Remembering John Prine, a Two-Time Cancer Survivor

Twice, and then something else

The Current reported that John Prine was diagnosed with squamous cell cancer in his neck in 1998, and that it was removed surgically. In 2013 he was diagnosed with lung cancer, which was also removed by surgery.

His recovery from the second operation came with an unusually specific prescription. His physical therapist told him to run up and down the stairs in his house, then pick up his guitar and sing two songs while still out of breath. He was touring again within six months.

He died on April 7, 2020, at the age of 73, at Vanderbilt University Medical Center in Nashville, from complications related to COVID-19. Not from cancer.

Those are the reported facts. Anything else about his care was private, and this article does not fill the gap with guesses.

What "head and neck cancer" covers

The term sounds vague and is in fact quite precise. NCI states that these cancers usually begin in the squamous cells that line the moist surfaces inside the head and neck.

They form in five areas: the oral cavity, the pharynx or throat, the larynx or voice box, the paranasal sinuses and nasal cavity, and the salivary glands. The pharynx itself is divided into three parts, the nasopharynx behind the nose, the oropharynx behind the mouth, and the hypopharynx above the food pipe.

The larynx has three regions of its own. The supraglottis sits above the vocal cords and includes the epiglottis. The glottis is the vocal cords themselves. The subglottis begins about a centimeter below the cords. The 2025 counts come from the American Cancer Society, quoted in NCI's PDQ summary: 13,020 new laryngeal cancers and 3,910 deaths in the United States.

Risk factors, stated plainly

NCI does not hedge on the first two. "Alcohol and tobacco use, including secondhand smoke and smokeless tobacco, are the two most important risk factors for head and neck cancers."

The third factor is viral and applies to one region. Human papillomavirus, chiefly type 16, causes cancers of the oropharynx, meaning the tonsils and the base of the tongue. NCI reports that about three-quarters of oropharyngeal cancers are caused by chronic HPV infection, and that the vaccine Gardasil 9 has FDA approval for preventing them.

The signs, by location

Where the tumor sits determines what a person notices first.

NCI reports that early cancers of the vocal cords are usually found because of hoarseness, which is the reason a persistent change in the voice is taken seriously.

Cancers above the vocal cords behave differently. NCI lists sore throat, painful swallowing, ear pain that is referred from the throat, a change in voice quality, or enlarged neck nodes. That last one is common. The supraglottic area drains richly into the lymphatic system, and NCI reports that 25 to 50 percent of patients have involved lymph nodes at presentation.

In the mouth, NCI describes white or red patches, growths in the jaw that make dentures fit poorly, and unusual bleeding or pain.

When to get checked

Ask for an examination if:

• Hoarseness or any change in your voice has not cleared after three weeks, and there is no cold to explain it.
• A lump in the neck has been present for three weeks or more, especially if it is painless and firm.
• Swallowing has become painful, or food feels like it catches.
• You have persistent ear pain on one side with a normal-looking ear.
• A sore in the mouth has not healed in two weeks.
• A white or red patch has been present in the mouth for two weeks or more.

Dental appointments matter here, because a dentist inspects surfaces you cannot see. There is no general population screening test for head and neck cancers, so symptoms are the way in.

Treatment, and the decision about the voice

For small laryngeal cancers with no lymph node spread, the outlook is good. NCI reports cure rates of 75 to 95 percent depending on the site, the bulk of the tumor, and how deeply it has grown.

Both surgery and radiation can cure early disease. NCI notes that radiation may be chosen specifically to preserve the voice, holding surgery in reserve if the cancer returns. Laser excision is another option for small, superficial tumors.

Advanced disease is usually treated with radiation and chemotherapy together, an approach aimed at keeping the larynx. Total laryngectomy, which removes the voice box entirely, is used for bulky tumors or when other treatment fails.

The evidence here contains an instructive wrinkle. NCI reports that concurrent cisplatin with radiation cut the risk of locoregional failure by 41 percent compared with radiation alone. Yet in the long-term results of the RTOG 91-11 trial, ten-year overall survival was 39 percent with induction chemotherapy, 32 percent with radiation alone, and 28 percent with concurrent chemoradiation, while the share of patients with an intact larynx at ten years ranged from 63.8 percent with radiation alone to 81.7 percent with concurrent chemoradiation. Better control of the tumor at its original site did not translate into longer overall survival. That distinction is easy to lose and important to keep.

Why survivors keep getting checked

Anyone treated for one of these cancers stays under surveillance for years, and NCI explains the reasoning without softening it.

If someone who has had one such cancer continues to smoke and drink alcohol, NCI states that the likelihood of curing that first cancer by any method is reduced, and the risk of a second tumor rises. It adds a further point that surprises people: because of the health problems that accompany heavy smoking and drinking, many patients in this group die of other illnesses rather than of the original cancer.

The whole lining of the mouth, throat, larynx, and lungs is exposed to the same substances, which is why a second primary cancer elsewhere in that tract is a recognized risk rather than bad luck. It is also why quitting after a diagnosis still changes the odds.

What the numbers show

For 2026 the American Cancer Society forecasts about 60,480 new cancers of the oral cavity and pharynx in the United States, with roughly 13,150 deaths, and SEER, the federal statistics program, carries that forecast. Five-year relative survival across that group was 69.9 percent for people diagnosed from 2016 to 2022.

These are population figures spanning many sites, stages, and ages. They provide context and nothing more. They describe no individual reader, and they did not describe John Prine, who survived both of his cancers.

Sources

• https://www.cancer.gov/types/head-and-neck/head-neck-fact-sheet
• https://www.cancer.gov/types/head-and-neck/hp/adult/laryngeal-treatment-pdq
• https://seer.cancer.gov/statfacts/html/oralcav.html
• https://www.cancer.org/research/cancer-facts-statistics.html
• https://www.thecurrent.org/feature/2020/04/07/singersongwriter-john-prine-has-died-at-age-73