Selected Podcast

Head and Neck Cancer: What to Watch For

What are some of the most common symptoms of head and neck cancer?

What treatment options are available?

Learn more from Paul W. Read, MD, a UVA Cancer Center expert in head and neck cancer.
Head and Neck Cancer: What to Watch For
Featured Speaker:
Paul W. Read, MD
Paul W. Read, MD., is a board-certified radiation oncologist who specializes in head and neck cancer along with working to develop more effective cancer treatments with fewer side effects.

Learn more about Paul W. Read, MD


Melanie Cole (Host):  We hear in the media about celebrities that have head and neck cancers. What are some of the most common symptoms of head and neck cancer?  My guest today is Dr. Paul Read. He is a board certified radiation oncologist who specializes in head and neck cancer at UVA Health System. Welcome to the show, Dr. Reed. When we talk about head and neck cancers what type of cancers are we discussing?

Dr. Paul Read (Guest):   That’s a great question. Head and neck cancers involve cancers of the sinuses, of the nose, of the mouth, the throat, and the larynx. It can include cancers of the salivary glands that make our saliva, as well as the thyroid gland.

Melanie:  People always want to know the symptoms. They want to know if they were to experience any of these symptoms. What would they be looking for for head and neck cancers?

Dr. Read:  That’s a great question. Patients can have swollen lymph nodes in the neck and, particularly if they don’t respond to antibiotics, that’s a real worry that they may have cancer that started in their throat or mouth and it spread to lymph nodes. They can sometimes have pain in the mouth or throat. They could have hoarseness or cough that doesn’t respond, again, to antibiotics; an obstructed sinus that they can’t breathe through their nose that doesn’t, again, respond to typical medications like antibiotics or steroids. They could have bleeding, either from the nose or mouth. That certainly should be investigated. Dentures that don’t fit like they used to fit is a common example of the reason to see a doctor about possibly having a cancer of the gum or the hard palate. Any changes in speech and/or new lumps or bumps on the head or neck region that are new and are slowly growing should be investigated by your doctor.

Melanie:  Are there certain risk factors, genetic components? What are some things you want people to know about their risk for these type of cancers?

Dr. Read:  That is also a great question. Smoking is far and away the most common reason that people get cancers of the mouth, throat and the voice box called the “larynx”. If we could have people stop smoking and never smoke again, we’d see far fewer head and neck cancers. The best thing you can possibly do to decrease your chances of getting a head and neck cancer is to stop smoking or using smokeless tobacco as well. Also, smoking can increase other cancers like lung cancer of course we know that as well. Another risk factor is drinking alcohol. Patients who drink alcohol and smoke really increase their risk of getting a throat cancer or a mouth cancer. Trying to use as little alcohol as is reasonable, maybe occasionally having social drink. Clearly, patients who drink every day, for example, are at a high risk. In addition, some head and neck cancers are caused by a virus. The HPV virus in particular is causing a real epidemic of cancers in the tonsil, as well as in the base of tongue. These can occur in patients who don’t drink or smoke at all. It generally happens in patients who are their middle age, in their 50’s and 60’s. These cancers can be caused by drinking and smoking or sometimes even by a virus.

Melanie:   Let’s talk about diagnosis. When you talk about the oral cavity and the gums and such, are we getting that check when we go to the dentist for our cleaning?  Are they looking for oral cancers? What about some of these others? How are they diagnosed?

Dr. Read:  A good dentist--the first thing they should do is look for the health of your tongue and your gums and your oral cavity and do a good exam, especially if you are a drinker or smoker. You should let them know. They should be especially careful to look for any areas that don’t look normal. The normal lining of the mouth and throat has a nice, healthy pink looking lining to it, so any red areas or whitish areas that have come up should be investigated and potentially biopsied. If a dentist doesn’t feel comfortable biopsying a patient, then they should be sent to a local ear, nose and throat expert who has expertise in diagnosing early head and neck cancers or sometimes to an oral surgeon as well.

Melanie:  When we talk about treatment, Dr. Reed, people hear about head and neck cancer and right away they are scared because when you’re thinking of oral cancers and things that involve your face and your throat and eating and all of these things. It can be so scary. What are some of the new, exciting treatments that you’re doing there at UVA?

Dr. Read:  The treatment of head and neck cancer, of course, depends on where the tumor’s located. Frequently, it involves surgery or radiation or chemotherapy or some combination of all of these treatments. Probably the most exciting thing for treatment that’s happened in the last five to six years is the use of the DiVinci Robot to do surgeries on patients’ throats, particularly tonsil cancer and basic tongue cancer. They used to have to do a very expensive type of surgery where they would have to cut a patient’s jawbone in half to get access to the tonsil or the base of tongue to be able to do surgery. With the robot they can do surgery without having to even touch the jawbone to operate in these areas. It’s really improved our ability to do surgery for patients who have early cancers of the tonsil and base of tongue in particular. This is a type of treatment that’s really only available at a few select sites like in Virginia. UVA is probably the state leader in pioneering this type of surgery for patients. For patients at the other end of the spectrum who have advanced spread of cancer, there are new types of treatment approaches using immunotherapy. If a patient has a spread of cancer from their throat to, say, their lungs to bones and, typically, they would receive chemotherapy for that. There is a new explosion of drugs that uses the body’s immune system to try and fight cancer. There are very good studies going on. There are clinic trials available at UVA for patients to explore the use of immunotherapy to help your own immune system help you live longer and live better.

Melanie:  If a patient does have to have surgery for an oral cancer and they might need reconstructive surgery or they are very worried about the results afterwards, how they’re going to look or they’re going to look a little bit different in their facial area. What do you tell them, Dr. Reed, to give them some hope?

Dr. Read:  First of all, you want to be at a place where you feel tremendous confidence for your surgeon if you’re a patient. I can tell you that UVA has some of the best head and neck cancer specialists with respect to surgery that there is. Three of the head and neck cancer surgeons have all done fellowships for reconstruction in doing what we call “free flap reconstruction”. If they were to remove a part of the tongue or a part of the mouth, they can use tissues from other parts of the body to reconstruct this so that you have a good functional outcome and a good cosmetic outcome.

Melanie:  In just the last few minutes, give your best advice for people to, hopefully, prevent head and neck cancers and why they should come to UVA for their care.

Dr. Read:  The best thing that patients can do to reduce their risk of head and neck cancer is not to smoke and, if you are smoking, to seek help to stop smoking. To use alcohol in moderation and to be vigilant that if you have the symptoms that we’ve described, see your local doctor to assess these so that you can be diagnosed at an early stage where the treatments that maybe require less surgery or less radiation or maybe even no chemotherapy for their treatment. Why should you go to UVA? I think anyone with a head and neck cancer should get a second opinion at a major medical center. This is a small subset of all cancers – cancers of the mouth and throat, sinuses and so forth. They are very technically challenging to treat; not only to cure people but also to cure people with the best quality of life and best outcomes. You really want to go to someone and a group of physicians who work as a team, who work closely together and who really understand all the new studies, all the new treatment options and how to treat people so that they have their best cure as well as their best functional outcome and best quality of life.

Melanie:  Thank you so much. What great information, Dr. Read. Thank you so much for being with us today. You’re listening to UVA Health Systems Radio and for more information you can go to That’s This is Melanie Cole. Thanks so much for listening.