman says that the goal of treatment is to cure the cancer while also minimizing the impact on the patient's quality of life.
• A head and neck cancer diagnosis can be very challenging emotionally. "Head and neck cancer can affect some of what I think makes us the people that we are," he says. "Your ability to speak, your ability to swallow, to socialize, to even have your face seen. These are the body parts that are affected by head and neck cancer."
• He emphasizes that the MUSC Health team is committed to providing patients with the best possible care, both physically and emotionally. A support group has been established at MUSC Health to help connect head and neck cancer survivors.

Read the Show Transcript

[00:00:00] Erin Spain, MS: Welcome to Advance with MUSC Health. I'm your host, Erin Spain. This show's mission is to help you find ways to preserve and optimize your health and get the care you need to live well. Your nose, tongue, face and throat. You may not think of cancer lurking in these places, yet many head and neck cancers originate here. And there are signs and symptoms related to the disease that you can look for. Today's guest is here to talk about the warning signs of head and neck cancer and the latest treatments offered to patients at MUSC Health.

[00:00:39] Dr. Jason Newman is a head and neck surgeon and director of the Division of Head and Neck Oncology and the Department of Otolaryngology at MUSC Health. Welcome.

[00:00:50] Jason Newman, M.D.: Thanks for having me.

[00:00:51] Erin Spain, MS: So you are a surgeon and surgery is a common and effective treatment for head and neck cancer, but tell me about the path that patients take before they meet you.

[00:01:01] Jason Newman, M.D.: These patients are often showing up at their primary care doctor. With a a simple complaint. "I have a lump in my throat", " I have a lump in my neck" and usually that's the starting point for these patients. Oftentimes, after potentially, other roads of investigation, these lumps aren't going away and they're sent to an E N T doctor or an otolaryngologist. And it's often in the hands of that doctor that a suspicion for cancer or a diagnosis is made. And at that point, we get the phone call to help take care of these patients.

[00:01:31] Erin Spain, MS: Is there sometimes a route where people are seen by a dentist and one of these cancers are detected?

[00:01:37] Jason Newman, M.D.: Absolutely. I would say that between the dental world and the primary care world, those are probably where most of these patients are starting. We try as much as possible to train the community of dentists around us that non-healing ulcers or lesions in the mouth are a major reason for those patients to be investigated and sent to us when appropriate.

[00:01:55] Erin Spain, MS: So let's talk about head and neck cancers. What are they? What aren't they? Where do they occur?

[00:02:01] Jason Newman, M.D.: Head and neck cancer is one of the more common cancers that is out there. Actually, the six most common in this country. They are largely in a category that are classified as squamous cell cancers. And squamous cells are the cells that line the inside of our mouth, the outside of our skin.

[00:02:17] The most common cancer in the head and neck is squamous cell carcinoma or squamous cell cancer. That cancer and some of the other ones we see involve almost all of the different parts of the head and neck area.

[00:02:26] So throat, voice box, sinuses, tongue. And then we see a lot of other cancers that are similar but not quite the same, like thyroid cancer, skin cancer, cancer of the salivary glands. So it's a pretty wide range of different types of things that we see.

[00:02:42] Erin Spain, MS: And we're talking about people's faces, people's necks, people's throats. There's an emotional component that comes when being diagnosed and having to have surgery on this part of your body. Can you just speak to that a little bit?

[00:02:52] Jason Newman, M.D.: I talk about that a lot because every cancer is devastating, undoubtedly. But if you can imagine having a cancer that affects some of what I think makes us the people that we are, that's probably one of the most devastating types of cancers. Your ability to speak, your ability to swallow, to socialize, to even have your face seen. Especially during the virtual era where most people are looking at each other on screens.

[00:03:16] These are the body parts that are affected by head and neck cancer. So I think we are very sensitive to the needs for patients, not just to be cancer free, but also get them back to as much of their lives as we can.

[00:03:26] Erin Spain, MS: Talk about some of these symptoms, the common symptoms that people really should not ignore.

[00:03:32] Jason Newman, M.D.: If we're talking about something like the throat, I would say a sore throat that doesn't resolve itself within four to six weeks. It certainly doesn't mean that that is cancer, but an unresolved sore throat needs to be investigated.

[00:03:44] Same thing with an unresolved ulcer or lesion, meaning a thing that you see either in your mouth or you feel in your throat that doesn't go away in four to six weeks really warrants investigation.

[00:03:54] Erin Spain, MS: What puts someone at risk for developing these cancers?

[00:03:58] Jason Newman, M.D.: So there's a few very common risk factors for this cancer, and probably number one on the list is still smoking. We see a large portion of patients who are smokers and being a smoker puts you at high risk for head and neck cancers. The other things that, are in that category, some of which are related like alcohol.

