Category Archives: Head and Neck Cancer

COMPLETING RADIATION FOR THROAT CANCER IS CRUCIAL-YOUR LIFE DEPENDS ON IT

Our dedicated experts will help you get through treatments. Your life depends on it.

Each and every week I hear the same questions from my patients with cancer of the head and neck. “Doctor, do I really need to have all 33 treatments? This is really hard. Haven’t we done enough? Can’t I just quit?”

My answer is almost always the same. “It’s not a good idea. You’ve come this far. Quitting now  puts your chances of a cure at risk. You really need to complete every one of the treatments.”

Now there is an important study that supports my answer. In the study of 8.388 Medicare patients with advanced cancer of the throat or larynx (voice box), the important result was that patients who did not complete chemotherapy and radiation therapy did worse than patients who did. Much worse, in fact.

The second important finding was the patients who completed chemotherapy and radiation therapy did just as well as those patients who had surgery. The surgery for advanced larynx cancer is called a laryngectomy that involves removing the voice box permanently. The study was published about one year ago in the prestigious journal titled Cancer.

So finishing those last few treatments of chemotherapy and radiation therapy-admittedly the hardest part of the process-really is important for your survival. It’s also the time where an experienced radiation doctor and support team, including the chemotherapist, radiation therapists, swallowing therapist and oncology nurses- are really crucial. The management of side effects is key. This is why having a dedicated team of experts who focus on you is so important to me as a physician.

If you have any questions about your head and neck cancer, please feel free to call me, Dr. Edward Hughes at 1-855-DAYTON1. I guarantee that I will see you in consultation in 1-3 days of your phone call. And when you call us, you’ll talk to directly to my team who work beside me; not a call center.

Head and Neck Cancer Patients Need Not Worry about Holiday Pounds

snowmenIt’s Not Just Loss of Arm Strength But Also Your Heart Strength That’s Affected

At First Dayton Cancer Care, I see and treat many patients with head and neck cancer each and every week.  I tell them that the big battle ground will be nutrition.  I tell them I don’t want to see them lose weight because it will be muscle rather than fat that they will lose.  After I tell my patients about all the side effects of chemotherapy and radiation treatment, an overwhelming experience to say the least, many patients just smile and say “I need to lose a few pounds anyway.”

Unintentional weight loss in cancer patients-called cachexia-not only results in loss of muscle mass but also may account for loss of heart muscle function.  Cachexia is defined as >5% weight loss and 3 of 5 other factors-loss of muscle strength, fatigue, lack of appetite, loss of muscle mass, low albumin and high C-reactive protein. In a remarkable summary of many studies, Dr. Couch and colleagues showed the cachexia is a major factor in the death of many head and neck cancer patients (Head Neck; 2015; 37: 594-604).  The surprising finding is that heart trouble related to cancer weight loss may account for up to 20-30% of head and neck cancer patient’s deaths.  Even if they are first cured of their cancer.

My clinical instinct over the years was that nutrition was one key to survival.  But I never thought that weight loss in cancer patients could affect their hearts to such an extent.  If Dr. Couch’s studies hold up, head and neck cancer specialists will lose up 30% of patients from cachexia, not cancer. But even more frustrating is the fact that while intentional weight loss is fixable by good nutrition alone, cachexia or unintentional weight loss in cancer patients, is not.  So much more medical work and research is needed here.

Don’t get me wrong.  The medical and technological breakthroughs in head and neck cancer care have been nothing short of miraculous over the past decade.  But I think head and neck cancer specialists need to take nutrition, especially new ways to battle cachexia, much more seriously than in the past.

 Diagnosing Cachexia-Related Muscle Loss Is Not As Easy As You May Think

 Diagnosing muscle loss seems easy, doesn’t it?  Plain and simple.  Just have the doctor or nurse weigh you and examine you.  And taking a good medical history may help.  But it’s not just that easy.

As head and neck cancer doctors, we rely “heavily” on BMI or body mass index-a formula based on height and weight. The BMI alone may mislead cancer doctors, especially in men who have more muscle mass than women.  That’s also true in men and women who are obese – underestimating loss of muscle mass. The change in BMI alone is likely to be misleading as a measure of loss of muscle mass or cachexia.  In fact, the gold standard for body composition assessment- a CT scan of the lower spine and pelvis- is rarely used to diagnose cachexia related loss of muscle mass.  I know of not a single cancer clinic in the country that uses CT scans to assess body composition to diagnose cachexia in cancer patients.

