I’m An Ex-Smoker And Drinker With Dreadful Acid Reflux: Should I Be Screened For Certain Cancers? Important Question For Head And Neck Cancer Awareness Month

And there’s plenty of information on the internet about who should be concerned about their potential risk for developing head and neck cancer, but we’d like to make it easier for you. So, if you’re someone who’s heard that their history of smoking or acid reflux disease or something else puts them at a higher risk for certain head and neck cancers and you’re wondering what you need to know about these diseases, you’ve come to the right place.

Understanding Head and Neck Cancer

“Head and neck cancer” is a broad term encompassing a number of different malignant tumors that develop in or around the throat, larynx, nose, sinuses and mouth, according to the American Society of Clinical Oncology (ASCO). Oral cancer is the most common type of head and neck cancer.

The two main risk factors for this group of diseases includes the following:

• Tobacco use. This is the single largest risk factor for head and neck cancer with researchers estimating that 70 to 80 percent of head and neck cancers being linked to tobacco use. Also worthy of note is that secondhand smoke may increase a person's risk of developing head and neck cancer.
• Alcohol use. Using alcohol and tobacco together increases your risk even more.

“Head and neck cancer patients, we know that tobacco smoking is a risk but also heavy alcohol use,” Dr. Jessica Geiger, a medical oncologist specializing in head and neck cancer at Cleveland Clinic Cancer Center, previously told SurvivorNet. “So, drinking more than two or three drinks if you’re a man per day, in addition to smoking. Smoking and alcohol are sort of additive carcinogens. Especially in cancer of the larynx or the voice box, we know that drinking heavily, heavy alcohol use, is just as important of a risk factor as tobacco smoking is.”

Other factors that can increase your risk of developing a head and neck cancer include the following:

• Prolonged sun exposure. This is especially linked to cancer in the lip area, as well as skin cancer of the head and neck.
• Human papillomavirus (HPV). Research shows that infection with HPV is a risk factor for head and neck cancer. Nearly every sexually-active person will get HPV at some point in their lives, but most people with the infection do not know they have it and never develop symptoms or health problems from it. The virus is spread via sexual activity and can manifest as warts on your genitals or mouth. Thankfully, we have three types of HPV vaccines that can reduce the rates of certain cancers.

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• Epstein-Barr virus (EBV). Exposure to EBV, which is more commonly known as the virus that causes mononucleosis or “mono,” plays a role in the development of nasopharyngeal cancer.
• Gender. Men are two to three times more likely than women to develop head and neck cancer. However, the rate of head and neck cancer in women has been rising for several decades.
• Age. People over the age of 40 are at higher risk for head and neck cancer.
• Poor oral and dental hygiene. Poor care of the mouth and teeth may increase the risk of head and neck cancer.
• Environmental or occupational inhalants. Inhaling asbestos, wood dust, paint fumes and certain chemicals may increase a person's risk of head and neck cancer.
• Marijuana. Research suggests that people who have used marijuana may be at higher risk for head and neck cancer.
• Poor nutrition. A diet low in vitamins A and B can raise a person's risk of head and neck cancer.
• Gastroesophageal reflux disease (GERD) and laryngopharyngeal reflux disease (LPRD). Reflux of stomach acid into the upper airway and throat may be associated with the development of head and neck cancer.
• Weakened immune system. A weakened immune system can raise a person's risk of head and neck cancer.
• Exposure to radiation. Exposure to radiation is associated with salivary gland cancer.
• Previous history of head and neck cancer. People who have had one head and neck cancer have a higher chance of developing another head and neck cancer in the future.

Treatment for head and neck cancers vary, but it generally involves a many-sided approach.

"The treatment of head and neck cancer and to cure head and neck cancer, it involves multiple specialties, radiation oncology, medical oncology, nutrition, speech and language pathology to make sure that patients are swallowing appropriately and getting their nutrition in," Dr. Geiger said. "All of us need to work together as a cohesive team in order to make that happen."

Dr. Geiger also says it can be difficult for some patients to get through treatment, but there are people out there to help.

"It can be a challenge to get them through treatment," Dr. Geiger said. "However, by the time I see them, they've already been diagnosed with cancer and so, I, in addition to being a medical oncologist and giving chemotherapy and following patients through their treatment, I also tell them that I serve as their cheerleader. I'm there to coach them through treatment."

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Another thing to consider when thinking about head and neck cancer patients or any cancer patient for that matter is their mental health. Dr. Geiger says it's not uncommon for head and neck patients to "feel depressed or down," and a good support system will be key for their cancer journey.