[00:04:13] So when we think about the combination of smoking and alcohol, that combination multiplies your risk for head and neck cancer. A few other less common ones are things like sun exposure, because we're looking at a part of the body that often is in the sun. So skin cancers in the head and neck are often caused by excessive sun exposure.

[00:04:31] And then one of the newer types of, exposures that we see are viral exposure, HPV or the Human Papilloma Virus and EBV Epstein Bar Virus are starting to become significant factors for head and neck cancers.

[00:04:43] Erin Spain, MS: Tell me a little more about that. HPV really has become a serious consideration when it comes to head and neck cancer.

[00:04:51] Jason Newman, M.D.: If I had looked 15 years ago, I never would've thought of HPV as a cause of head and neck cancer, but currently it is one of the most important causes of head and neck cancer. And in fact, head and neck cancer is the number one cancer caused by this virus. It used to be cervical cancer in this country, but now head and neck cancer unfortunately has overtaken cervical cancer as the number one cancer caused by this virus.

[00:05:13] Erin Spain, MS: And explain HPV for folks who are listening.

[00:05:16] Jason Newman, M.D.: HPV is a sexually transmitted infection and it is very common and in the pre- vaccination era, the statistics show that about 90% of Americans have probably had exposure to the virus. And now of course we have a vaccination for the virus. So for those who get vaccinated at the right time, they may never experience cancers related to that virus.

[00:05:37] Unfortunately, for many people, we probably have had exposure to that virus before the vaccine was introduced. So some people remain at risk despite knowing that this vaccine is still out there.

[00:05:47] Erin Spain, MS: And with the HPV virus, the folks that you are seeing with cancers related to it, how old are they? Who's the typical patient that you see coming in? Might surprise people?

[00:05:57] Jason Newman, M.D.: That's a really good question because that wouldn't just surprise patients. That still surprises even a lot of healthcare providers. Meaning we are seeing young, healthy people, non-smokers, non-drinkers who are often in their forties and fifties and are showing up at their healthcare providers with a lump in their neck or with something in their throat.

[00:06:16] And , based on the training that many of us received, historically, we wouldn't have put them in the category of a high risk for head and neck cancer patient. But now really it's important to realize that those patients are definitely in the higher risk category. So our job is to educate the public, but also even providers of healthcare to have them understand that those patients need to be looked at differently these days.

[00:06:35] Erin Spain, MS: And you mentioned the vaccine for HPV. Who can get the vaccine? Is it just for young people?

[00:06:41] Jason Newman, M.D.: The guidelines have moved around a little bit, but in general, they are now recommended for both boys and girls, in their early teen or preteen years. But you are eligible to get the vaccine routinely up to 26, but now the FDA has actually approved it all the way up to 45 in certain patients.

[00:06:58] So I would say it's something to discuss with your healthcare provider, but I certainly recommend to every person who asks me to get this vaccine. It will prevent all of the cancers related to this virus.

[00:07:08] Erin Spain, MS: So we talked about surgery being a very common part of treatment. Explain the other parts that go into the treatment of this disease.

[00:07:16] Jason Newman, M.D.: So as we mentioned previously, this is a disease that affects patients in so many different ways. It's very important that when they touch ground at a place like MUSC that we really think about all of the different options that are available for them. Because surgery is often a great choice, but we also wanna make sure that it's the best choice for that patient.

[00:07:34] We have a lot of new and interesting things happening. Some of the more common things that we do are treating patients with a combination of either surgery or radiation or chemotherapy, or some variation of all of those. Things like immunotherapy are new on the head and neck, arena, but are also things that we, often consider when we're, managing patients with head and neck cancer.

[00:07:54] Erin Spain, MS: MUSC Health Hollings Cancer Center is the only NCI designated cancer center in the state of South Carolina. Tell me about that status and how it benefits patients.

[00:08:04] Jason Newman, M.D.: This is something I think is really important to consider. It is not just a stamp of approval. This is actually a comment from a national organization that we are meeting the highest standards of cancer care. And that is not just surgery, but it's really every detail, including pathology, radiology, the research component, our social workers, our nurse navigators.

[00:08:25] All of these parts really have to be in place for you to get this designation. So I think it's important to really think. "What tools do I as a surgeon need to help me make the right decisions?" And that includes all of those things that I mentioned. This is not a one person show, so if you're part of an NCI designated cancer center, you're really demonstrating that you are able to commit to a holistic approach to patient care.

[00:08:48] Erin Spain, MS: And there are sometimes when people will have to come to Charleston to have surgery, to receive some care, but there is a big effort to reach people all across the state of South Carolina can you tell me a little bit about that?

