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The head and neck are home to so many structures like nerves and blood vessels that intimately impact function. From speaking to swallowing to breathing to facial expressions, these functions help make us who we are.?

As a head and neck surgeon and researcher, I understand how head and neck cancers and their treatments can potentially impact these important functions. That¡¯s why my team strives not only to cure patients, but also to preserve their quality of life.

Here is what MD Anderson patients can expect from their care here.

If it matters to you, it matters to us

At MD Anderson, our teams get to know each patient and what makes them them.

Being diagnosed with cancer is a very emotional time for patients and their families. Our teams understand this. We give patients the freedom and safety to express how they are feeling. We pay attention to what's important for each patient; we value what they value. Then, we make treatment decisions with those values in mind.

What brings me the most satisfaction in what I do is being able to take my patients through their treatment journey. I meet them during or after their cancer diagnosis, which for many is a devastating time filled with unimaginable questions and fear. Then, I am with them through treatments such as surgery, systemic therapy and radiation. It is immensely gratifying when I see them with their families once they recover from their treatment and see that they're doing very well.

A team approach to head and neck cancer care?

MD Anderson is unique because of our multidisciplinary team approach. A head and neck care team may include surgeons, radiation oncologists, medical oncologists, speech language pathologists, dental oncologists, physical therapists and more.?

Patients here benefit from having an entire team of experts dedicated to the treatment of head and neck cancers. During our weekly tumor board meeting, surgeons, radiation oncologists, medical oncologists and others gather to discuss the best treatment options for each patient. That means patients aren¡¯t getting the brains of one or two individuals; they¡¯re getting the whole team of 50 to 60 people who treat this disease. We're able to make a decision together, determining the best course of treatment for an individual patient.

Moving the needle through research?

In Head and Neck Surgery at MD Anderson, we place a strong emphasis on conducting research and bringing the most cutting-edge research into our practice. So, in addition to my clinical colleagues, I also work closely with amazing scientists from across the fields of genetics, computational biology and molecular biology. As a physician-scientist, I know the research we do can be directly translated into better therapies for our patients. My research focuses on understanding head and neck cancers at a genomic level (DNA/RNA) using materials from tumors that patients have donated. Having access to these very precious and unique materials allows us to really understand these tumors at a deeper level and identify new ways we can better personalize treatment based on a patient¡¯s molecular underpinnings.

Another way our research makes a difference for patients with head and neck cancers is through clinical trials. Clinical trials are critical to cancer care because we're always looking for better therapies and methods of applying those therapies that can help us cure cancer and preserve quality of life.

Through research, we've been able to move the needle for head and neck cancers. For example, I work in the treatment of a very rare cancer called anaplastic thyroid cancer. Only a few years ago, the prognosis for this type of cancer was very poor: in the realm of weeks to months. But recently, I was at a meeting where I saw a patient seven years out from treatment. That brings me immense gratitude and satisfaction.

A shared mission to end cancer

When you walk through the doors at MD Anderson, it's very clear that everybody who works here shares a common goal; we're united in what we're trying to achieve. Unfortunately, a lot of us have direct or indirect personal experiences with cancer, so our mission of Making Cancer History? touches us in a very emotional and motivating way.??

Because MD Anderson is focused on ending cancer, we have very deep expertise in different types of cancer. Even within the field of head and neck surgery, our experts are able to develop sub-specialization because we see so many patients and so many different types of head and neck cancers.

For treatment of any kind of cancer ¨C and particularly less common cancers like head and neck cancer ¨C you want to go to a place that treats it every single day. You want the surgeons who operate on you to do this kind of surgery every single week. Volume has been shown to equate to better outcomes, which is one of the most important reasons why individuals should choose MD Anderson.?

Here, I know I am contributing to moving the needle forward. We are delivering current therapies, but we¡¯re also focused on developing the next generation of therapies and diagnostics for our patients. That drive to develop better options for our patients is something I¡¯ve never felt anywhere else; it¡¯s something that can only be felt by being here.

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For high school football coach Mark Teague, the only symptom of throat cancer he noticed was a small lump beneath his jaw.?