                                                                 CANCER CACHEXIA =

3 or more symptoms                                    +                    Weight Loss > 5% within 12 months

  • Fatigue
  • Loss of Appetite
  • Decreased Muscle Strength
  • ↑CRP or ↓ Albumin
  • Low Fat-Free Muscle Mass on CT Scan
 So What Can A Head and Neck Cancer Patient Do to Diagnose Cachexia?

First and foremost, be upfront and honest with your head and neck cancer specialist.  Do tell your doctors about any loss of muscle strength, fatigue, and lack of appetite.  Ask your doctor about blood tests that measure if you are anemic, have a low level of the blood protein called albumin, or increase in the level of the broad protein called C-reactive protein or CRP for short.

The syndrome of cachexia in head and neck cancer patients-unintentional weight loss, loss of muscle mass, anemia, lack of appetite, and fatigue-is all too common.  But what is starting to be learned about this cancer syndrome may also have profound effects on your heart muscle, resulting in 20-30% of deaths in head and neck cancer patients.

So much more time and money for medical research into cachexia is long overdue.

My expert staff works closely with our patients to ensure that weight loss is at a minimum during radiation therapy. If you have concerns, please talk to me, Dr. Ed Hughes at 1-855-DAYTON.1

The Cyber Knife Breaths with You

Dr. Hughes explains how the Cyber Knife is used to treat cancers such as lung, prostate, kidney, brain, spine and many others. Not only can we control the radiation beam to mere millimeters, the real time imaging allows the Cyber Knife to track the tumor to ensure that we target only the cancer. It actaully breaths with our lung cancer patients.  It follows the motion of the prostate. It sees into the brain during treatment. There is NO other radiation treatment that can do this. Watch!

You Need an Experienced Head and Neck Cancer Doctor

An experienced radiation oncologist can save you from head and neck cancer.

An experienced radiation oncologist can save you from head and neck cancer.

A landmark study of over 6,200 patients with head and neck cancer treated with radiation therapy revealed a startling result.  The cure rates increased by 21% – a huge number – for those patients treated by an experienced radiation oncology doctor. Dr. I.  J.  Boero and colleagues from the University of California, San Diego published their study in the March 1 issue of the prestigious Journal of Clinical Oncology (J Clin Oncol 2016; 34:684-690).

Their conclusion was clear; high volume radiation oncology doctors did better for their patients than low volume doctors. Volume indicates how many patients they treat in a year with a cancer of the head and neck region.

A BIG CANCER CLINIC IS NOT THE SAME AS EXPERIENCE

If you ask me, it is not a surprising conclusion.  What was surprising was the magnitude of the difference.  Head and neck cancer patients have a 21% better chance of survival if they are  treated by an experienced head and neck radiation oncology physician.  The second surprising conclusion was that the benefit is not seen with patients who are treated with conventional radiation therapy performed at many hospitals. This concludes the argument that the better result with high-volume radiation oncology doctors are not due to the experience of other team members, including the medical oncologist, nurses, speech pathologist, or the radiation therapists who actually set up the patients and treat them on a day-to-day basis.  IMRT takes much more skill and experience on the part of the radiation oncology doctor than conventional head and neck radiotherapy.

SEEK EXPERIENCE IN HEAD AND NECK CANCER TREATMENT

So experience counts. A lot.  Finding an experienced radiation oncology doctor is the key first step in successful treatment of your head and neck cancer.  When seeking a physician to treat you, ask them how many patients do they treat with this type of cancer. For instance, many cancer centers today are joined with urologists, so their focus is prostate cancer. Many are attached to a neuroscience center, so their focus is brain and spine. Seek a physician who has experience with head and neck cancers.

At First Dayton Cancer Care, we have the most experienced, high-volume radiation oncology doctors in Southwest Ohio.  If you have any questions about your head and neck cancer, please feel free to call Dr. Edward Hughes or Dr. Donald Marger at 855-Dayton 1.

