Head and neck cancer Q&A: HPV-linked disease has better outcomes

May 19, 2014 | by Sayeh Hirmand

Americans have heard much about head and neck cancer lately, with one form of that disease – throat cancer – being prominently linked by actor Michael Douglas to infection with human papillomavirus, or HPV. It’s true that the virus can increase risk of the disease, but in reality, the disease has many causes.

Head and neck cancer expert Ellie Maghami Ellie Maghami, chief of head and neck surgery at City of Hope, explains the risk factors and treatment options for head and neck cancer.

Head and neck cancer is a general term for a variety of cancers with different risk factors, cells of origin, behavior, treatment and prognoses. Head and neck cancers are the sixth-leading cancer by incidence worldwide, with 500,000 new cases reported a year.

Here, Ellie Maghami, M.D., associate clinical professor and chief of head and neck surgery at City of Hope, explains the various causes of head and neck cancer, the different treatments – and the fact that HPV-related cancers often have the best prognoses.

What causes head and neck cancers?

The most important risk factor related to head and neck cancer is tobacco use; adding alcohol compounds this risk significantly. Using either tobacco or alcohol alone is a major risk factor, but coupling the two greatly increases the chance of developing cancer in the head and neck, especially aerodigestive tract cancers (that is, the lips, mouth, tongue, nose, throat, vocal cords and part of the esophagus and windpipe).

Geography also plays a large role in the prevalence of head and neck cancer risk factors. For example, in India there is a huge prevalence of mouth cancer from chewing tobacco. Diverse trends in different countries can affect the occurrence of various head and neck cancers.

What are the three most common cancers that occur in the head and neck region?

In the aerodigestive tract, specifically, the most common cancers are oral cancer, oropharyngeal cancer (which starts in the back of the throat), and laryngeal cancer (which starts in the larynx).

Are cancers of the head and neck increasing or decreasing? Why?

There are some diseases that seem to be on the uprise. Papillary thyroid cancer, which is an endocrine cancer in the head and neck region, has an increased incidence worldwide, and it is not known why that is. Some of it may be due to improved early detection, but aside from that, there truly is an increase in incidence. Melanoma is on the uprise as well, and again, it is not known why but may have to do with increased UV exposure.

A disease that is a noticeable global epidemic is HPV-mediated oropharyngeal cancer. Seventy percent of oropharyngeal cancers in the United States alone are HPV-mediated. HPV oropharyngeal cancer affects younger patients, frequently men in their 40s and 50s who are nonsmokers. This is a lifestyle disease and is linked to liberal sexual practices in early adulthood.

How are cancers of the head and neck diagnosed?

The pattern of detection is different and depends on symptoms as well as the disease site. Oral cancer is often detected early because the mouth is visible and the cancer may take the form of a noticeable ulcer in the mouth that does not go away, even after being treated with antibiotics.

Left untreated, cancer can gain access to lymphatics and show up as an enlarged mass in the neck. But, as you move further down the oropharynx, tumors are not as visible, and therefore present themselves in a more advanced stage as a mass in the neck. Tumors in the larynx are asymptomatic and also stay hidden until they manifest in the way of a neck mass, except for the vocal cords. Vocal cords are very delicate, so even the smallest lesion often times leads to an audible change in voice.

How are these cancers treated?

The treatment plan for each patient is dependent upon a number of factors, including the site of the tumor, the stage of the cancer, and the person’s age and general health. For early-stage disease, surgery and radiation are options for treatment. For advanced-stage disease, combination therapy is required, as surgery alone is often not sufficient. There are also situations in which nonsurgical management is considered. Physicians have to find the best compromise between cancer outcome and the quality of life.

In HPV-mediated cancers, treatment is similar but, the outlook and prognosis is different. It is much more favorable if the tumor is HPV-mediated then if it is HPV-negative. HPV-mediated tumors tend to be more responsive to surgery, radiation and chemotherapy. Overall, chances of cure and survival are higher compared to an HPV-negative tumor in the same location and stage in a smoker who has that disease. The best chance of cure is in a nonsmoker with HPV-mediated cancer. Any exposure to tobacco still deteriorates the outlook.

Are there any new technologies available for treatment?

Technology has evolved, and there are new minimally invasive procedures that are especially geared toward oropharynx and larynx tumors, which may provide patients both excellent cancer cure and functional outcomes. The goal is to improve the cure rates, decrease treatment side effects, and maintain the ability to breathe, speak and swallow. These tools can only be administered in select qualifying patients who have a favorable anatomy and tumor. We offer these modalities to suitable patients here at City of Hope, and our experience so far has been very positive.

What should the partners of patients diagnosed with HPV-mediated cancer know?

They should know that they are not at an increased risk for throat cancer. Their risk of oral HPV infection is similar to that of the general population. Most partners are able to clear the virus they are exposed to within one to two years. Cancer risk in partners remains extremely low.

Finally, are there any questions your patients should ask, but often don’t?

What are all my treatment options? How do they compare with regard to cure rates and function preservation?

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Learn more about head and neck cancer treatment at City of Hope.

Learn more about becoming a patient or getting a second opinion by visiting our website or by calling 800-826-HOPE (4673). You may also request a new patient appointment online. City of Hope staff will explain what's required for a consult at City of Hope and help you determine, before you come in, whether or not your insurance will pay for the appointment.

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