¡°I¡¯d been aware of it for a while,¡± says Teague, who was diagnosed with HPV-related throat cancer at age 49. ¡°But I¡¯d had sinus problems all my life, so I didn¡¯t think anything of it. I just assumed it was another swollen lymph node.¡±

George Brownfield had a similar experience.

¡°I found a little lump on my neck one day while shaving,¡± says the senior systems analyst, who was diagnosed with the same disease at age 48. ¡°I remember thinking, ¡®Hey, why does that side of my neck look so puffy?¡¯ and going to my general practitioner. He told me it was probably an infection and prescribed some antibiotics.¡±

The most common throat cancer symptoms: painless neck lumps and swollen lymph nodes

Mark and George¡¯s experiences are not unusual. Most people with throat cancer don¡¯t have any symptoms. But when they do, a swollen lymph node or a painless lump in the neck are among the most common.

Why?

¡°Lymph nodes are essentially tiny little sieves that capture dangerous particles circulating around our bodies,¡± explains head and neck cancer surgeon ¡°Sometimes, cancer cells get caught in there and start growing in place. Eventually, they form tumors that can get big enough to grow out of the lymph nodes.¡±

Other throat cancer symptoms, including (rarely) pain

Other MD Anderson patients have reported different throat cancer symptoms, such as news photographer Damion Smith, who lost his voice, and senior civil engineering inspector Scott Courville, who developed pain in his jaw, felt lumps in his throat and saw little white spots on his tonsils.

¡°Laryngitis, visible abnormalities and pain are far less common symptoms of throat cancer,¡± notes Lango. ¡°Though we do occasionally see patients who report ear pain, a type of ¡®referred¡¯ pain from the tongue or throat. And, sometimes, people say it feels like something is kind of caught back there.¡±

Pain as a symptom of throat cancer is almost always only on one side, though. ¡°It¡¯s usually not in the middle,¡± Lango says. ¡°And it tends to be both dull and persistent. Once it¡¯s there, it¡¯s always there. It never goes away. That¡¯s a sign that it should get checked out.¡±

When to see a doctor for throat cancer symptoms

As a general rule, you should see a doctor about any worrisome symptoms that don¡¯t resolve on their own within two or three weeks. But see a doctor much sooner if you experience any of the following throat cancer symptoms:

• swallowing difficulties
• involuntary weight loss
• breathing problems
• a change in your voice or ability to speak clearly
• bleeding in the throat (which may be coughed or spit up)

¡°All of these symptoms should be considered more urgent,¡± explains Lango. ¡°They might not warrant an immediate emergency room visit, but they do need to be looked into pretty quickly.¡±

Having one or more of these symptoms doesn¡¯t necessarily mean you have throat cancer. But it¡¯s important to be evaluated because throat cancer is easiest to treat when it¡¯s caught in its earliest stages.

¡°You¡¯re much more likely to need a combination of treatments ¡ª such as surgery plus radiation rather than surgery alone ¡ª if you¡¯re diagnosed in the latter stages of throat cancer,¡± notes Lango. ¡°And that can mean both a longer course of treatment and more side effects. So, early diagnosis can make a huge difference.¡±

See a complete list of throat cancer symptoms.?

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Judd Woehrle has always been a firm believer in listening to your own body when something feels off. When he noticed a painless swollen gland on one side of his neck in January 2023, he wanted it checked out. He saw his primary care doctor near his home in San Antonio who referred him to an ENT for a needle biopsy.

The biopsy revealed a type of?head and neck cancer?called?oropharyngeal cancer caused by the?human papillomavirus (HPV).

¡°Receiving a cancer diagnosis was a surreal?experience?for me,¡± recalls Judd. ¡°Especially since I was in the best physical shape I had been in years. I was feeling great.¡±

Judd immediately got online to research treatment options. Knowing MD Anderson is the top cancer hospital in the nation, he .

Finding care and compassion at MD Anderson

From his initial contact with MD Anderson, Judd remembers the support and compassion he received. He appreciated how appointments were scheduled for him so that he could focus on treatment and recovery.