The Latest News From the Front Line: The Multidisciplinary Head and Neck Cancer Symposium 2016

 

Dr. Hughes enjoyed some February Arizona sunshine while he learned the latest research to help his patients here in Ohio.

Dr. Hughes enjoyed some February Arizona sunshine while he learned the latest research to help his patients here in Dayton.

I personally attended The Multidisciplinary Head and Neck Cancer Symposium along with hundreds of head and neck cancer specialists  from around the world – surgeons, chemo therapists, and radiation therapists – to hear about the latest in state-of-the-art treatment for head and neck cancer patients.

A number of presentations struck me as important for our head and neck cancer patients and their families living in Dayton, Ohio. 

1.  Head and Neck Cancer Patients Can Be Sure that Radiation Therapy in Dayton, Ohio Is Just As Good As At The James Cancer Center  

The key study for Southwestern Ohio head and neck cancer patients came from our own James Cancer Center at the Ohio State University.  The James’ head and neck cancer specialists looked at 333 patients who had their surgery at OSU.  Of these, 139 patients had their radiation at OSU and 194 patients had radiation in their hometown.  The important finding was that there was no difference in survival in those patients who had their radiation at OSU (139 patients) as compared to this patients (194) who underwent radiation therapy at centers closer to home. I have always firmly believed that people do better when they stay close to their support system and when they can live life as normal as possible during treatment.

2. Immunotherapy for Recurrent Head and Neck Cancer Patients 

Dr. Siewert from the University of Chicago School of Medicine reported on the Checkmate 141 trial.  The Checkmate 141 trial looked at a new immune checkpoint inhibitor drug called Opdivo.  Opdivo has been proven to be effective for patients with metastatic malignant melanoma as well as recurrent lung cancer.  Immune checkpoint inhibitors unleash your body’s own immune system to attack your own head and neck cancer, unlike chemotherapy that suppresses your immune system.

Remarkable results were seen with Opdivo in treating patients with recurrent head and neck cancer, that is after surgery, chemotherapy, and radiation therapy.  In fact, so remarkable that the study was halted early because more than 50% of patients with recurrent head and neck cancer responded to Opdivo.  And with few side effects.  More importantly, the effects of Opdivo lasted on average 18 months, far greater than with palliative chemotherapy.

Dr. Siewert reminded us that these patients with recurrent head and neck cancer had been, as he put it, “heavily pretreated.”  That is to say, these patients had many courses of chemotherapy.  These patients already had a suppressed immune system from chemotherapy.  Just imagine if Opdivo would be used as first line therapy for patients with recurrent head and neck cancer.  Dr. Siewert expects rapid approval of Opdivo for recurrent head and neck cancer patients by the FDA. 

3.  Say Goodbye to Stage IV Tonsil/Base of Tongue Cancer For HPV-positive Patients

 Dr. Brian O’Sullivan of the Princess Margaret Hospital in Toronto proposed a new staging system for HPV positive patients with squamous cell carcinoma of the tonsil as well as base of tongue.  His studies showed that chemotherapy and radiation therapy are so good in this patient group that a new classification system is needed for prognosis as well as to guide treatment.  He proposed only 3 new stages.  Stage IV is now reserved for that very rare patient who comes to clinic where the cancer has already spread to other organs, such as lung or liver.

Dr. Chera of the University of North Carolina at Chapel Hill went a step further and proposed that in early stage HPV positive head and neck cancer patients, radiation dose could be reduced from the standard 6-1/2 weeks to 5 weeks with exactly the same results – but with fewer side effects.  Until further studies are done, this reduced radiation dose regimen will be for selected patients with cancer of the tonsil and base of tongue who are non-smokers/non-drinkers and HPV positive. 

If you have any questions about head and neck cancer or if you just want a second opinion, please feel free to call me, Dr. Edward Hughes, at 855-DAYTON1. 

Weight Loss in Head and Neck Cancer Patients: It’s Not Just the Cancer That Can Kill You

It’s Not Just Loss of Arm Strength But Also Your Heart Strength That’s Affected

At First Dayton Cancer Care, I see and treat many patients with head and neck cancer each and every week.  I tell them that the big battle ground will be nutrition.  I tell them I don’t want to see them lose weight because it will be muscle rather than fat that they will lose.  After I tell my patients about all the side effects of chemotherapy and radiation treatment, an overwhelming experience to say the least, many patients just smile and say “I need to lose a few pounds anyway.”

