Cancers rise with HPV, but treatments keep pace

R. Bryan Bell, M.D., D.D.S., FACS
Medical director, Providence Oral, Head and Neck Cancer Program
Providence Cancer Center

Published August 2012

Human papilloma virus has been established as a major risk factor for squamous cell carcinoma of the tonsil and base of the tongue. It’s also the reason for a striking increase in the incidence of oral, head and neck cancers in younger patients who never smoked.

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If recent trends for HPV-driven cancers continue, it is estimated that by the year 2020, the number of oropharyngeal cancers diagnosed in the United States each year will surpass cervical cancers. Even more alarming, more Americans die from oral, head and neck cancers than from melanoma, cervical cancer and ovarian cancer combined.

The silver lining in this discouraging trend is that HPV-related cancer appears to have a better prognosis than its counterparts.

According to a recently published report, the three-year survival of HPV-positive oropharyngeal patients is 84 percent, compared with a 57 percent survival for HPV-negative patients who were treated with the same standard chemoradiation therapy protocols.

Diagnosing oral, head and neck cancer

HPV-driven oropharyngeal cancer (base of tongue and tonsil) most commonly presents as firm neck mass in adults 60 or younger.

Patient may present with throat pain, difficulty swallowing or hoarseness.

Tonsil mass or enlarged pharyngeal tonsil may or may not be present.

Base-of-tongue tumors generally require nasopharyngoscopy to identify.

Neck mass in an adult is metastatic squamous cell carcinoma until proven otherwise.

This has led some researchers to consider “de-escalating” standard therapeutic protocols to improve functional outcomes and quality of life without sacrificing disease control. One less-aggressive option is transoral robotic surgery, or TORS, a minimally invasive technique that allows tumors of the oropharynx to be resected through a natural orifice.

Such resections used to require extensive operations, or they were treated with combinations of chemotherapy and radiotherapy. TORS offers the advantage of eliminating the need for radiation or chemotherapy in some patients, or possibly decreasing the dose of postoperative radiation therapy, thus minimizing the side effects of treatment. Surgeons at Providence Cancer Center were among the first on the West Coast to perform transoral robotic surgery for malignant tumors.

Other treatment options

For many patients with oral, head and neck cancer, surgery remains the primary modality of treatment. Modern reconstructive techniques, such as microvascular free tissue transfer, coupled with digital treatment planning and image guidance pioneered at Providence Cancer Center, have significantly enhanced the surgeon’s toolkit for the predictable reconstruction of ablative defects following cancer resections.

These techniques allow surgeons to remove the cancer and restore the patient’s speech, swallowing and appearance in a single operation. Specialty dentists also collaborate to replace missing bone and teeth, returning the patient to optimal oral function.

These surgical advances are coupled with novel chemotherapeutic regimens and well-established radiation therapy that uses salivary gland-sparing intensity-modulated radiation therapy, or IMRT, techniques.
 
Providence Oral, Head and Neck Cancer Program opened at Providence Cancer Center in 2009. Our goal is to improve patient care through multidisciplinary diagnosis and treatment. We use the latest technology to provide less-invasive therapy and to improve functional outcomes, and we collaborate with translational scientists to develop novel therapeutic agents and bring them to clinical trial.