¡°I was consistently amazed?by the professionalism, speed and efficiency of my entire MD Anderson care team,¡± says Judd. ¡°They kept me informed and I never had to worry about the planning.¡±

After he met with his care team, they developed his treatment plan: robotic surgery with surgical oncologist , followed by 30 rounds of proton therapy under the care of radiation oncologist

Undergoing oropharyngeal cancer treatment ?

In April, Judd had TransOral Robotic Surgery (TORS) to remove the primary tumor in his tonsil. In this procedure, the surgeon uses a highly specialized robot with small and nimble arms designed specifically for operating on the mouth and throat. He also had a neck dissection to remove 38 lymph nodes. Two of the lymph nodes had cancer present.

In June, after allowing time to heal from surgery, Judd began 30 rounds of proton therapy. Because proton therapy limits the amount of radiation to normal structures, radiation did not affect the other side of his neck.

Being a cancer survivor herself, his wife was there for him every step of the way. They moved to Houston for five months, and Judd took short-term disability from work to focus on his recovery.

Managing side effects from treatment

Following surgery, Judd had difficulty eating and drinking. He underwent physical therapy for his shoulder after neck dissection during surgery.

Radiation presented a separate set of challenges for Judd. Some of his side effects during treatment included skin irritations?that felt like a severe sunburn, mouth sores, a sore throat, fatigue and difficulty swallowing.

Judd credits his care team at MD Anderson¡¯s Proton Therapy Center for managing his symptoms. ¡°Nurse practitioner Ian Moore prescribed me liquid lidocaine to temporarily numb the sores in my mouth so I could eat,¡± says Judd. ¡°My care team made pain management a priority.¡±

Now that he¡¯s completed treatment, Judd says the big side effects are behind him. With diligent oral care and swallowing exercises, Judd¡¯s sores soon healed. He still has some lymphedema in his neck and numb areas on his face from the surgery, though.

He kept count of his daily calorie intake to keep his body strong and make sure he did not lose any weight. He ate soft foods, like pudding, broth, yogurt, smoothies and scrambled eggs. ¡°Anything crunchy or spicy was out,¡± says Judd.

Judd¡¯s takeaways from cancer treatment

Judd quickly learned how much his mindset mattered during treatment. ¡°While it sounds cliche, time is our most precious?commodity,?and I want to spend it doing the things most important to me,¡± he says.

Here is what helped him during treatment:

• Push for definitive tests and ask questions. If something does not feel right, get it?checked?out.
  
  
• Trust your care team. MD Anderson moves with urgency to get you the best treatment possible.
  
  
• Keep a positive attitude. It can be tough, painful or scary, but you can do this. Find your inner strength and step up for the challenge.
  
  
• Lean on your support system. Rely on your network?of friends and family for love and?support.

Judd completed his last treatment in July 2023. He returns to MD Anderson for scans every three months and remains cancer-free. ¡°Even though my diagnosis wasn¡¯t great, I?had access to the best medical team in the world at MD Anderson and a large support network to get me through,¡± says Judd. ¡°Find the things you¡¯re grateful for and let that power you through.¡±??

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The palate ¡ª or roof of the mouth ¡ª consists of two sections. The soft area toward the back of the mouth is considered a part of the throat. The hard, bony part closer to the front is considered a part of the oral cavity.

Cancer of the hard palate isn¡¯t very common. Only about 54,000 cases are diagnosed each year worldwide.

To learn more about this rare cancer ¡ª including how it is diagnosed and treated ¡ª we spoke with head and neck tumor surgeon Here¡¯s what he shared.

What types of cancer are typically found in the hard palate?

• Squamous cell carcinoma: This is the most common type of hard palate cancer. It accounts for about 90% of all cases diagnosed each year. It is associated with excessive tobacco and alcohol use, as well as poor dental hygiene.
• Adenoid cystic carcinoma: This is a type of salivary gland tumor. It usually starts in the tiny little salivary glands located in the roof of the mouth. We don¡¯t really know what causes adenoid cystic carcinoma, but it¡¯s often associated with a DNA mutation.?
• Mucosal melanoma: We don¡¯t see this type of cancer too often, as it¡¯s extremely rare in the hard palate. I¡¯d say fewer than 100 cases are diagnosed in the United States each year.?

