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| MOUTH CANCER, HEAD AND NECK CANCERS > LISTEN TO THE PODCAST |
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TRANSCRIPT BEGIN
Rachel: Today we're going to be talking about head and neck cancer. Head and neck cancer is
often described as being a Cinderella disease. What this means is that, over the last 40 years there have
been very few treatment developments in this area. And yet, prevalence is set to rise over the next 20
years.
I'm joined by Christine Piff from Let’s Face It, Dr. Joshi will be joining us over the phone from the Mouth
Cancer Foundation, and Suzanne Rogers will be telling us about her experiences.
So Christine, maybe you could tell us a little bit about your experiences, and Let’s Face It.
Christine: Well it's-it's hard to believe, but it was 30 years ago that I was first told that I had facial
cancer. And it was 7 years after all the surgery, um, and the reconstruction, that I was asked to make a
television programme where I launched a charity because during that 7 years, I had no one, to talk to.
And I felt the desolation of facial disfigurement, which, really slowly eats away at your identity, and your
face is changed dramatically, that you become a different person, and yet you feel the same person inside.
Um, and so it was 7 years later in 1984 that I launched, um, the charity Let’s Face It. And... the charity
has helped me accept who I am and find myself again. And that's exactly what it does because facial
disfigurement is... so... shocking, psychologically. It's bad enough to go through the radiotherapy, chemo
and surgery. But it's the after affects; going back into your home and in society where you lived before,
feeling, and looking different.
Rachel: Suzanne, maybe you could tell us a little bit about your experiences.
Suzanne: I was diagnosed with tongue cancer in July 2006. I had a mouth ulcer; what I thought to
be an ulcer on my tongue, which didn't heal. And, I went to my GP after about 3 weeks as it started to
get a bit more enlarged and a bit more painful. And... at first he thought it was an infection, and
prescribed me antibiotics. Erm, but it didn't get any better. So I went to my dentist, and she was worried
enough to refer me to a ma-maxillofacial consultant. And um, about 3 weeks later I was diagnosed with
tongue cancer.
Rachel: Dr. Joshi, maybe you could clarify for us exactly what head and neck cancer encompasses.
Dr. Joshi: Cancer can occur in any part of the head and neck. Mouth cancer refers to cancers of the
mouth, tongue, lips, throat, salivary glands, pharynx, larynx, sinus and other sites located in the head and
neck area.
Rachel: Christine, we've said this is a growing problem, but how many people is this really
affecting?
Christine: Well, surprisingly, um, there are 7,800 people diagnosed with facial cancer every year, and
this has gone up by 25%. 25%, in the past 10 years.
Rachel: Dr. Joshi, what are the risk factors for head and neck cancer, and what should people be
looking for?
Dr. Joshi: The risks are increased by smoking or chewing tobacco and consuming alcohol. One
should really avoid these risk factors. The risk can also be reduced by having a low-meat, low-fat diet,
rich in vegetables and fruit with servings of bread or beans everyday.
Rachel: Maybe you could tell us what the symptoms of head and neck cancer are, and what people
should be looking out for.
Dr. Joshi: In its very early stages, mouth cancers can be easy to ignore. It's important to know what
to look out for, and to do a self-check. Mouth cancer can present as a sore or ulcer in the mouth that has
not healed within 3 weeks; a lump appearing anywhere in the mouth or neck; a white or red patch on the
gums, tongue or lining of the mouth. Sometimes it can present as a difficulty in swallowing or chewing; or
difficulty in moving the jaw and tongue. Sometimes it can present as a numbness of the tongue or other
area of the mouth. Sometimes the cancer presents as a swelling of the jaw that causes a well-fitting
denture to fit poorly or become uncomfortable suddenly. It can also present as a unexplained looseness of
a tooth.
Rachel: Christine, why is it important for people to be so aware of the symptoms of head and neck
cancer?
