"The moment I opened my mouth, the oral surgeon just said, 'Oh.'"
Wendy Jackson's voice breaks as she flashes back to the moment she knew she had oral cancer. She was referred to a head and neck specialist at Penn State Health after her dentist noticed an irregularity in her cheek. She was diagnosed with an aggressive head and neck cancer that carried a 50% survival rate after five years. Three children and a husband depended on her, so she needed immediate care. Fortunately, the team at Penn State Health moved quickly.
Within a week of her diagnosis, Jackson was scheduled for surgery. The cancer was not only removed, but her outward side effects were minimized through reconstructive surgery. Two years later, Jackson looks and feels like herself again - a woman enjoying life with her family.
A group of cancers with shifting causes
Head and neck cancer is a group of more than two dozen cancers that occur on the head and in the mouth or neck, according to Vinita Takiar, chair of the Department of Radiation Oncology at Penn State College of Medicine. They include cancers in the salivary glands, sinuses, nose, mouth, pharynx (vocal cords) and larynx (throat).
Tobacco and alcohol use have long been identified as the primary risk factors of many of these cancers, especially those found in the mouth, but human papillomavirus (HPV) is now a major cause of head and neck cancers, especially in the throat and tonsils. Head and neck cancers have historically affected men over age 40. Now, HPV-related cases are on the rise but outcomes for these cancers are better than those unrelated to HPV.
Click here to view a video about Penn State Health's Head & Neck Cancer Team.
Head and neck cancer symptoms and detection
Jackson's cancer was first detected during a routine oral cancer screening by her dentist. Primary care visits also include checks for warning signs. Takiar said lumps in the neck that don't hurt but don't go away, persistent sore throat, painful swallowing and changes in voice can all be signs to get checked out.
Neerav Goyal, division chief of head and neck oncology and surgery at Penn State Health, said detection and diagnosis of head and neck cancers have advanced in recent years, including the ability to test tumors to determine their causes and tailor treatment accordingly.
"Now, we can take a biopsy of the tumor and, using molecular screening, see what's unique about it. That allows us to better tailor our treatment," Goyal said. "We also have a blood test that determines if the tumor is caused by HPV. If it is, we can potentially give the patient a different treatment that could have fewer side effects."
After surgery or radiation treatment, the same blood test will determine whether those markers are still present, allowing the care team to follow up with additional therapies. Goyal said they can also run tests for markers that can predict a patient's response to immunotherapy. These tests allow the team to design a treatment plan unique to each patient. Depending on the results, they may use immunotherapy as a first-line treatment to reduce the need for radiation or lessen its intensity, and potentially reduce the need or intensity of other therapies.
More precise and less invasive treatments
Although radiation and surgery are most often needed to treat head and neck cancers, Takiar said radiation therapy has continued to evolve, and they are now able to precisely target treatments to save surrounding tissues and reduce side effects.
"Our radiation is highly focused. We intentionally treat the cancer but spare adjacent areas from radiation, which is important since there are so many vital organs in the head and neck region," Takiar said.
She noted that in the past, radiation delivery to oral cancers often affected salivary glands, leading to significant side effects. Today, treatment planning can avoid those areas and reduce complications such as dry mouth and difficulty swallowing.
"We're able to treat exactly what we want to treat and spare what we want to spare, and reduce unwanted side effects," Takiar said.
Likewise, Goyal's surgical team uses advanced robotic surgical techniques that have improved precision, especially for early-stage cancers.
"Using a surgical robot, which has more dexterity and magnification during surgery, allows us to get good clearance around a tumor," Goyal said. "For appropriate patients and tumors, robotic surgery can be the only needed treatment."
Team-based care improves outcomes
Head and neck cancer treatment at Penn State Health is guided by a multidisciplinary team of physicians that meets weekly. The tumor board includes surgeons, radiation oncologists, medical oncologists, pathologists, dentists, radiologists, dietitians, speech-language experts, staff from the Penn State College of Medicine Clinical Trials Office and nurse navigators to help patients navigate treatment options and manage the day-to-day challenges of their treatment.
"This team-based approach to care lets us focus on maximizing treatment outcomes while reducing side effects and maximizing quality of life," Goyal said.
The head and neck cancer team is also involved in new clinical trials exploring gene therapies to reduce dry mouth and drugs that can lessen chemotherapy side effects. This research can lead to major advances in care, as Penn State executive vice president and provost Fotis Sotiropoulos experienced firsthand.
"Many years ago, I battled neck cancer, but thanks to early diagnosis, extraordinary care and a clinical trial that later became standard treatment, I was cured," Sotiropoulos said. "My journey is living proof that research isn't abstract - it saves lives and gives people a future. Clinical trials open the door to tomorrow's breakthroughs, and awareness of head and neck cancer is critical to help more people seek care sooner."
Sotiropoulos and Jackson are proof of what's possible with early diagnosis, a multi-pronged approach and investment in innovative clinical research. That combination makes a life-changing difference.
"I wouldn't be here, wouldn't look like this, wouldn't function like this if it weren't for this team," Jackson said. "It saved my life, and I'm grateful."