How unusual are hard palate cancers in general?

They¡¯re not very common. Only about 900,000 head and neck cancers are diagnosed worldwide each year. Of those, about 30% are in the oral cavity. And of those, only about 20% are cancers of the hard palate.

What are the symptoms of hard palate cancer?

The most common symptoms are:

• an ulcer that won¡¯t heal
• a bump on the roof of the mouth
• a rough white patch that¡¯s new and won¡¯t go away

Mucosal melanoma, which is rare in that location, is usually dark like a mole. But these are hard to see unless people are actively looking inside their mouths with a flashlight and a mirror. That¡¯s where oral cancer screenings come in.?

Most dentists perform oral cancer screenings as a part of their patients¡¯ checkups. So, if you¡¯re already getting your teeth cleaned twice a year, chances are any oral cancers will be caught early, when they¡¯re easiest to treat.?

How are hard palate cancers diagnosed??

A biopsy is always the first step in diagnosing hard palate cancers. These are usually followed by a CT scan or an MRI. We may also run a small camera up inside a patient¡¯s nose or sinuses so we can determine the full extent of their cancer before deciding on a treatment plan.

How is hard palate cancer typically treated??

It depends on how advanced the disease is, of course, but it usually starts with surgery. Early-stage tumors can sometimes be completely removed this way, so surgery may be all that¡¯s needed. With more advanced tumors, you¡¯ll likely need that plus radiation, and possibly chemotherapy and/or immunotherapy.

What are the latest advances in the diagnosis and treatment of hard palate cancer?

Molecular markers allow us to make more accurate diagnoses, so we¡¯ve gotten a lot better at identifying even the rarest hard palate cancers now. That¡¯s the key to getting patients the right treatment.

Proton therapy lets us target tumors more precisely while avoiding healthy tissues. We¡¯re also exploring treatment options with immunotherapy and targeted therapy.?

But the biggest advances in treatment are related to reconstruction. When you remove the roof of the mouth either partially or totally, you¡¯re taking out the natural barrier that exists between the oral cavity and the nasal passage and/or sinuses. Without that barrier, patients can neither eat nor talk.

We have two ways to correct this:

1. Prosthetics are the quickest and easiest way to solve the problem. An obturator is a custom-made device designed to cover the hole left behind in the hard palate by tumor-removal surgery. It looks a bit like a denture but has a dome-shaped structure that fits snugly into the defect and clips onto the remaining teeth. The first one is usually fabricated by our prosthodontics experts during surgery, but patients often get new ones as their healing progresses.
2. Reconstructive surgery is a fairly complicated procedure, so it¡¯s important to have a very experienced doctor performing it. When the surgeon goes to remove the tumor, he or she will determine the most appropriate site to pull donor material from ¡ª usually the patient¡¯s thigh or arm ¡ª and then transfer that tissue to the roof of the mouth. If teeth are involved, the surgeon may also need to harvest bone, which may serve to facilitate dental implants.

But whether we¡¯re talking about tissue replacement or prosthetics, our techniques have evolved to return patients to a very normal level of functioning after surgery.?

Other than tobacco and alcohol use, are there any other risk factors for hard palate cancer?

Chewing betel nuts is associated with a higher risk of developing it. But that¡¯s a more common habit in India and Southeast Asia. It¡¯s not as big of a factor here in the U.S.

Anything else you want people to know about hard palate cancers?

I don¡¯t want everyone with a canker sore to be concerned about cancer. Most oral ulcers are not cancer and will heal just fine on their own. But any abnormal mass or ulcer on the roof of your mouth that doesn¡¯t go away within two weeks should be evaluated by a specialist.

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After a spearfishing trip, I noticed an unusual earache. When spearfishing, it is typical to dive down 50 to 60 feet in the water to fish, so I thought it was simply some water in my ear. Then my lymph node in my neck became swollen.?

