Actor Stanley Tucci is known for his roles in such films as ‘The Devil Wears Prada’, ‘The Hunger Games’, ‘The Lovely Bones’, ‘Spotlight’ and ‘Julie and Julia’. But now he is becoming known for another role: cancer survivor.
In an interview in the September issue of Virgin Atlantic’s 2021 inflight magazine Vera, 60-year-old Tucci revealed that he had been diagnosed with cancer at the base of his tongue 3 years ago. “It was too big to operate, so they had to do a high dose of radiation and chemo,” he explained.
Tucci was very reluctant to undergo this treatment, having seen the effects of this regimen on his first wife, Kate, who died of breast cancer in 2009. “I swore never to do anything like that because my first wife died of cancer, and to watch her go through those treatments for years was horrible,” he said.
He was equally concerned about the effects of his illness on his five children. “The kids were great, but it was hard for them,” he noted. “I had a feeding tube for six months. I could barely make it through the twins’ high school.”
Now Tucci said he is confident the cancer is unlikely to return:[Cancer] makes you more scared and less scared at the same time. I feel much older than before I got sick. But you still want to move forward and get things done.”
And that is exactly what he has been doing for the past 2 years. He has launched a new CNN series, “Stanley Tucci: Searching for Italy,” and has written a book, Taste: My Life Through Food, due out in October.
Cancers of the head and neck can form in the oral cavity (including the lips, the anterior two-thirds of the tongue, the gums, the insides of 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), the pharynx, the larynx, the paranasal sinuses and nasal cavity, and the salivary glands.
It should be noted that the anterior two-thirds of the tongue is considered part of the oral cavity, while the base of the tongue is part of the oropharynx. The tongue begins to develop around the fourth week of intrauterine life. The anterior portion of the tongue is derived from the first pharyngeal arch while the base of the tongue is derived from the mesoderm of the second, third, and fourth pharyngeal arches. This difference in origin makes the characteristics of these two cancers very different, which is why the treatment is very different for each type.
According to the Surveillance, Epidemiology, and End Results (SEER) Program, the estimated number of new cases of all tongue cancers in 2021 was 17,960 (0.9% of all new cancers), with an estimated 2,870 deaths. The 5-year relative survival is 68.1% for all stages. For patients with localized disease, the 5-year survival rate is 82.9%.
Cancers at the base of the tongue can grow in an infiltrative or exophytic pattern. Because the base of the tongue lacks pain fibers, these tumors are often asymptomatic until significant progression.
Signs and symptoms may include the following:
Pain Dysphagia Weight loss Referred otalgia secondary to cranial nerve involvement Trismus secondary to pterygoid muscle involvement Fixation of the tongue caused by deep muscle infiltrationA mass in the neck
Lymph node metastases are common. Approximately 70% of patients with advanced tongue base cancer have ipsilateral cervical lymph node metastases, while ≤30% have bilateral cervical lymph node metastases.
The most common risk factors for oropharyngeal squamous cell carcinomas (SCCs) include:
Smoking history of more than 10 pack years and other tobacco use Heavy alcohol use Human papillomavirus (HPV) infection, especially HPV 16 Personal history of head and neck cancer
As cigarette smoking declines in the US, smoking-related oropharyngeal cancer is declining; however, oropharyngeal cancer due to HPV infection is on the rise. According to the tissue repository data from the SEER program from 1988 to 2004, the prevalence of HPV-negative oropharyngeal cancers decreased by 50%, while HPV-positive cancers increased by 225%.
HPV positive oropharyngeal cancers may represent a distinct disease entity associated with an improved prognosis. Several studies have shown that patients with HPV positive tumors have significantly improved survival.
Oropharyngeal tumors are more likely to be HPV positive compared to tumor sites in the oral cavity and non-oropharyngeal sites. HPV positive oropharyngeal cancers mainly occur in the palatal or lingual tonsils.
As with any cancer, the treatment of patients with base of tongue cancer depends on a number of factors, including pathology, histology, clinical stage, age of the patient, and general medical condition. In patients with tongue cancer, immunohistochemical staining for p16 status is important.
For early stage base-of-tongue SCC, surgical resection and/or radiation therapy is often used. For advanced tumors, surgical resection can be combined with radiation and chemotherapy or with chemoradiation therapy (CRT). The typical regimen for early and advanced lesions includes 6 weeks of radiation with a platinum-based chemotherapy agent.
While effective, radiation therapy and CRT can have significant side effects and affect quality of life. Common side effects include dry mouth, mucositis, speech difficulties, dysphagia, aspiration, or respiratory distress. Patients may require a feeding tube or tracheostomy during treatment to protect their nutritional status or airways.
Studies are also being conducted to assess EGFR inhibitors, such as the monoclonal antibody cetuximab (Erbitux), for SCC of the tongue base. Research is also being done on immune checkpoint inhibitors.
It is essential that treatment approaches also include the treatment of bilateral lymph nodes, either with radiation therapy or surgical resection.
Michele R. Berman, MD, is a pediatrician turned medical journalist. She was educated at Johns Hopkins, Washington University in St. Louis and St. Louis Children’s Hospital. Its mission is both journalistic and educational: to report on common diseases that affect unusual people and summarize the evidence-based medicine behind the headlines.