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New Otolaryngologist Focuses on Head and Neck Cancers

Northland physicians now have a resource for patients with symptoms indicative of head and neck cancers (HNC). Gaurav Prasad, MD, otolaryngologist with Meritas Health ENT, treats malignancies arising from the upper aerodigestive tract and its supporting structures as well as salivary gland cancer. His special interest is in the resection of head and neck cancers and microvascular reconstruction.

“When treating patients, we not only have to pay attention to oncologic outcomes but also to their functional capacities such as speech and swallowing,” Dr. Prasad explains. “That requires a multidisciplinary approach.”

PET/CT showing FDG-avid uptake in a large T4 left tonsil SCCA with extension to lateral pharyngeal wall

PET/CT showing FDG-avid uptake in a large T4 left tonsil SCCA with extension to lateral pharyngeal wall

Examination

“Since the oral cavity is easily accessible, PCPs can see manifestations of HN cancers from the lips to the tonsils,” Dr. Prasad notes. As the disease progresses, most patients will have symptoms, including persistent sore throat, problems with speech, dysphagia, a neck mass and weight loss. If adjacent bone of the palette or jaw is involved, numbness or problems with dentition may occur.

“The patient’s demographics are important when the PCP makes an evaluation,” Dr. Prasad adds. For example, PCPs should maintain a higher index of suspicion for a persistent sore throat in an otherwise healthy younger patient when compared to similar symptoms in an elderly smoker.

“If a patient comes in with ear pain on one side (referred pain), trismus, hemoptysis or change in speech, the PCP should look for an underlying cause.”

“If a patient comes in with ear pain on one side (referred pain), trismus, hemoptysis or change in speech, the PCP should look for an underlying cause,” Dr. Prasad says. “A neck mass may be the only thing a patient presents with to indicate the origin of an Oropharynx tumor.”

When the PCP detects symptoms such as mucosal lesions or masses or nonhealing ulcerated wounds inside the mouth, he should refer the patient to an ENT for further evaluation. “A thorough head and neck exam, in addition to maintaining a high index of suspicion, are paramount to avoiding a delay in diagnosis of head and neck cancers,” Dr. Prasad says.

Incidence Rate

Head and neck cancers are relatively rare, accounting for only 3% of all malignancies. More than 59,000 Americans are affected every year, resulting in an estimated 12,290 deaths, according to the American Cancer Society’s 2014 Cancer Facts and Figures.

HN cancers are three times more common in men than in women, with the exception of thyroid cancer, Dr. Prasad reports. Traditionally, HN cancers have been more prevalent in men because of their higher alcohol and tobacco use.

Thyroid Concerns

Thyroid nodules pose a different diagnostic issue. For nodules greater than 1 cm, Dr. Prasad recommends an FNA test or fine-needle biopsy. “A tissue diagnosis is needed, preferably before the patient is referred,” he explains. “That helps streamline diagnosis.”

Diagnosis

Fiberoptic laryngoscopy, CT, MRI and X-rays may be used to diagnose and stage HN cancers, which may be one of the following:

  • Oropharynx (OP) cancer involve the base of the tongue or tonsils, often linked to HPV. Symptoms include dysphagia, pain with swallowing, or sore throat or ear pain on the same side as the tumor.
  • Nasopharynx (NP) cancer can present with a neck mass or persistent middle-ear effusion. 
  • Hypopharynx cancer is often associated with tobacco and alcohol use. Symptoms include hoarseness, hemoptysis, dysphagia, neck masses and weight loss.

More than 90% of cancers of the upper aerodigestive tract are diagnosed as squamous cell carcinomas.

“The site helps dictate and drive the management recommendations,” Dr. Prasad explains, “That’s because all subsites are treated a little differently, depending on the tumor location — oral cavity, Oropharynx, Nasopharynx, pharynx or hypopharynx.”

OP Cancer Increases

T1 oral tongue SCCA

T1 oral tongue SCCA

While tobacco-related cancer has significantly declined with the decrease in smoking in the past 30 years, the same period has shown a significant increase in the incidence of oropharynx cancer. HPV infections, which are usually associated with cervical cancer, are now being linked more with oropharyngeal cancer.

“This is important from a treatment perspective because HPV-positive cancers have a better prognosis and survival rate than non-HPV-related cancers,” Dr. Prasad noted.

Prevention

FDA-approved HPV vaccines provide an additional opportunity for primary prevention in the at-risk population. The three commercially available vaccines are Gardasil, Gardasil 9 and Cervarix. Depending on each vaccine’s protocol, both males and females can be vaccinated between the ages of 9-26.

“ENTs nationwide have had a big push to increase awareness of appropriate vaccination of young people,” said Dr. Prasad.

Additionally, avoiding tobacco and excessive alcohol use will lower HN cancer risk. Safe sex practices may reduce the risk of contracting HPV related oropharyngeal tumors.

Gaurav Prasad, MD

Gaurav Prasad MDDr. Prasad received his medical degree from and completed his otolaryngology residency at the Saint Louis University Department of Otolaryngology. He completed a fellowship in head and neck surgery and ablative/microvascular surgery from the Indiana University Department of Otolaryngology.