In October 2022, I went to see my primary care doctor. She prescribed an antibiotic and eardrops. She told me not to worry and to follow up if things did not improve. I procrastinated and did not go back until January 2023 when I was due for my annual physical exam. When I mentioned my lymph node was still swollen, she scheduled a test and then referred me to an ENT to have a biopsy. Things were moving quickly, and that gave me a lot of anxiety. I knew something was wrong.?

Results from the biopsy showed that I had a head and neck cancer called squamous cell carcinoma on the right side of my neck.??

Facing my squamous cell carcinoma diagnosis

At a local hospital in Florida, I had robotic surgery on the back of my throat to remove the cancer, along with 32 lymph nodes. After surgery, a biopsy showed microscopic spreading, even though they had clear margins when removing the tumor. Two of the 32 lymph nodes in my neck tested positive for cancer. The doctors suggested I start chemotherapy and traditional radiation therapy. But I wanted a second opinion.

I have always had trouble swallowing, so I was scared that side effects from radiation treatment would make it worse. My brother, Dion, lives in Houston and connected me with a friend who had the same type of cancer. Everyone told me to get multiple opinions from various hospitals.?

So, a week later, I visited another cancer hospital. They said the cancer was confined and suggested proton therapy since I only needed radiation to one side of my neck. The benefit of proton therapy is that the radiation could be delivered to only one side of my neck. This would minimize side effects to the other side of my neck, as well as my eyes, mouth and brain.

Once I found out that proton therapy was the right treatment for me, I was relieved. I wanted to find the best proton treatment facility I could.?

Finding care and compassion at MD Anderson

At the beginning of April, I made plans to get another opinion at MD Anderson because I knew they were the top cancer hospital in the nation.?

The day I was supposed to leave for Houston, I got busy at work and almost canceled the trip. At the last minute, I decided to go.?

At MD Anderson, I had appointments with my full care team to review my case and set up my treatment plan. I met with medical oncologist , radiation oncologist Dr. Steven Frank, along with physical therapy, speech therapy, hearing and dental oncology.?

At my first appointment with Dr. Frank, I remember asking him why I should come to MD Anderson for proton therapy. He mentioned that proton therapy is like a scalpel. Everyone has one, but it is who is using the scalpel that matters.?

¡°We give patients the full benefit of resources of the nation¡¯s top-ranked cancer center, such as knowledge, expertise, world-renowned research, clinical trials and technology,¡± says Frank.

Making that trip to MD Anderson to meet Dr. Frank and the rest of my care team changed the course of my treatment.?

Dr. Frank took the time to explain the process. That put me at ease. When he learned that my brother Dion and I attended the Naval Academy, at my next appointment, he surprised us by walking in wearing his former Naval Submarine Officer uniform. That level of compassion and camaraderie was like nothing I had experienced with any other doctor.?

Managing side effects from treatment

My wife, Karen, stayed in Florida while I traveled to Houston to begin treatment. I lived with Dion and worked remotely every day. I rented a car to drive myself to daily treatments for six weeks of chemotherapy and proton therapy.?

Toward the end of chemotherapy, I experienced nausea, so I took medication to help. The lymph node dissection during surgery caused lymphedema in my neck and limited the range of motion in my arm. I still cannot raise my arm as normal but have started physical therapy. The surgery also severed nerves in my neck, making it hard to open the corner of my mouth, which is expected to be permanent.?

The side effects from proton radiation were not as bad as I anticipated. I had a slight sunburn at the site of radiation, but it improved after two weeks. I ate my normal diet, but I did lose my sense of taste temporarily. I gained a few pounds during treatment, which I was not expecting.

Getting a second opinion led me to the right treatment for me

My last treatment was on June 7, 2023. As a token of appreciation, I ordered personalized Navy hats for Dion and Dr. Frank, along with a custom submarine photo and a Zippo lighter. These are typical Navy gifts, and I wanted to show my appreciation to them both.? ?

Had I known about proton therapy from the beginning, I would not have had surgery.?

If you have any doubts about your diagnosis or treatment plan, get a second opinion. I spent five weeks getting several opinions for my treatment options. Even though I did not learn about proton therapy until week four, it was the perfect solution.?

or by calling 1-877-632-6789.?

