Online Health Chat with Dr. Brian Burkey

April 15, 2010


Cleveland_Clinic_Host: Head and neck cancers account for 5 to 10 percent of all cancers in the United States. Head and neck cancer is more common in people over age 50 and three times more common in men than in women. If detected early, head and neck cancer is often curable. In fact, it can be prevented easily through some basic lifestyle changes.

Because head and neck cancers may involve the digestive and respiratory tracts, tumors – if left untreated – can interfere with eating, swallowing, and breathing, and can invade other parts of the body. The larger a tumor becomes the more life-threatening it is. Twelve thousand Americans die from head and neck cancer each year. Early detection and treatment are critical and can save lives.

Cleveland Clinic head and neck surgeon, Brian Burkey, MD answers questions about the signs, symptoms and treatment options for head and neck cancers, which include the following areas:

  • Oral cavity: the lips, tongue, gums, lining of the cheeks and lips, bottom and top of the mouth, and behind the wisdom teeth. This is the most common type of head and neck cancer.
  • Salivary glands: These produce the saliva that keeps your mouth and throat moist. The main glands are on the bottom of the mouth and near the jawbone.
  • Sinuses: the hollow spaces in the bones surrounding the nose
  • Nasal cavity: the hollow area inside the nose
  • Tonsils
  • Throat (pharynx)
  • Voicebox (larynx)
  • Ears
  • Lymph nodes in the upper part of the neck

Brian Burkey, MD, was recently recruited from Vanderbilt Medical Center in Nashville, TN and appointed Head of the Section of Head and Neck Surgery and Oncology in the Head & Neck Institute of Cleveland Clinic. Patients are benefiting from the institute model, which integrates most of the specialties needed in the comprehensive care of patients with complex head and neck tumors (i.e., head and neck ablative surgeons, microvascular and reconstructive surgeons, dentists and maxillofacial prosthetic experts, speech and language pathologists, and dedicated nurses and advanced practice nurses).

Dr. Burkey has been listed in Best Doctors and America's Top Doctors, since 2001; America's Top Doctors for Cancer, since 2005; America's Top Surgeons, since 2008 and he received the Distinguished Service Award of the American Academy of Otolaryngology-Head and Neck Surgery, 2009.

Cleveland_Clinic_Host: Welcome to our Online Health Chat with Cleveland Clinic surgeon Dr. Brian Burkey. We are thrilled to have Dr. Burkey here today for this chat. Let’s begin with the questions.

Head & Neck Cancers: General Information

blanek2: What types of cancers are categorized as head and neck cancer?

Speaker_-_Dr__Brian_Burkey: Usually, the term head and neck cancer is used for those cancers originating in the upper aerodigestive tract, which includes the air and food passages from the lips and nose to the upper trachea and esophagus. Other cancers also include those of the thyroid, lymph nodes and soft tissues of the face and neck.

Brain tumors are separate and are treated by neurosurgeons and other cancer specialists.

weed: For thyroid cancer, how long does it take for thyroid cancer to turn into lymph cancer?

Speaker_-_Dr__Brian_Burkey: Thyroid cancer may travel to lymph nodes and require treatment at that site. Not all cancers will travel to lymph nodes and even small cancers may travel quickly, so there is not a perfect answer to your question. However, in general, the lymph nodes should be evaluated in the workup of all thyroid cancer.

weed: Have you any knowledge of head or neck cancerous masses resolving, without medical intervention? Like a miracle cure or it just goes away?

Speaker_-_Dr__Brian_Burkey: There are always sporadic reports of tumors which resolve on their own, but these are very rare indeed. The tumor where this is most commonly reported is melanoma of the head and neck skin, where spontaneous resolution will occur in a very small subset of patients. However, this again is a very rare occurrence and active treatment of cancer is always preferable, where cure is desired.

Head & Neck Cancers: Treatment Options

stevie: If there are no side effects, does that mean it is not working? Can one person tolerate the treatments better than someone else?

Speaker_-_Dr__Brian_Burkey: Please clarify which treatments to which you are referring--I am uncertain what you are asking exactly. Thank you.

jr: With cancer of the tongue and/or throat, what is done with swallowing/eating problems? Also, my brother is waiting almost 2 months for treatment to begin. Why would this be so?

