The Importance of Educating Yourself About Cancer

In this Fox 8 House Call series, Cone Health experts explore cancer, including:

• Rick Diehl, BSN, RN, CHPN, talks about head and neck cancer.
• Martin Portillo, MD, discusses minorities and cancer risk.
• Christine Brannock, BSN, RN, OCN, explains the importance of screenings and early detection.

Cancer: Head and Neck Cancer

Head and neck cancer affects the mouth, throat, nose, larynx, lips and salivary glands. Approximately 4% of all cancers diagnosed annually (about 65,000 cases) are concentrated in the head and neck areas. Oral cancers can be found during routine dental checkups and annual physicals, which is why it’s very important to make and keep these wellness appointments. Symptoms depend on what area of the head and neck they start, and include:

• Chronic sore throat.
• Changes in voice.
• A lump on the neck.
• Ear pain.
• Pain when swallowing.

If these symptoms don’t go away within two to three weeks, you should see your primary care doctor, who may refer you to an ear, nose and throat specialist.

Tobacco (both smokeless and cigarettes) and excessive alcohol use are the two main causes of head and neck cancer. About half of all head and neck cancers occur in nonsmokers, where the majority of those show evidence of human papillomavirus (HPV), a common sexually transmitted infection. There is still a great deal of research being done in this area. Given that HPV is causing more cancers, it is recommended preteens receive the HPV vaccine between the ages of 11 and 12, ages at which they can develop immunity before exposure. Dentures that fit improperly can also be a risk factor for developing oral cancer.

Head and neck cancer treatment depends on the location of the tumor causing it, the stage of the cancer and overall health of the patient. There are three types of treatment, and depending on the patient, some could receive one or a combination of all three:

• Surgical: Can be a simple or extensive surgery to remove the tumor.
• Radiation: High doses of radiation to kill cancer cells and shrink tumors. Radiation is the cornerstone for the treatment of many head and neck cancers.
• Chemotherapy: Used in combination with other treatments, usually radiation.

Rick Diehl, BSN, RN, CHPN, is a head and neck oncology navigator at the Cone Health Cancer Center at Wesley Long Hospital. He received his Bachelor of Science in nursing from the University of North Carolina at Greensboro in 2007. He has 7 years of experience in hospice and palliative care, and has been the head and neck oncology navigator for 3 years.

Cancer: Minorities and Cancer Risk

Despite improvements in health care, differences in care still exist in minority populations, particularly when it comes to cancer. Treatments and outcomes can sometimes vary. There are higher rates of cancer in certain minority groups. While gaps are sometimes linked to genetic factors, they are often caused by cultural barriers that prevent some groups from getting or finishing treatment.

Cone Health is committed to equal care for all patients. We have taken part in research studies that look at patient groups and their treatment outcomes based on race and ethnicity. As a result, we have taken steps to help make sure patients get and finish treatment. For example, Cone Health worked with the Greensboro Health Disparities Collaborative on a study to increase overall treatment and eliminate differences for black patients and white patients with early lung cancer. Using data from the study, Cone Health formed a plan that includes:

• An automated real-time warning system for missed appointments and unmet milestones in expected care.
• A nurse navigator trained in race-specific barriers.
• Quarterly staff trainings around equal care.

A system-based plan tested in 5 cancer centers reduced racial gaps and improved care for all.

Health care networks and the community must work together to match patients with the correct services; then changes can be made system-wide to create equal care. Staff, providers and clinicians must go through cultural training. Cone Health’s quality department works nonstop to collect data that is used to improve patient outcomes.

Martin Portillo, MD, is president of Cone Health Medical Group and senior vice president of Ambulatory Services. He earned his medical degree at Rutgers Medical School in Camden, New Jersey. His residency was at Stamford Hospital in Stamford, Connecticut. Dr. Portillo is a fellow in the American College of Physicians and a member of the American College of Healthcare Executives.

Cancer: Importance of Screenings and Early Detection

Preventative screenings play a vital role in maintaining overall wellness, especially for women. Starting at age 21, women should begin getting regular Pap smears to screen for cervical cancer. They should get a Pap smear every 3 years between the ages of 21 and 30.

If they are 30 or older, and their Pap test is normal and HPV test is negative, they can wait 5 years before being tested again for cervical cancer.

If they have a hysterectomy where the cervix is removed, they don’t need a Pap smear unless it was removed because of uterine or cervical cancer. In that case, they need a Pap smear every year for 20 years. It is important for women to discuss their personal and family health history with their doctor, as this may factor into how frequent the screenings should be completed.

While it is recommended that women begin going for yearly mammograms at age 40 to screen for breast cancer, women in their 30s should begin looking for changes in their breasts. Those include change in breast size, shape and color, an inverted nipple, and bloody or clear spontaneous discharge. Women should listen to their bodies; sometimes you can see a lump better than you can feel it. If you can feel pain in a specific place with 2 fingers or less (not the entire breast), you should also talk to your doctor. Women should also pay attention to changes in their armpit area as well.

Skin cancer is the most common form of cancer in the world, and it can become very serious and difficult to treat if not detected early. Therefore, it is important for men and women to regularly examine their skin and recognize which spots are not concerning versus which ones are concerning. While there is no specific age that is recommended for skin cancer screenings to begin, they are recommended once a year. If you are concerned about a spot or growth on your skin, it is important to schedule an appointment with your primary care provider or a dermatologist as soon as possible to be professionally examined. Like all cancer, the sooner it’s detected, the better the treatment outcomes.

Low-dose CT lung cancer screening is the only proven, research-supported method of detecting lung cancer at an early and treatable stage, which is why Cone Health has developed a lung cancer screening program for patients in the community. Since the screening program has been available, Cone Health has found more cases of stage I lung cancer than ever before, even in patients without symptoms. Individuals who are eligible for the program must:

• Be between the ages of 55 and 77.
• Smoke or have quit smoking within the last 15 years.
• Have a 30-pack-a-year history of smoking (1 pack a day for 30 years or 2 packs a day for 15 years).

Christine Brannock, BSN, RN, OCN, is the oncology outreach manager at Cone Health Cancer Center. Brannock earned a Bachelor of Science in public health education from the University of North Carolina at Greensboro in 2001, an associate degree in nursing at Guilford Technical Community College in 2004, Bachelor of Science in nursing from East Carolina University in May 2016, and is an Oncology Certified Nurse. She has been an employee at Cone Health for nearly 20 years.