Arik Mayer had just graduated from high school and was eagerly anticipating his new life as a college student. But during his first year at Idaho State University, he was diagnosed with COVID-19, strep throat, and cancer.

¡°Instead of enjoying being on campus, I was miserable,¡± he says.

Arik tested positive for COVID-19 first. Just as he was recovering, strep throat knocked him back down. Antibiotics helped, but an inflamed lymph node in Arik¡¯s neck refused to shrink. When his ear, nose and throat doctor ordered a lymph node biopsy, the results came as a shock. Arik had stage IV nasopharyngeal cancer, a rare type of head and neck cancer. It starts in the nasopharynx ¨C the upper part of the throat behind the nose.

¡°I was stunned,¡± Arik says. ¡°I assumed the strep infection caused the swollen lymph node. I never imagined it was cancer.¡±

Proton therapy for nasopharyngeal cancer

Doctors in Arik¡¯s hometown of Pocatello, Idaho, recommended an advanced form of radiation therapy called proton therapy. Instead of using X-rays like regular radiation treatment, it uses protons to send beams of high energy that target tumors more precisely. Doctors and physicists work together to focus the proton beam on the exact size and shape of the tumor. The beam kills the tumor cells layer by layer, sparing surrounding healthy tissue.?

But Arik would have to travel to get proton therapy, since it¡¯s not widely available.

He and his parents began researching options. They learned that?MD Anderson not only provides the treatment, but it¡¯s the No. 1 cancer center in the country.

¡°That gave us tremendous peace of mind,¡± Arik says. ¡°I made an appointment.¡±

Settling in at MD Anderson for nasopharyngeal cancer treatment

At MD Anderson, radiation oncologist , planned out Arik¡¯s treatment: seven weeks of proton therapy, five days a week, with each session lasting about 40 minutes. Arik would also undergo chemotherapy, which can make proton therapy treatments more effective. To ensure the best chance of treatment success, it was vital that he never miss an appointment. ?

¡°Bring it on,¡± Arik challenged Gunn. ¡°Let¡¯s crush this cancer.¡±

He and his grandmother rented an apartment near MD Anderson. They would live there for the next two months while Arik underwent treatment.

Music therapy strikes a chord

As a new patient, Arik was scheduled to visit MD Anderson¡¯s Adolescent and Young Adult Clinic. Specialists there help young patients access services designed just for them. One of those offerings ¨C music therapy ¨C struck a chord with Arik.

¡°I started playing violin at age 10, then I transitioned to the guitar in high school,¡± he says. ¡°I enjoy music, so I was thrilled to learn MD Anderson had a music therapist on staff.¡±

Melissa Sandoval, the Faris Foundation Music Therapist in the Arts in Medicine program at MD Anderson Children¡¯s Cancer Hospital, recalls how shy and reserved Arik was during their first meeting.

¡°He was vulnerable and dealing with a lot,¡± she says. ¡°I knew music therapy could help him process and share his feelings.¡±

Three times a week, she and Arik strummed guitars and talked about ¡°anything and everything.¡± Every time they met, Arik opened up a little more.?

One day, Melissa suggested he write songs about his cancer experience.

¡°Songwriting can help people release their emotions, empower themselves and connect with one another,¡± Sandoval says. ¡°My job was to tease out the songs that were already inside Arik.¡±

Sandoval offered creative ideas for Arik to consider. But, she says, ¡°He had a strong guiding force that dictated how his songs would unfold.¡±

Within days, he completed his first song, ¡°Trying to Find Myself.¡± The plaintive ballad portrays Arik¡¯s feelings of losing his identity and control over his life in the face of cancer.

Now his creativity had been unleashed. The songs just kept coming. He wrote five more, which Sandoval compiled into an album titled ¡°An Unsettling Journey.¡±

Each song¡¯s lyrics and tone correspond with how Arik was feeling at the time. When chemotherapy was taking a toll on his body, his guitar playing and vocals became rigid and rough. As he approached the end of treatment and was preparing to go home, his songs became breezy and celebratory.