Unintentional weight loss in cancer patients-called cachexia-not only results in loss of muscle mass but also may account for loss of heart muscle function.  Cachexia is defined as >5% weight loss and 3 of 5 other factors-loss of muscle strength, fatigue, lack of appetite, loss of muscle mass, low albumin and high C-reactive protein. In a remarkable summary of many studies, Dr. Couch and colleagues showed the cachexia is a major factor in the death of many head and neck cancer patients (Head Neck; 2015; 37: 594-604).  The surprising finding is that heart trouble related to cancer weight loss may account for up to 20-30% of head and neck cancer patient’s deaths.  Even if they are first cured of their cancer.

My clinical instinct over the years was that nutrition was one key to survival.  But I never thought that weight loss in cancer patients could affect their hearts to such an extent.  If Dr. Couch’s studies hold up, head and neck cancer specialists will lose up 30% of patients from cachexia, not cancer. But even more frustrating is the fact that while intentional weight loss is fixable by good nutrition alone, cachexia or unintentional weight loss in cancer patients, is not.  So much more medical work and research is needed here.

Don’t get me wrong.  The medical and technological breakthroughs in head and neck cancer care have been nothing short of miraculous over the past decade.  But I think head and neck cancer specialists need to take nutrition, especially new ways to battle cachexia, much more seriously than in the past.

 Diagnosing Cachexia-Related Muscle Loss Is Not As Easy As You May Think

 Diagnosing muscle loss seems easy, doesn’t it?  Plain and simple.  Just have the doctor or nurse weigh you and examine you.  And taking a good medical history may help.  But it’s not just that easy.

As head and neck cancer doctors, we rely “heavily” on BMI or body mass index-a formula based on height and weight. The BMI alone may mislead cancer doctors, especially in men who have more muscle mass than women.  That’s also true in men and women who are obese – underestimating loss of muscle mass. The change in BMI alone is likely to be misleading as a measure of loss of muscle mass or cachexia.  In fact, the gold standard for body composition assessment- a CT scan of the lower spine and pelvis- is rarely used to diagnose cachexia related loss of muscle mass.  I know of not a single cancer clinic in the country that uses CT scans to assess body composition to diagnose cachexia in cancer patients.

                                                                 CANCER CACHEXIA =

3 or more symptoms                                    +                    Weight Loss > 5% within 12 months

  • Fatigue
  • Loss of Appetite
  • Decreased Muscle Strength
  • ↑CRP or ↓ Albumin
  • Low Fat-Free Muscle Mass on CT Scan
 So What Can A Head and Neck Cancer Patient Do to Diagnose Cachexia?

First and foremost, be upfront and honest with your head and neck cancer specialist.  Do tell your doctors about any loss of muscle strength, fatigue, and lack of appetite.  Ask your doctor about blood tests that measure if you are anemic, have a low level of the blood protein called albumin, or increase in the level of the broad protein called C-reactive protein or CRP for short.

The syndrome of cachexia in head and neck cancer patients-unintentional weight loss, loss of muscle mass, anemia, lack of appetite, and fatigue-is all too common.  But what is starting to be learned about this cancer syndrome may also have profound effects on your heart muscle, resulting in 20-30% of deaths in head and neck cancer patients.

So much more time and money for medical research into cachexia is long overdue.

 

It is Reds Opening Day. Not all Baseball Traditions are Good.

Baseball’s Long SmokelessTobacco Tradition

Baseball and tobacco traditionally go hand and hand. With the start of baseball season, the debate is renewed. Last year’s passing of  legend Tony Gwynn renewed the debate about smokeless tobacco and its use by baseball players of all ages.

Smokeless tobacco is referred to as dip, snuff or chew and has been banned in dugouts in high school, college, and professional minor league baseball. However, while Major League Baseball (MLB) recognizes the harmful effects, it is not banned. New commissioner Rob Manfred and Tony Thurmond, a state assembly member in California, are both actively advocating for a culture change by asking the MLB Players Union for a ban. In 2011, with the urging from public groups such as the Campaign for Tobacco-Free Kids, the MLB opened a Tobacco Cessation Center that offers educational sessions to their players and staff about the dangers. They are hoping to break this long standing tradition associated with baseball.

