Remembering Eddie Van Halen and Head & Neck Cancer

What is on the record

Eddie Van Halen died on October 6, 2020, at age 65. His son Wolfgang announced it: "I can't believe I'm having to write this, but my father, Edward Lodewijk Van Halen, has lost his long and arduous battle with cancer this morning." NPR's obituary noted that Van Halen had a bout with tongue cancer in the early 2000s. Coverage of his death, including CNBC's, described a long fight with throat cancer.

That is the extent of what he and his family made public. Nothing else about his care belongs to the rest of us. What does belong to everyone is the medicine, and it is worth knowing.

"Throat cancer" is a headline, not a diagnosis

Doctors do not treat "throat cancer." They treat a specific tumor in a specific place, and the place changes almost everything.

The National Cancer Institute groups these tumors as head and neck cancers. The family covers the oral cavity, the throat (pharynx), the voice box (larynx), the paranasal sinuses and nasal cavity, and the salivary glands. Most are squamous cell carcinomas, meaning they start in the flat, tile-like cells that line these surfaces.

The oral cavity alone is not one place. NCI's clinician guidance divides it into the lip, the front two-thirds of the tongue, the inner cheek lining, the floor of the mouth, the upper and lower gums, the retromolar trigone behind the last molars, and the hard palate. A tumor on the front of the tongue is an oral cavity cancer. A tumor at the base of the tongue is an oropharyngeal cancer. Different subsite, different behavior, different plan.

Two causes, moving in opposite directions

NCI names tobacco and alcohol as the two most important risk factors for head and neck cancers, and says most squamous cell cancers of the mouth and voice box are caused by them. Using both together is worse than either alone.

Then there is human papillomavirus, or HPV. NCI reports that about three-quarters of all oropharyngeal cancers are caused by long-term HPV infection. The trend lines split. HPV-driven oropharyngeal cancer is rising in the United States, while oropharyngeal cancer from other causes is falling. NCI notes that the Gardasil 9 vaccine is approved to prevent oropharyngeal and other head and neck cancers in people aged 9 through 45.

Betel quid, chewed in parts of South and Southeast Asia, is strongly linked to mouth cancers. Epstein-Barr virus is linked to nasopharyngeal and salivary gland cancers.

When to get checked

These cancers grow where you can often see or feel them. That is the advantage. Here are the specific signals, with time limits attached.

• A mouth ulcer that has lasted more than three weeks. Three weeks is the standard threshold used by the NHS, and it is the single most useful number on this page.
• A red or white patch inside your mouth that will not go away.
• A lump inside the mouth, on the lip, in the neck, or in the throat. A painless neck lump still counts.
• Pain in the mouth that is not settling, or pain when swallowing.
• Hoarseness or a croaky voice that does not go away. NCI lists a voice change as a warning sign for laryngeal cancer.
• A sore throat or cough that does not go away, or ear pain on one side with no ear infection.
• Losing weight without trying, or dentures that suddenly stop fitting.

A dentist can start this. Dentists look at soft tissue at every visit, and they are often the first to spot a patch that a patient has not noticed.

Getting a real answer

The workup is physical first. A clinician examines the mouth, throat, and neck by hand and by sight. A scope passed through the nose or mouth lets them see the larynx and pharynx directly.

Nothing is settled until a biopsy is done. Tissue is taken, usually during a laryngoscopy or endoscopy. Imaging then maps the extent: CT, MRI, PET, PET-CT, and sometimes a barium swallow or a bone scan.

Staging uses the TNM system, now in its eighth edition. T describes the tumor, N the lymph nodes, M distant spread. For oral cavity tumors, NCI's clinician guidance highlights depth of invasion, meaning how far down into tissue the tumor has grown. A positive surgical margin, or a depth greater than 5 mm, significantly raises the risk that the cancer comes back locally. Extranodal extension, where cancer has broken out through the wall of a lymph node, is a significant adverse prognostic factor and is now built into the staging system.

What treatment asks of a person

For stage I and II lip and oral cavity cancer, NCI says surgery and radiation therapy produce similar cure rates, and how high those rates run depends on the exact site. NCI puts cure rates for early cancers of the lip at 90% to 100%, and for early lesions of the front of the tongue at 70% to 85%. The choice often comes down to which one causes less lasting harm to speech, chewing, and swallowing for that particular tumor.

Stage III and IV disease usually needs both surgery and radiation. Lymph nodes in the neck may be removed in a neck dissection. When a tumor cannot be removed, NCI reports that concurrent chemotherapy and radiation gave an 8% absolute survival advantage over radiation alone.

One detail deserves emphasis. NCI notes that smoking during radiation therapy reduces how well the radiation works. Quitting is not a moral point here. It is part of the treatment.

Speech-language pathologists, dietitians, and dentists are part of serious head and neck care, not extras. Swallowing therapy started before treatment tends to work better than swallowing therapy started after a problem appears.

The survival picture, for a group

These figures describe large populations, not any one person. SEER, the federal cancer statistics program, hosts an American Cancer Society projection of 60,480 new oral cavity and pharynx cancers in the United States in 2026, about 2.9% of all new cancers, and 13,150 deaths. Five-year relative survival across all stages was 69.9% for people diagnosed from 2016 to 2022. The median age at diagnosis is 65.

Stage matters enormously. Within that 2016 to 2022 group, SEER records five-year relative survival of 88.7% when the cancer is still localized, 69.7% once it has reached regional nodes, and 36.0% once it is distant. Only about 26% are caught while localized. More than half are found at the regional stage.

That gap between 88.7% and 36.0% is the whole argument for the three-week rule.

Sources

• NCI: Head and Neck Cancers
• NCI: Lip and Oral Cavity Cancer Treatment (PDQ) — Health Professional Version
• NCI: Laryngeal Cancer Treatment (PDQ) — Patient Version
• SEER Cancer Stat Facts: Oral Cavity and Pharynx Cancer
• NHS: Symptoms of mouth cancer
• NPR: Eddie Van Halen, Guitar Hero, Dies At 65
• CNBC: Rock legend Eddie Van Halen has died after long battle with throat cancer