[00:08:59] Jason Newman, M.D.: Absolutely. And I feel that that is actually a major initiative and really something exciting that MUSC is doing. South Carolina is a big state and there's a lot of people who do not have great access to healthcare so it's really important that we try to bring as much of this care as possible to the local community.

[00:09:16] So how do we do that? Well, there are certainly things that we can do to get parts the patient's treatment done locally. Certainly in some cases doing chemotherapy and even radiation locally is possible. For now the surgery because of its complexity is often still done, in Charleston.

[00:09:32] But certainly we know we can provide a lot of the services closer to home. Not just even the treatment ones, but also the post-treatment ones. The care that needs to be delivered, the speech and language pathology, the nutrition. So really in growing cancer programs across the state that help support MUSC's mission, we're really able to give that to patients in a way that feels very much similar to the quality and level that we are doing downtown.

[00:09:55] Erin Spain, MS: And this is especially needed with head and neck cancer because South Carolina does have a higher prevalence than some other states of head and neck cancers. Can you tell me about that? 

[00:10:06] Jason Newman, M.D.: Within the state of South Carolina, unfortunately, we have a higher incidence of things like smoking and drinking, and also a lower rate of vaccination for things like HPV. And then of course, we're also in the southern part of this country, so we have a lot of sun exposure and people who work on farms.

[00:10:21] And you take that and combine it with a slightly lower rate of access to healthcare. And not only do we see more patients who have these cancers, but we're seeing that they often present at more advanced stages because it might take a little longer for a patient to see a doctor and for that doctor to get the patient into the system.

[00:10:39] So, it really is on our shoulders to try to help get the education both to patients and providers, and then to be able to actually take care of them in a way that allows them to be treated sooner and to hopefully even reduce the rate of these cancers.

[00:10:52] Erin Spain, MS: Tell me about some of the things that are happening right now at MUSC Health that can really benefit your patients.

[00:10:57] Jason Newman, M.D.: There's just so many different things that we're doing. I'd like to tell people that the standard of care is great, but we're still leaving a lot of patients who are not being cured, or even if they are being cured, we're leaving them with devastating side effects.

[00:11:10] So in my head, when I think about standard of care, that isn't good enough. So we are doing a lot of things to help push even the standard of care to that next level. So, for example, we're doing things like minimally invasive surgery, reducing the rate of radiation and decreasing the amount of chemotherapy that we're getting.

[00:11:27] And we're doing these, not just on a one off basis, but by doing them as part of a study so that we can actually demonstrate that these approaches are the right ones.

[00:11:35] The other type of things that we're doing are, clinical trials. And I would say clinical trials aren't just experiments, but they are ways to help demonstrate that we can make small or sometimes big changes to the way that we deliver cancer care. We are doing, something called liquid biopsies.

[00:11:51] Liquid biopsies are a new approach to attempting to evaluate and detect cancer in the blood instead of by doing a physical biopsy or instead of by scanning a patient. So we're using, the DNA that is made by the cancer and finding it in the bloodstream and attempting to use that as a marker for either a response to therapy or to help identify if a patient has recurrence.

[00:12:13] Some of our early studies have demonstrated that we are better able to predict a recurrence of cancer by this simple blood test than by all of the very expensive and complicated scans and other evaluations that we do for people. So that's really helping change the way that we identify these cancers, as well as the way that we follow patients who have had these cancers.

[00:12:31] Erin Spain, MS: The care of these patients doesn't end after treatment. Your group also helps with survivorship, and you recently established a support group. Tell me about that and some of the care that it's provided after the surgeries and treatments are done.

[00:12:44] Jason Newman, M.D.: A lot of patients that we treat have understandably a very difficult time reintegrating into their normal society when they have undergone all of these treatments. I routinely have patients tell me that, you know, if they go out to dinner with their friends, they feel that it's difficult for them even to get through an entire meal because they eat much more slowly now. They might have to concentrate a little bit more. So it really can get in the way of the good parts of our life. So I think it's helpful for patients to connect with other patients and really get an understanding of how they've overcome these obstacles.

[00:13:15] There are sometimes ways that people can get through this. And also just to know that, other patients are going through the same thing, I think is very helpful. But we've also more formally investigated and are starting to investigate with some clinical trials that are ongoing and hopefully very exciting: how do we do a better job at helping these patients reintegrate into society? What specific tools do we need to have and do we need to provide to them so that they can feel like they're back to the person that they were before all of this? So that involves a lot of psychological investigation, a lot of body image concepts, and we're really exploring this because we know that this is important. Curing the cancer is important, obviously, but it's only step one in how we take care of these patients. The rest of it is how do we let them land safely back into their lives and have us feel like we've done the whole part of our jobs and not just part of it?