"It's important for caregivers and support that patients have either a spouse or a close family member, or friend or relative to help get them through treatment as well," Dr. Geiger said. "No one can get through treatment for head and neck cancer on their own. It really does take a community. Not just with the medical professional staff but also caregivers and support at home."

Screening for Head and Neck Cancer

Currently, there are no screening methods for head and neck cancer that have been proven to improve patient outcomes. Even still, it’s important to be on the look out for signs and symptoms of the disease and report them to your doctor should any appear. People with head and neck cancer do not always have these symptoms or signs, but they can often experience the following:

• Swelling or a sore that does not heal; this is the most common symptom
• Red or white patch in the mouth
• Lump, bump or mass in the head or neck area, with or without pain
• Persistent sore throat
• Foul mouth odor not explained by hygiene
• Hoarseness or change in voice
• Nasal obstruction or persistent nasal congestion
• Frequent nose bleeds and/or unusual nasal discharge
• Difficulty breathing
• Double vision
• Numbness or weakness of a body part in the head and neck region
• Pain or difficulty chewing, swallowing or moving the jaw or tongue
• Jaw pain
• Blood in the saliva or phlegm, which is mucus discharged into the mouth from respiratory passages
• Loosening of teeth
• Dentures that no longer fit
• Unexplained weight loss
• Fatigue
• Ear pain or infection

Early detection may help with prognosis or successful treatment of the disease, so you should always report any changes to your health listed above or otherwise to a medical professional. And Dr. Gieger said that tobacco users (former or present) should take the following guidance when considering a sore that develops within their mouth.

“If the sore gets worse, grows over time or becomes very painful and doesn’t go away, then you should seek medical attention,” Dr. Gieger said. “Typically, a patient who develops a sore on the tongue or a lesion in the inside of the mouth that doesn’t heal, they’ll be seen by their primary doctor first who then will refer them to an ear, nose and throat surgeon or an oral surgeon.

“Oftentimes, we have patients who are referred to our clinics from their dentists office who notice a sore that doesn’t seem to be healing, or a wound that is on the inside of their mouth or around their teeth. Then, we set the patients up with a biopsy to confirm cancer or to show something else and we proceed from there.”

And if you have acid reflux, like many Americans do, you should also take your cancer risk (including some cancers of the head and neck) into consideration.

“When you have acid reflux, stomach acid can make its way up into your esophagus,” Dr. Maie St. John, chair of head and neck surgery and Co-Director of the Head and Neck Cancer Program at UCLA Health, previously told  SurvivorNet. “When your saliva, which has a high nitrate content, meets with these acidic gastric juices, it may cause a chemical reaction that creates substances, including nitrous acid and nitrous oxide, which could raise risk for cancer formation.”

One study even suggested that people who had acid reflux were up to two times more likely to develop certain cancers of the larynx (a type of head and neck cancer) and esophagus (NOT a type of head and neck cancer) than people who didn't have reflux.

"This study doesn't suggest that if you have GERD (gastroesophageal reflux disease a more severe and long-lasting condition where acid reflux causes repeated symptoms that are bothersome or leads to complications over time) you need preventive screenings for laryngeal or esophageal cancer, but it does suggest that if you have GERD and develop symptoms of these cancers, such as hoarseness, a change in your voice, difficulty or pain swallowing, an unexplained ear ache, or breathing trouble, you should get it checked out because your GERD may be a risk factor for these types of cancers," Dr. Theodoros Teknos, president and scientific director of UH Seidman Cancer Center in Cleveland, OH, previously told SurvivorNet. Dr. Teknos specializes in head and neck cancers.

You can always talk with your doctor about your risk for head and neck cancer if you are concerned or recognize that some of the risk factors for this group of diseases applies to you. And, in general, multiple cancer centers including Yale Cancer Center, Moffitt Cancer Center and Memorial Sloan Kettering Cancer Center advise that all patients whether they have risk factors or not undergo regular inspection from their doctors and dentists.

“Our doctors advise that all individuals have a yearly physical examination of the head and neck and oropharynx (the middle section of the throat that includes the soft palate, the base of the tongue, and the tonsils) conducted by their primary care physician, as well as a yearly routine dental evaluation to include examination of the neck and inspection of the oropharynx and the mouth,” the Memorial Sloan Kettering Cancer Center cite reads.

For oral cancer specifically, the American Dental Association says all clinicians should have an updated medical, social and dental history and perform an intraoral (inside of the mouth) and extraoral (outside the oral cavity) conventional visual and tactile examination in all adult patients. And if the doctor finds a suspicious lesion, they should immediately perform a biopsy or refer the patient to a specialist.

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