A team player from a young age, head and neck cancer expert Saral Mehra, MD, was drawn to his specialty by the intricacies of the surgeries, the culture of the clinicians, and his fellow surgeons.
“They work hard, they do very delicate, fine work,” says Dr. Mehra, who is section chief of head and neck surgery at Smilow Cancer Hospital. “It’s intricate anatomy and the kind of surgery that requires a lot of attention to details.”
After earning his medical degree, when Dr. Mehra was applying to residency programs, head and neck was not on his list. “But during my journey in residency, I saw head and neck cancer surgery done and done right. That’s when I realized it was what I wanted to do.
“It’s a team sport,” Dr. Mehra said, adding that practically from the beginning of his relationship with a patient, he’s consulting with other oncologists and a team of experts ranging from pathologists to therapists of all kinds, nurses, social workers and more.
During a recent radio interview with Yale Cancer Center Director Eric P. Winer MD, Dr. Mehra explained his research, as a member of YCC, and shared details about his specialty and what people should about it. Following are topics the two discussed in Q&A format.
What causes throat cancer, mouth cancer or other head and neck cancers?
The major risk factors are tobacco use, alcohol consumption, and HPV (human papillomavirus) infection. Tobacco and alcohol synergize to significantly increase cancer risk, meaning those with long-term use of alcohol and tobacco together, the risk increases significantly. Also, HPV-associated head and neck cancers are really on the rise.
What are the survival rates for head and neck cancers?
It depends on when you catch the cancer. Advanced stage head and neck cancers—those that have spread to the lymph nodes or just beyond the original site—have a 50% survival rate at five years, while early-stage cancers that have not spread to lymph nodes or elsewhere can have an 80 to 90% cure rate.
What symptoms should people watch out for?
Be aware. There are no screening tests such as mammograms or colonoscopies. Watch for symptoms, including a sore in the mouth that does not heal after a few weeks, persistent throat pain, ear pain, changes in voice, difficulty swallowing, and a lump in the neck. Get those checked out.
Why might head and neck cancers be less well-known compared to other cancers?
Head and neck cancers are relatively rare, comprising only about 4% of all cancers in the United States, and they are very diverse unlike some large organ cancers such as breast or pancreatic. Head and neck cancers include those in the mouth, throat, nose, salivary glands, thyroid, and skin and they encompass various types of cancer including carcinomas, sarcomas, and lymphomas.
How has the understanding of HPV’s role in head and neck cancers evolved?
It’s nearly a new disease. HPV association with these cancers has been recognized only in the last 20 to 30 years, which is not long for a disease. HPV-associated head and neck cancers have increased significantly —about 200% in the last 20 years. The HPV vaccines have significantly reduced cervical cancers, so that HPV-associated head and neck cancers have surpassed cervical. Almost all are back-of-throat cancers—tonsils and base of the tongue.
What is the treatment approach for HPV-associated head and neck cancers versus non HPV-associated cases?
If we have an early cancer, one with a 80-90% cure rate, we are looking at whether we need to do everything—surgery, chemotherapy, radiation and everything—and the answer is no, we don’t. We are working on treatments for HPV-associated cancers that can be de-intensified due to their better prognosis. That’s because there are a lot of consequences to treatment including complications for swallowing, speech and other quality of life aspects.
Patients may come to a center because they have a doctor’s name and by time they are done with treatment it’s been a whole team that cared for them.
Absolutely. There are the oncologists, who all consult to determine the optimal treatment, and of course the pathologist, radiologists, therapist (language, swallow and mental therapists), nurses, psychiatrists, psychologists, social workers and more.
How do you talk to patients about doing less treatment when they want you to do everything possible to be sure the cancer won’t come back?
The first thing I talk to them about is the importance of getting all the information. I tell them it can be the most frustrating part of the journey, but it’s worth the tradeoff to do the right work and get to see everyone on the multi-disciplinary team. Most of them are happy to take less treatment as long as they are confident it will not affect their cure rates because they’ve read about the treatment complications to their quality of life.
What is your research focus?
We focuses on health services research, studying the delivery of cancer care and reducing variability in treatment access and quality across different regions. We look at national and regional trends and we look at barriers to access to the care.