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Avoidance and surveillance are key steps

Photo: Studies by Lori Wirth, MD indicate that the use of a pain reliever called Celebrex may slow the growth of lesions that can lead to head and neck cancers.

Studies by Lori Wirth, MD indicate that the use of a pain reliever called Celebrex may slow the growth of lesions that can lead to head and neck cancers.

The burden of head and neck cancer would dwindle dramatically in a tobacco-free world, as smoking is by far the biggest risk factor for the debilitating disease. Smokeless tobacco puts users at higher risk, too.

In 2004, however, tobacco consumption is not yet history, and millions of current and former smokers are in danger of developing mouth and throat cancers—not to mention lung cancer, heart disease, and other illnesses.

With early diagnosis, head and neck cancers can be treated successfully, sometimes with surgery alone. Medical centers offer screenings, and dentists are trained to examine the tongue, lips, and mouth for lumps and precancerous lesions, which appear as persistent white or red patches on the lining of the mouth.

Although these lesions are typically treated surgically, that step often does not remove all the precancerous cells. And because only 30 percent of precancerous lesions progress to cancer, so eliminating them does not necessarily benefit every patient, says Lori Wirth, MD, a medical oncologist with the Dana-Farber/Brigham and Women's Cancer Center Head and Neck Oncology Program.

As a result, Wirth is studying chemoprevention, the use of drugs to forestall the progression of early lesions into full-blown cancer. She currently heads a trial of Celebrex, a pain reliever known as a Cox-2 inhibitor, in patients who have premalignant mouth lesions. It's too early to assess the drug's effectiveness in preventing cancers, but Wirth says preliminary data shows that Celebrex appears to have suppressed a chemical that is overactive in the precancerous lesions.

Prevention is "a tough problem to study in people because the at-risk population is fairly large," says Wirth, "and oral cancer develops slowly over many years." Consequently, prevention studies take a long time. Surveillance is also important, not only to catch these cancers early, but to watch for recurrences after treatment—a significant risk in head and neck tumors.

Paths of Progress, Fall/Winter 2004

Paths of Progress Archive

Looking for signs

Here are some common warning signs of oral, head, and neck cancers:

  • Red or white patch in the mouth that lasts more than two weeks
  • Change in voice or hoarseness that lasts more than two weeks
  • Sore throat that doesn't subside
  • Pain or swelling in the mouth or neck that doesn't subside
  • Unexplained lump in the neck

Warning signs that occur during the later stages include ear pain, tongue numbness, and difficulty swallowing or breathing.