¡°Everything you hear on the album ¨C the singing, the guitar playing, the lyrics and notes ¨C it¡¯s all Arik,¡± Sandoval says. ¡°I just helped him channel his creative force by getting him to open up about his feelings.¡±

She urged Arik to share those feelings with his doctors.

¡°I told him, ¡®The words in your songs are important for you to share with your medical team. They need to hear what you¡¯re feeling.¡±

It worked. Doctors, nurses and social work counselors noticed that Arik had blossomed.

¡°The music gave him the courage to do that,¡± Sandoval says.

A new revelation

Today, Arik is preparing to return to college, where he¡¯ll switch his major from computer science to music education with an emphasis in guitar.

¡°Music therapy was the highlight of my hospital stay,¡± he says. ¡°I¡¯ve come to realize that I want a career that allows me to share the immense enjoyment I have for making music with others. It¡¯s a kind of give-back opportunity.¡±

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In the fall of 2020, Bill Middelthon felt something like a canker sore in his mouth. Normally, canker sores heal on their own in about 2 to 3 weeks. So, when the sore in his mouth persisted, he made an appointment with a local periodontist in his hometown of Miami, Florida. His doctor recommended a biopsy. The results showed a type of??head and neck cancer?called squamous cell carcinoma of the oral tongue.?

After the tumor was removed surgically, he did two things: quit smoking cigars and made an appointment at MD Anderson.?

¡°My local oncologist wanted me to start radiation therapy,¡± Bill says.?

Bill was concerned about the potential side effects of having radiation on his mouth. His son, Matthew, had a friend who had minimal side effects after receiving proton therapy for a similar diagnosis at MD Andersons. So, Bill decided to make an appointment at MD Anderson.?

A life-changing second opinion for head and neck cancer

Bill remembers the ease he felt when setting up his first appointment at MD Anderson. ¡°Shonie Pickron in Business Services led me through the appointment process and helped me prepare,¡± says Bill.

In January 2021, Bill made the trip to Houston to meet head and neck surgeon and radiation oncologist They determined that he did not require radiation treatment. Instead, they recommended he undergo monitoring every three months.?

?¡°If it wasn¡¯t for MD Anderson, I would have received unnecessary radiation to my mouth,¡± Bill says. Relieved, he returned home to Florida.

Facing a second cancer diagnosis

During a routine checkup that August, bloodwork showed that Bill¡¯s prostate-specific antigen?(PSA) levels were elevated. His local urologist put him on??active surveillance, also known as ¡°watchful waiting.¡± A month later when his levels increased, it was time for a biopsy.

By January 2022, Bill was diagnosed with prostate cancer. The biopsy showed four spots in his prostate where the cancer was present. ¡°There was no doubt in my mind that I wanted to get back to MD Anderson as soon as I could,¡± says Bill.?

Prostate cancer treatment: proton therapy and the NOVA fiducial marker?

On June 28, Bill returned to MD Anderson to see Dr. Frank. This time, Bill¡¯s care team recommended he receive NOVA fiducial markers followed by proton therapy.

The NOVA technique, pioneered?at MD Anderson, uses a positive MRI signal to provide more precise planning and localization of the tumor in the prostate. This pinpoints the exact location of the tumor before a patient receives radiation.

¡°The NOVA fiducial marker creates a precise guide from an MRI or CT scan to help physicians guide proton therapy. Without the fiducial marker, the tumor is harder to see, making treatment more difficult,¡± says Frank. ¡°This allows patients to be treated with the maximum radiation dosage and reduces exposure to nearby healthy tissue.¡±

On July 8, Bill was ready to start seven weeks of proton therapy. Midway through treatment, the side effects he felt from proton therapy were fatigue and increased urination.?

Bill credits his many radiation therapists at MD Anderson Proton Therapy Center and nurse practitioner Ian Moore for helping him through treatment. ¡°They were very professional and answered all my questions,¡± Bill says.

Advice for other cancer patients

After a two-month stay in Houston, Bill returned home to Florida. He returns to Houston for follow-up appointments with Dr. Lewis every three months and with Dr. Frank every six months.?

Bill encourages other men to keep a watch on their prostate-specific antigen?(PSA) levels and to get a second opinion if they have doubts about their diagnosis or treatment plan.?

