24 JUNE 2013

Ask The Expert: Addressing your questions on head and neck problems

Contributed by: Dr Lim Hong Liang

There are many different places that cancer can develop in the head and neck areas, including cancers of the mouth (oral cancers) the throat, the nose, sinuses, salivary glands and ear. It is strongly associated with certain environmental and lifestyle risk factors, including tobacco smoking, alcohol consumption, and certain strains of viruses, such as human papillomavirus(HPV). Thankfully, head and neck cancer is highly curable if detected early.

Dr Lim Hong Liang is a senior medical oncologist with more than 25 years of experience, with a special interest in head and neck cancers.

If you have any questions on cancers of the head and neck region including nasopharyngeal carcinoma Dr Lim will be online to address them for our upcoming #Ask The Expert live chat

Date: 24 June 2013, Monday

Time: 4:30pm – 5:00pm

Place: Online, on this event wall

About the Expert

Dr Lim Hong Liang is a senior medical oncologist with more than 25 years of experience. In addition to general medical oncology, he has a special interest in lung cancers, and head and neck cancers.

Dr Lim is a Fellow of the Academy of Medicine and a member of American Society of Clinical Oncology and International Association for the Study of Lung Cancer. He is also a member of the Singapore Cancer Registry Advisory Committee. Past positions include President of the Singapore Society of Oncology, member of the Ministry of Health Advisory Committee for Cancer Care and Medical Oncology Training Committee.

Recap for #ASK THE EXPERT Session (24 June 2013) with Senior Oncologist Dr Lim Hong Liang

Q1. How can people who have had head and neck cancers reduce their risk of developing a second primary (new) cancer?

We can reduce the risk of a second primary head and neck cancer by avoiding the known risk factors. The common risk factors include tobacco smoking / chewing and alcohol. Chewing betel nut, a common habit in certain population also increases the risk of H&N cancer. Human papillomavirus (HPV) is being recognized as an increasing cause of oral cavity cancer in the last 10-20 years, especially in H&N cancers who are not smoker or alcohol drinker. The common HPV subtype for oral cavity cancer is the HPV 16. Although vaccination for HPV is available and recommended for female to prevent cervical cancer, HPV vaccination is at present not routinely recommended to prevent H&N cancer.

Q2. I often have this pain from the back of my neck and till the left side of the back of my ear, up till my left eye and forehead, which i suspected migraine, but when the pain get stronger, i can feel a vein coming out from the back of my ear... Is it normal?

If the pain is severe / persistent and is affecting your normal activity, I would see a doctor to get a firm diagnosis of migraine or not migraine. Effective treatment is available for migraine headache. Not very sure how the vein you described look like. But a prominent vein which appear on and off is usually not a serious problem.

Q3. I use to carry heavy sling bag and this cause me neck pain-from the bottom of my head to my top shoulders. Pain relief patch and massages are not very helpful to me. Is there any other way to heal? Will this cause cancer in future?

Will give the easy answer first - NO it will not cause cancer in future. To minimise the pain, will probably have to change the way you carry your heavy bag... lessen the weight, equal distribution of weight over both shoulders, etc

Q4. How common are head and neck cancers?

When we use the term head and neck cancers, it refers to a group of cancers occurring in the head and neck region. These include the nasopharyngeal carcinoma (commonly known as nose cancer), cancer of the oral cavity (include cancer of the tongue, tonsil, cheek), cancer of the throat (pharynx and larynx), and cancer of the salivary gland. Some would include thyroid cancers. Primary cancer of the brain is not included under head and neck cancer. In the Singapore Cancer Registry 2003 – 2007, nasopharyngeal carcinoma was the 7th commonest cancer in males, and not within the top 10 in females. The incidence is 3 times higher in males compared to female. Other head and neck cancers are less common. If we include NPC and all head and neck cancers, there are more than 500 new cases per year… and this is more than cancer of the stomach, liver or lymphoma.

Q5. Who is most prone to get nose cancer? If I have family history of nasopharyngeal cancer, does it increase my risk?

Nose cancers or nasopharyngeal carcinoma (NPC) tend to occurs more in Chinese originating from Southern China. Certain populations from North Africa and Middle East countries also have increased risk. In Singapore among the 3 main races, it’s most common in Chinese and least common in Indians. It is 3 times more common in males compared to females. Other modifiable risk factors include cigarette smoking, excessive consumption of salted fish at an early age and high consumption of preserved or fermented food. The risk of NPC is slightly higher for those with first degree relatives having the disease. However, most NPC patients do not have other members in the family having the same cancer.

Q6. What HPV virus can cause head and neck cancers? And how can I prevent infection?

There are many subtypes of HPV. Some are known to increase the risk of cancers, including oral cavity cancer. HPV 16 is the subtype that is commonly linked to oral cavity cancers, as well as cervical cancers. In cervical cancers, transmission is due to direct exposure from sexual activity from an infected partner. HPV vaccination has been shown to prevent HPV infection (including HPV 16) and cervical cancers in females before they have acquired the infection through other ways. The effectiveness in preventing HPV infection in males and prevention of head and neck cancers is not as well studied.  

Q7. Recently I have very bad headache until I have to stop by roadside to rest awhile before I continue my journey. I have been practicing burn the midnight oil for few years.. Would this a cause for the headache or stress of work?

The causes of headache can be many. Stress and inadequate rest can be a cause. But the headache you described sound serious. If you have been burning midnight oil for many years and the headache is only of recent onset, we may need to look for other causes. Suggest getting a proper medical evaluation.    

TAGS nasopharyngeal cancer
READ MORE ABOUT Cervical Cancer, Head and Neck Cancer, Lung Cancer, Nasopharyngeal Cancer