Speaker_-_Dr__Brian_Burkey: In treatment of cancers of the tongue and throat, swallowing and eating is almost always affected. Specialists rely on speech and swallowing pathologists to help in the diagnosis and treatment of these functions caused by either surgical or nonsurgical treatment of head and neck tumors. They are a vital part of the treatment team.

The beginning of treatment is sometimes delayed due to the need to assess tumor spread and for the removal of nonviable teeth that are in radiation fields, along with healing time.

weed: A young family member contracted thyroid cancer at 17. The thyroid was removed. She was given radiology isotope treatment. She is now diagnosed with lymph cancer. What are the options for treatment, and what CCF departments would treat her.? Endocrinology is for the thyroid, but she doesn't have a thyroid anymore. How can they help? Should she also see someone in oncology?

Speaker_-_Dr__Brian_Burkey: Your family member should be evaluated by a thyroid surgeon and the endocrinologist together. Most probably, the best treatment will include surgical removal of lymph nodes and additional radioactive iodine.

At Cleveland Clinic, both the endocrine and head and neck institutes have surgeons specializing in the treatment of thyroid cancer and they all work closely with the endocrinologists, including presentations at a multidisciplinary thyroid tumor board.

ks2: Can you please explain what exactly is done in a Retropharyngeal Node resection?

Speaker_-_Dr__Brian_Burkey: This is an uncommon procedure where the lymph nodes behind the pharynx are removed via an incision in the neck and dissection down to the throat and then removal of the nodes along with associated fat and fibrous tissue.

Care is taken to avoid injury to the great vessels of the neck, including the carotid and jugular vessels.

lexie: How successful is surgery (removing the cancerous gland) in treating cancer? My cousin has cancer in a salivary gland and is having it removed. Will she have to go through chemo and radiation too or does it depend on the stage of the cancer? What would cause someone who is only 20 to get this kind of cancer?

Speaker_-_Dr__Brian_Burkey: Salivary gland cancer is relatively uncommon and there is no known reason or risk factor for this disease. Treatment includes surgical removal of the gland and sometimes the nearby lymph nodes.Depending on the pathology found at the time of surgery, additional radiation and/or chemotherapy may be indicated.

kate: What do you consider the worst (most difficult to treat) head and neck cancer?

Speaker_-_Dr__Brian_Burkey: Any head and neck cancer may be difficult to treat if it is diagnosed at a late stage, which is why it is important to see a head and neck specialist if you are having worrisome symptoms.

Head and neck cancer awareness week is an annual event that occurs in many locations all over the country. The event includes free screenings for head and neck cancer, including screenings at the Cleveland Clinic on April 14, 2010 (all day - two locations). Please check the Internet for more information by searching Oral, Head and Neck Cancer Awareness Week, 2010. For Cleveland Clinic activities, go to for more information.

weed: If cancer is found in a lymph node in another area of the body, in this case the chest, what specialty would be included in the care of the patient?

Speaker_-_Dr__Brian_Burkey: In thyroid cancer, chest metastases are treated with radioactive iodine and this is overseen by endocrinologists and nuclear medicine specialists.

sassy: Do all types of head and neck cancer require surgery?

Speaker_-_Dr__Brian_Burkey: Head and neck cancer can be treated in three general ways: surgery, radiation therapy and/or chemotherapy. Surgery may be done through an incision or endoscopically. The best treatment is determined by the type of cancer, its site and its stage. Again, specialists in head and neck cancer are best able to provide this information once all the factors have been evaluated.

seek9: Do you work in conjunction with oncology?

Speaker_-_Dr__Brian_Burkey: Most all head and neck surgeons work closely with a medical and radiation oncologist, and I am no exception. The team approach to patient care invariably will provide the best cancer and functional results.

billoviatt: My brother has squamous cell cancer. I have read medical journal articles on the benefits of advanced nutraceutical supplementation before, during and after chemotherapy and radiation - makes the good cells stronger and the cancer cells weaker.. I know this concept does not have much credibility within typical US oncologists being the fear of weakening the free radical effect of the chemo and radiation. What is your thinking here??