¡°Local doctors can get you to a certain point, but when your PSA goes up and they say surgery, get to MD Anderson,¡± Bill says. ¡°I was blessed to be treated by doctors and medical staff who are experts in their area of care.¡±

Disclosure: Steven Frank, M.D., and MD Anderson Cancer Center? licensed IP related to NOVA fiducial markers to C4 Imaging, LLC, and Dr. Frank holds equity in the company.

??or by calling 1-877-632-6789.

For patients with complex head and neck tumors, proton therapy allows us to treat the tumors effectively while minimizing the radiation dose to vital structures such as the eyes, mouth, and brain. That means a patient¡¯s vision, smell, taste, and swallowing may not be affected by proton therapy. It also means side effects such as nausea, severe dry mouth, difficulty swallowing, loss of taste, and thyroid dysfunction are not as severe with proton therapy.

But some head and neck cancer patients will experience skin irritations, mouth sores, sore throat and painful swallowing due to the tumor and treatment location.?

As nurses at MD Anderson Proton Therapy Center, we get a lot of questions from head and neck cancer patients and caregivers about managing these proton therapy side effects. Here¡¯s how we answer some of the most common ones.

How do I deal with skin irritations from proton therapy?

We recommend that patients wash the affected skin daily with mild moisturizing soap to cleanse. Use an?unscented moisturizer starting on the first day of treatment. Do not use anything abrasive on the skin, and avoid wearing shirts with collars. Use an electric razor, and avoid aftershaves or perfumes. Do not apply makeup to the affected area and avoid direct sunlight.

Why is oral care important during proton therapy?

Oral care is important during and after treatment. Mouth sores can become infected, so practice good oral hygiene and tell your care team about any symptoms. Use baking soda and salt rinses four to six times a day. This helps the PH balance and reduces bacteria in your mouth. Brush your teeth with a soft toothbrush after every meal and at bedtime. Avoid commercial mouthwashes that contain a large amount of salt or alcohol.

Also be sure to perform the jaw and neck exercises as instructed by your medical team. These exercises will help with stiffness or tightening of the jaw and neck, mouth opening challenges, and difficulty chewing.

How do I avoid unwanted weight loss?

Many cancer patients lose weight unexpectedly because they struggle with nausea or cannot eat well during treatment. Proper nutrition can help you maintain your weight and hydration, which helps ensure successful treatment results. Good nutrition will also improve your quality of life during and after cancer treatment.

Eating soft, moist foods and avoiding anything that irritates your mouth, such as spicy, rough, acidic, extreme temperatures, or carbonated drinks. If you¡¯re having trouble eating, you may want to try meal replacement drinks like Boost and Ensure. It's also important to talk to your doctor about any vitamins, nutritional or herbal supplements you're taking.?

You should also avoid drinking alcohol or using tobacco products, as these habits can increase treatment side effects.

How can I prevent dry mouth?

Dry mouth can make eating, speaking, and sleeping more difficult. Without saliva, patients also run the risk of increased bacterial growth, bone infection, and nutritional deficiencies.

You can avoid dry mouth by chewing sugar-free gum, over-the-counter saliva substitutes, and staying hydrated. It also helps to swish a baking soda/water solution around your mouth a few times a day. It may be beneficial to sleep with a cool-mist humidifier next to your bed during and after treatment as well.

How can I reduce fatigue?

Fatigue is a normal and often expected side effect of cancer treatment. Try taking naps earlier in the day so that you don¡¯t disrupt your sleep pattern.

Some patients find their fatigue improves with light exercise such as walking. Be sure to check with your care team before starting a new exercise routine.

What can I expect after proton therapy for head and neck cancers?

Side effects from proton therapy may continue or even increase for two to three weeks after treatment for head and neck cancer patients. Be sure to continue the regimen your care team recommends for caring for your mouth, throat, skin, and maintaining proper nutrition. It usually takes four to six weeks for your body to heal after proton therapy.

Remember, your care team is here for you and will provide resources and specific product recommendations for your side effects. Be sure to follow them. The patients that do the best are those who get ahead of their side effects.

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