Eddie Van Halen’s Head and Neck Cancer

Speciality News

Legendary guitar player and co-founder of the rock band Van Halen, Eddie Van Halen has died at the age of 65. According to his son, Wolfgang Van Halen, his father “lost his long and arduous battle with cancer.” Known for his signature guitar solo “Eruption,” Van Halen was a long-time heavy smoker and drinker and was first diagnosed with “throat cancer” in 2000. At that time, he underwent surgery to remove the cancer and approximately one-third of his tongue. Declared “cancer-free” in 2002, he subsequently had to intermittently have “cancer cells scraped out of his throat after they migrated there.”

In 2015, Van Halen told Billboard his theory about how he got his cancer:

“I used metal picks — they’re brass and copper — which I always held in my mouth, in the exact place where I got the tongue cancer,” he says. “Plus, I basically live in a recording studio that’s filled with electromagnetic energy. So that’s one theory. I mean, I was smoking and doing a lot of drugs and a lot of everything. But at the same time, my lungs are totally clear. This is just my own theory, but the doctors say it’s possible.”

Approximately 5 years ago, the cancer returned. In addition to undergoing treatments in the U.S., he also frequently traveled to Germany for treatment. The cancer had spread to his lungs, and in recent weeks to his brain as well as “other organs.”

Head and Neck Cancer

Cancers that are known collectively as head and neck cancers usually begin in the squamous cells that line the moist, mucosal surfaces inside the head and neck. These squamous cell cancers are often referred to as squamous cell carcinomas of the head and neck. Cancers of the head and neck are further categorized by the area of the head or neck in which they begin:

Oral cavity: Includes the lips, the front two-thirds of the tongue, the gums, the lining inside the cheeks and lips, the floor of the mouth under the tongue, the hard palate, and the small area of the gums behind the wisdom teeth.

Pharynx: The pharynx is a hollow tube about 5 inches long that starts behind the nose and leads to the esophagus. It has three parts: the nasopharynx (the upper part of the pharynx, behind the nose); the oropharynx (the middle part of the pharynx, including the soft palate [the back of the mouth], the base of the tongue, and the tonsils); the hypopharynx (the lower part of the pharynx).

Larynx: The larynx, also called the voice box, is a short passageway formed by cartilage just below the pharynx in the neck. The larynx contains the vocal cords. It also has a small piece of tissue, called the epiglottis, which moves to cover the larynx to prevent food from entering the air passages.

Paranasal sinuses and nasal cavity: The paranasal sinuses are small hollow spaces in the bones of the head surrounding the nose. The nasal cavity is the hollow space inside the nose.

Causes of head and neck cancers

Alcohol and tobacco use (including smokeless tobacco) are the two most important risk factors for head and neck cancers, especially cancers of the oral cavity, oropharynx, hypopharynx, and larynx. At least 75% of head and neck cancers are caused by tobacco and alcohol use. People who use both tobacco and alcohol are at greater risk of developing these cancers than people who use either tobacco or alcohol alone.

Infection with cancer-causing types of human papillomavirus (HPV), especially HPV type 16, is a risk factor for some types of head and neck cancers, particularly oropharyngeal cancers that involve the tonsils or the base of the tongue. In the United States, the incidence of oropharyngeal cancers caused by HPV infection is increasing, while the incidence of oropharyngeal cancers related to other causes is falling.

How common are head and neck cancers?

According to the National Cancer Institute’s SEER program: It is estimated that there will be 53,260 new cases of oral cavity and pharyngeal cancer in 2020, along with approximately 10,750 deaths.

Based on 2015-2017 data, approximately 1.2% of men and women will be diagnosed with oral cavity or pharyngeal cancer at some point in their life. In 2017, there were an estimated 383,415 people living with oral cavity and pharynx cancer in the United States.

Overall, the relative 5-year survival rate is 66.2%. This rises to 85.1% for patients diagnosed with localized disease and decreases to 40.1% for those with distant disease.

Symptoms of Head and Neck Cancers

The symptoms of head and neck cancers may include a lump or a sore that does not heal, a sore throat that does not go away, difficulty in swallowing, and a change or hoarseness in the voice. Symptoms that may affect specific areas of the head and neck include the following:

Oral cavity: A white or red patch on the gums, the tongue, or the lining of the mouth; a swelling of the jaw that causes dentures to fit poorly or become uncomfortable; and unusual bleeding or pain in the mouth.

Pharynx: Trouble breathing or speaking; pain when swallowing; pain in the neck or the throat that does not go away; frequent headaches, pain, or ringing in the ears; or trouble hearing.

Larynx: Pain when swallowing or ear pain.

Paranasal sinuses and nasal cavity: Sinuses that are blocked and do not clear; chronic sinus infections that do not respond to treatment with antibiotics; bleeding through the nose; frequent headaches, swelling or other trouble with the eyes; pain in the upper teeth; or problems with dentures.

Treatment Options for Oropharyngeal Cancer

An optimal approach for the treatment of oropharyngeal cancer is not easily defined because no single regimen offers a clear-cut, superior-survival advantage. The literature reports various therapeutic options but does not contain reports presenting any valid comparative studies of these options. Treatment considerations should account for functional and performance status including speech and swallowing outcomes. Current standard treatment options listed by the National Cancer Institute are summarized below:

Stage I and stage II oropharyngeal cancer

Treatment options: Radiation therapy using standard fractionation; surgery.

Stage III and stage IV oropharyngeal cancer

Treatment options: Surgery followed by postoperative radiation therapy with or without concurrent chemotherapy for patients with locally advanced disease; radiation therapy using altered fractionation; concurrent chemoradiation therapy; neoadjuvant chemotherapy followed by concurrent chemoradiation therapy.

Metastatic and recurrent oropharyngeal cancer

Treatment options: Surgical resection, if technically feasible and the tumor does not respond to radiation therapy; radiation therapy, if the tumor is not completely removed by surgery and curative doses of radiation have not been given previously; a second surgery, if the tumor was not completely removed initially and if technically feasible; or stereotactic body radiation therapy with concurrent cetuximab.

In the past few years, immunotherapy and targeted agents have been added to the armamentarium for treatment of head and neck cancer in patients with metastatic and recurrent disease.

Immunotherapy: Pembrolizumab and nivolumab are monoclonal antibodies and inhibitors of the programmed death (PD-1) pathway. They have been shown to have significant activity, either alone or with chemotherapy in patients with advanced squamous cell carcinoma of the head and neck.

Targeted Agents: Monoclonal antibodies are a type of targeted therapy being used in the treatment of oropharyngeal cancer. Cetuximab works by binding to a protein called epidermal growth factor receptor, which is found on some types of cancer cells. It inhibits cells from growing and dividing. It has also been shown to have activity alone or in combination with chemotherapy.

Michele R. Berman, MD, and Mark S. Boguski, MD, PhD, are a wife and husband team of physicians who have trained and taught at some of the top medical schools in the country, including Harvard, Johns Hopkins, and Washington University in St. Louis. Their mission is both a journalistic and educational one: to report on common diseases affecting uncommon people and summarize the evidence-based medicine behind the headlines.

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