Dr. Donald Marger, Oral, Head and Neck Cancer expert at First Dayton CyberKnife, explains that “the cancer causing chemicals in smokeless tobacco is no different than what is in cigarettes and pipes. While they will not contribute to your risk for lung cancer, there is still danger of cancers of the tongue, floor of mouth, throat, gums, cheeks and lips.” Oral, head and neck cancer affects 55,070 newly diagnosed Americans each year with approximately 12,000 deaths. Other health issues include severe dental problems and the terrible staining of the teeth.

Many MLB players and coaches claim to only use dip while in uniform. They say it is simply a habit and a way to relax and pass the time during a game. David Ortiz of the Boston Red Sox only puts snuff in his mouth while he is at bat. Others admit it is a terrible addiction that they simply cannot break and they wish they had never started.

“Cancer of the oral cavity, besides being potentially fatal, almost invariably results in marked physical deformity, swallowing problems, difficulty with speech and breathing. The primary treatment is radical surgery followed by radiation therapy”, explains Dr. Marger.

The debate is not whether dip is harmful ‑‑ clearly it is. The debate is whether or not we want our children looking up to their baseball all-stars and emulating their behavior. At the thousands of baseball fields around our country you see t-ballers chewing bubble gum, high schoolers spitting seeds and professionals spitting tobacco. Would it have made a difference to Tony Gwynn or the many other baseball players with these cancers if someone had told them to never start? Does it need to remain a part of America’s most beloved sport?

April is Oral, Head and Neck Cancer Awareness month. Our local Support for People with Oral and Head and Neck Cancer  will be offering screenings around Dayton the month of April. You will find Dr. Ed Hughes doing FREE screenings on April 18 at the Levin Family Foundation Celebrating Life Health Fair at Sinclair Community College.

Blog contributed by: Kathy Corbett of First Dayton CyberKnife

 

Debate Over Tobacco in Baseball Heightens

The passing of baseball legend Tony Gwynn has started a much needed debate about smokeless tobacco and its use by baseball players of all ages.

Smokeless tobacco is referred to as dip, snuff or chew and has been banned in dugouts in high school, college, and professional minor league baseball. However, while Major League Baseball (MLB) recognizes the harmful effects, it is not banned. You still see many players use it during games. In 2011, with the urging from public groups such as the Campaign for Tobacco-Free Kids, the MLB opened a Tobacco Cessation Center that offers educational sessions to their players and staff about the dangers. They are hoping to break this long standing tradition associated with baseball.

Dr. Donald Marger, Oral, Head and Neck Cancer expert at First Dayton CyberKnife, explains that “the cancer causing chemicals in smokeless tobacco is no different that in cigarettes and pipes. While they will not contribute to your risk for lung cancer, there is still danger of cancers of the tongue, floor of mouth, throat, gums, cheeks and lips.” Oral, head and neck cancer affects 55,070 newly diagnosed Americans each year with approximately 12,000 deaths. Other health issues include severe dental problems and the terrible staining of the teeth.

Many MLB players and coaches claim to only use dip while in uniform. They say it is simply a habit and a way to relax and pass the time during a game. David Ortiz of the Boston Red Sox only puts snuff in his mouth while he is at bat. Others admit it is a terrible addiction that they simply cannot break and they wish they had never started.

“Cancer of the oral cavity, besides being potentially fatal, almost invariably results in marked physical deformity, swallowing problems, difficulty with speech and breathing. The primary treatment is radical surgery followed by radiation therapy”, explains Dr. Marger.

The debate is not whether dip is harmful ‑‑ clearly it is. The debate is whether or not we want our children looking up to their baseball all-stars and emulating their behavior. At the thousands of baseball fields around our country you see t-ballers chewing bubble gum, high schoolers spitting seeds and professionals spitting tobacco. Would it have made a difference to Tony Gwynn or the many other baseball players with these cancers if someone had told them to never start? Does it need to remain a part of America’s most beloved sport?