[00:14:03] another, one of the really exciting things that we're doing is something called fluorescent guided surgery. And really, if you think about surgery, one of our main goals is to achieve what we call negative margins. Meaning we want to get around these tumors. 

[00:14:17] But if you think the head and neck is a area of the body that has such dense anatomy and so many critical structures, we have to thread that needle between taking very wide margins, which of course in some cases sounds like a great idea, because that increases the chance that you'll get around a tumor. but of course that also means potentially damaging a lot of the surrounding structures. But if you take margins that are too narrow, you have a risk that you will leave cancer behind. So one of the technologies that we have started to investigate is this fluorescent molecule concept. That adds another layer of data to the decision making that we're doing in the operating room. You know, we normally use just regular white light to decide how are we gonna make the decision between where we make the margin of our cuts, and now we have a layer to add on top of that. So really this is cutting edge technology that allows us to really, try to be better at getting a higher rate of achieving negative margins. We're always asking, "can we do better?"

[00:15:10] Erin Spain, MS: MUSC Health is also training the next generation of surgeons like yourself, and this is sort of creating a pipeline of more and more people who can do this very intricate surgery that you're talking about and use the latest cutting edge tools.

[00:15:23] So tell me who might a patient encounter, as far as a fellow or a medical student when they come to see you?

[00:15:29] Jason Newman, M.D.: I'm committed to the importance of educating the next generation of people who do this surgery. I joke sometimes it's so that they can take care of me if I ever get this, but I do believe that that's one of our roles at MUSC and I've always been committed to it. And I make sure that patients understand that this is not something that I feel apologetic about.

[00:15:48] Training that next generation of surgeons actually allows us to take care of even today's patients better. It keeps us all on our, the top of our game. It makes us feel like we have to do the best job because this is us teaching the next generation of people to do this.

[00:16:01] So our patients are going to run into everything from nursing students to medical students, to residents, to fellows. And we really believe that that's part of what we can do to help better serve the patients.

[00:16:12] Erin Spain, MS: You were actually brought into MUSC Health about one year ago to help expand the head and neck cancer program.

[00:16:20] What can we expect in the future?

[00:16:22] Jason Newman, M.D.: Well, I would tell you that the expansion so far has gone wonderfully. As much as is sad for me to see how many patients need our help, I think it's also important for us to realize that that's what we're here for. We are just expanding our physical space to include a much larger area for us to see patients. Which will allow us really not just to see more patients, but to do it in a way that allows all of the subspecialties to be together.

[00:16:46] So not just the surgeons, but also the radiation oncologist, the medical oncologist, the speech and language pathologist, nutritionist, palliative care, physical therapy, everyone. So this is really an opportunity for us to really help patients from day one and have them feel like their care is being delivered by a team that works and exists together on a pretty regular basis.

[00:17:06] Erin Spain, MS: If you could share some parting words of wisdom to listeners when it comes to head and neck cancer and things that they can do or look out for, what would you say to them?

[00:17:15] Jason Newman, M.D.: When I think about head and neck cancer, I think about a few different parts of it. One is prevention. And I would say that if you, are, , a smoker, I would encourage you to consider quitting. For those who are in the age eligible category for HPV vaccination, I would say absolutely get vaccinated. In the category of people who are worried that they have cancer I would say seek out care. Look for your primary care doctor. Look to your dentist, an oral surgeon, an E N T. Those people can help you detect these cancers quickly. There is a big difference between outcomes when these cancers are caught quickly and when when they're caught late. It is not equivalent.

[00:17:50] So the sooner you identify that you have these, the better. And then unfortunately, if you're someone who's already had these cancers, it's really important to just continue to follow up. We know that these cancers can come back. We hope they don't, but we also want to be realistic about making sure that if they do, we catch them really quickly so we can treat you as fast as possible.

[00:18:08] Erin Spain, MS: what do you do to optimize your health and live well?

[00:18:10] Jason Newman, M.D.: I try to separate to some degree what I do every day from the time that I spend outside of work. I like to exercise. I love to go on walks with my family and with my dog. I believe that doing some kind of meditation or yoga is really important.

[00:18:25] I think eating healthily and being mindful about your own health are important. So paying attention to any medical issues that you have, not putting them under the rug like we tend to. And just making sure you take good care of yourself and enjoy your time away from the difficult days when you're working.

[00:18:40] Erin Spain, MS: Thank you so much Dr. Jason Newman for all the information today.

[00:18:44] Jason Newman, M.D.: Thanks for having me, Erin. Really much appreciate it.

[00:18:46] Erin Spain, MS: For more information on this podcast, check out advance.muschealth.org