Christine: I think the difficulty with this one is... to actually notice. It can be there without you
actu... be-before it presents itself, um, but there are signs like um... a blister on the tongue that doesn't
get better, um, and if you notice it and it lasts for a while, then go to your GP, go to your dentist, er, and
say that there's something here that, you know, it-it might be sinister, but it may not be, it might be quite
innocent. But just go and check it out.
Rachel: Are there specific groups who might be at greater risk of getting head and neck cancer?
Christine: Er, again, difficult question to answer. Um, but I think what I-I've seen over the years of
running the charity, that it is really quite widespread. Younger people now seem to be getting more and
more cancers, and I think it could well be the environment that we live in. Um, people in the city. And
yet there are farmers who, who have facial cancer, so that can be directly being out of doors in the sun all
the time. Um, and of course, there's the same old scenario; smoking and alcohol. And I'm sure, um, that
there are people who do smoke who've said 'Oh, not again. You know, we get blamed for everything'.
But obviously, it is a significant factor, and should be taken into consideration.
Rachel: So, Suzanne, does this mean if I'm young and female, I'm unlikely to be affected?
Suzanne: Well, I'm twentys.., well I'm 27 now, I was 26 when I was diagnosed... and, obviously
female. And... yeah, unfortunately, there's a growing trend of more younger people er, being affected,
and also people that don't necessarily have the risk factors concerned. So, the vast majority of people
who get, er, mouth cancer are smokers and drinkers, or one or the other. Um, and.. and I wasn't.
Rachel: Dr. Joshi, we've talked a lot about the people who might be affected by head and neck
cancer, but what are the survival rates for this disease?
Dr. Joshi: Well, the survival rates differ according to the site, and earliness of detection. Overall,
about 55 out of 100 diagnosed will live for at least 5 years. And about 41 out of 100 will live for at least
10 years. Unfortunately for throat cancers it is much less. Only about 35 out of every 100 will live at
least 5 years. Whereas for lip cancer, it is much better. Nearly 90% of patients will be alive 5 years later.
For tongue cancers, it's somewhere in-between. With just over 40% being alive 5 years later. For the
rest of the oral cavity, only 47% will be alive 5 years later. Early detection can, however, improve
survival.
Rachel: So, how is head and neck cancer identified? And, how is it diagnosed?
Dr. Joshi: Once the mouth cancer is suspected, it needs to be confirmed. The specialist will need to
do a biopsy. A biopsy is a surgical procedure that involves removing a piece of the suspicious tissue, and
sending it for examination. This is usually done under local anaesthesia. The specimen is sent to a
pathology laboratory for examination. Upon completing the tissue examination, the pathologist will inform
the surgeon. The biopsy not only helps in establishing the diagnosis, but it also helps develop an
appropriate treatment plan. The examination often also includes having chest x-rays and a CAT scan to
see the cancer spread.
Rachel: So, how is head and neck cancer treated?
Dr. Joshi: The treatment options for these head and neck cancers are surgery, radiotherapy, or
chemotherapy or combinations of them. But they all have side effects. Surgery and radiotherapy causes
morbidity which affect the quality of life, causing difficulties with speech, swallowing, dry mouth and facial
disfigurement. Chemotherapy too, causes nausea, vomiting and painful mucositis. We really need new
effective treatments that reduce the morbidity and side effects.
Rachel: So, could you both tell me how it felt when you were diagnosed. Christine?
Christine: How did I feel? It's as if... I had been kicked off the world, and the world is going on
without me. And I stand there as a stranger just watching, and looking on. It was a very strange feeling.
Um, but then the positive side kicked in – which it does for me, always – um, with that attitude yeah, well,
okay, I have cancer, but I'm going to have it treated, and I'm going to get better.