Speaker_-_Dr__Brian_Burkey: This is an emerging field in the adjuvant treatment of head and neck cancer. However, the research is certainly in its infancy and many people in this country are wary of potential side effects and dilution of more standard treatments.

I would never substitute unproven treatments for proven treatments, but I am supportive of anything that may improve the overall immune capabilities of an individual without causing significant side effects.

The details of the potential treatment depend on the specifics, as always the devil is in the details.

Head & Neck Cancers: Prevention

arobert6: Is there a way to avoid thyroid cancer? Some say dental xrays play a role?

Speaker_-_Dr__Brian_Burkey: Thyroid cancer is quite common and is more common as people age. For many types, there is no obvious cause.There are certain types of thyroid cancer that are associated with a familial tendency, and so a family history of thyroid cancer may put a person at increased risk.

Also, exposure to low level radiation also predisposes a person to thyroid cancer, that is, increases that person's risk of cancer. Examples include radiation given in the past for acne or tonsillitis, treatments that are now obsolete.

Dental x-rays are very low level radiation and are probably safe in low numbers, and so should be used when the information is worth the radiation exposure.

jenjen: What can you do to prevent head and neck cancers?

Speaker_-_Dr__Brian_Burkey: The best ways to prevent head and neck cancers is to avoid tobacco use in all forms, smoking and chewing, and to drink in moderation. When you smoke and drink together, this increases your risk significantly.

These two factors make up the greatest risk factors for head and neck cancer--over 80% of head and neck cancers are preventable with these lifestyle choices.

If you currently smoke and stop, your chance of developing cancer will continue to decrease every year, over a 20 year period.

Symptoms of Throat Cancer

kpazdernik: What are the key symptoms in throat cancer? For a couple months now I have been feeling like I am swallowing "past something" in the right side of my throat. I do not feel it when I swallow food or drink, only saliva. It is not painful, it’s just there. I will add that my grandfather died of throat cancer at a young age (around 60, I think)

Speaker_-_Dr__Brian_Burkey: The keys symptoms of throat cancer are trouble swallowing, painful swallowing, ear pain, change in voice, weight loss and coughing up blood.Your symptoms could be due to a cancer, or more likely, gastroesophageal reflux. This means that stomach acid can track up the esophagus and cause burns in the throat and symptoms which mimic cancer.

The best way to distinguish is to see a head and neck specialist for an exam in the office, which can help differentiate between benign and malignant causes of your symptoms.

Diagnosing Head & Neck Cancers

kpazdernik: What are the red flag symptoms when looking at head/neck cancers?

Speaker_-_Dr__Brian_Burkey: The keys symptoms of head and neck cancer are trouble swallowing, painful swallowing, ear pain, change in voice, weight loss, an unexplained lump in the face and neck, coughing up blood, and pain/numbness in an area of the face and neck.

Head & Neck Cancer: Research

goals: What is the latest research being done?

Speaker_-_Dr__Brian_Burkey: The answer depends upon the specific area of interest. Much research is being done in all areas of prevention and treatment of head and neck cancer, as well as education. One good source of new information is on the web site of the American Head and Neck Society.

cappy: Are there any long term effects to the radiation treatment I am receiving?

Speaker_-_Dr__Brian_Burkey: If the radiation treatment is given over six to seven weeks, daily, then there are long term side effects. The most common is acute swelling and tenderness of the lining of the mouth and throat. Most patients will also develop a dry mouth and lack of saliva that may last forever. Thus, good care of any remaining teeth after radiation therapy is essential, as is long term follow up with a dentist.


Cleveland_Clinic_Host: I'm sorry to say that our time with Cleveland Clinic head and neck surgeon Dr. Brian Burkey. Thank you again Dr. Burkey for taking the time to answer our questions about head and neck cancer.

Speaker_-_Dr__Brian_Burkey: I was happy to take the time to chat with you today. Remember, next week is Oral, Head and Neck Cancer Awareness Week. Free screenings and educational pieces will be provided all over the world. Check out different head and neck cancer websites for information on local events. For more information regarding Cleveland Clinic's events, go to for more information.

More Information

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