Suzanne: Er, I was... I was very shocked. Er, I... I wasn't particularly prepared for the diagnosis,
because when-when I first got the symptoms I went on the internet and I read about mouth cancer, but it
always... it always said that the people most affected were... men, sort of men over 50 usually, er, people
who had smoked, people who drank a lot. And erm, I've never smoked, and I-I rarely drank, so I was... I
just kept thinking, surely... this is wrong, erm, you know, how can it be... er, cancer? Yeah, it took, it
took a while to come to terms with... not on-not only the word cancer which is so... imbued with such...
you know, everyone is scared of the word cancer. But also the fact... of coming to terms with what long-
lasting effects the treatment would have.
Rachel: So, Suzanne, Christine. How easy has it been for you to get back on with things and
resume your life in the way that you want to?
Suzanne: Erm, it has been hard... but I'm now almost a year down the line, and erm, I've had
months and months of speech therapy and I feel like my speech has come on really well. And, erm,
eating was also very difficult. I had weeks when I couldn't eat properly. Well, months, to be honest.
And... and that's still a bit of an issue. There's still some foods that I avoid, and I think will probably, that
will probably always be the case. But... yeah, I'm just... really grateful I'm... still... still here and I've
gone back to work and I'm-I'm doing everything I used to do before, so I don't feel like it's... I've had to
stop being me.
Christine: It's an ongoing um, scenario for me. It just – and for many cancer patients who's... – it's
the reconstruction. Um, initially the tumour was in my sinus, and I lost half my palate and my upper
teeth. I was unable to speak without an artificial palate called an obturator. Later that year I... the
tumour came back, and I lost my eye, um, and it was 2 years later before I had a facial prosthesis with an
eye. So... for me to accept those things and to get back to being a normal mum, and wife, was the
hardest thing I have ever, ever, done.
Rachel: Suzanne, how do you view your future now?
Suzanne: I think er, one of the positive things to come out of getting ill was the fact that it was a
real chance to re-focus on what I want out of life and um, my dreams and aspirations. So... I remember
sitting in hospital writing a list, a sort of to-do list... erm... this will sound quite morbid but, er, writing a
list of erm, what I would want people to remember me for. The sort of characteristics I would want people
to think... I was like. And then that got me thinking about just the sort of things I want to do, and erm,
what I want to do with my life. Erm, so there's all sorts of things on there, and one thing is um... I've
always dreamt of going on safari in Africa, and erm, I'm going to be doing that this summer.
Rachel: So, Christine, if people listening to this are concerned, who should they be turning to?
Who should they go and talk to?
Christine: I think professionally, you need to go to see your GP depending on your symptoms. Um,
either your GP or your dentist. Um, that's vitally important. And don't leave it. We all tend to leave
things. And, I know I did, um, I had been kissed by the children at playgroup where I worked, and I
thought when I put my make-up on my chee – the pain was under my left eye on my cheek – um, and it
was there for quite a while before I realised that when I put my head down, the pain and discomfort –
there was something wrong. Um... but I was wrapped up in looking after my three children and my
husband and going to work that I ignored it. It wasn't too late for me. I was one of the lucky ones. But
it's the same old story with any cancer; early diagnosis is the safest.
Rachel: And, if people are looking for more information, where should they look?
Christine: Get in touch with me. Quite simple. We have the resources for recovery, and we at Let’s
Face It will supply the patients with whatever they need. And we're there to talk to them one-to-one, to
have regional groups, to put them in touch with other people who have similar problems, um, and to
support them until they want to leave us.
Rachel: And, after your diagnosis, who did you turn to for, for advice?
Suzanne: Well, I was treated at the Queen Victoria hospital in East Grinstead. And, right from the
beginning I felt very well supported by the team there. They just gave me all the information and support
that I needed, and were very encouraging about... erm, the treatment and what I could expect
afterwards. Realistic, yet, encouraging about erm, the fact that my, you know, my life would continue and
I would get my life back, erm, once I was recovered. Erm, and the internet was also a big resource for
me. Er, I turned to the Mouth Cancer Foundation website quite a lot. It has a message board where you
can... talk to other patients. So, I found that useful to ask questions of other patients to... er, find out
what their experiences were as well.
TRANSCRIPT END
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