When you think of throat cancer, you think of smokers, not sexually transmitted diseases. However, a growing body of evidence is pointing toward Human Papillomavirus (HPV) and its connection to throat cancer.
“We’re in the dawn of understanding oropharyngeal cancer of the back of the throat. Its link to HPV, a sexually transmitted illness, is poorly understood,” says otolaryngologist Ron J. Karni, M.D., Division Chief of Head and Neck Surgical Oncology at McGovern Medical School at UTHealth and affiliated with Memorial Hermann Cancer Center – Texas Medical Center. “What’s more newsworthy is the rising incidence of HPV-related cancer and that it can affect anyone.”
Test your knowledge of the disease by taking our True/False quiz.
TRUE OR FALSE: MORE PEOPLE ARE DIAGNOSED WITH HEAD AND NECK CANCER THAN CANCER OF THE CERVIX.
TRUE. Despite a drop in known risk factors like smoking and heavy alcohol use, oropharyngeal cancer (cancer of the back of the throat, including the base of the tongue, voice box and tonsils) has been rising in the last 15 years. “We see higher numbers each year,” Dr. Karni says.
The U.S. Centers for Disease Control and Prevention report 15,738 new cases yearly. Men are three to four times more likely to be diagnosed, typically in their 40s through 60s.
TRUE OR FALSE: SEXUAL ACTIVITY CAN CAUSE CANCER.
FALSE. “Sex-causing cancer makes a catchy headline, but it’s not true,” Dr. Karni says. “There’s very little evidence that sexual practices are somehow tied to developing cancer. You cannot give someone cancer by having sex with them. HPV is a sexually transmitted illness that most sexually active Americans have been exposed to at some point. Why some people develop cancer 20 or 30 years later is not well understood.”
While 80 percent of sexually active adults are believed to have been exposed to HPV, “far fewer will get throat cancer,” Dr. Karni says. “Most HPV infections go away on their own.”
There are no currently recommended routine screening tests for HPV-related cancer. This is in contrast to cervical cancer, where early detection of cancer cells by routine pap smear has helped to detect cancer early and improve outcomes for over a generation.
TRUE OR FALSE: BOYS CAN GET VACCINATED FOR HPV.
TRUE. Both boys and girls should get vaccinated for HPV, ideally before they become sexually active. The latest recommendation is for pediatricians to give the first vaccination at age 11 or 12, with a second dose a half year later, Dr. Karni says. Current guidelines say youths as young as nine and as old as 26 can be vaccinated.
The vaccine originally was developed to decrease cervical cancer, also a HPV-connected disease in women, but now it’s believed to be helpful for both sexes, Dr. Karni says. “How helpful?” We’ll have to wait and see what happens when this generation grows up.”
TRUE OR FALSE: ONCE VACCINATED, YOU DON’T NEED TO BE CHECKED FOR CANCER.
FALSE. If you develop a lump in the neck, often painless, this can be a first symptom of head and neck cancer, and warrants further evaluation by a physician.
TRUE OR FALSE: DON’T WAIT FOR ANNUAL FREE SCREENINGS.
TRUE. While UTHealth’s Department of Otorhinolaryngology – Head and Neck Surgery offers free annual screenings each April during Oral, Head and Neck Cancer Awareness week, you may need to be examined before then. “If you find a lump in your neck, it’s a very alarming sign, especially if you’re 35 or older. It needs to be evaluated right away,” Dr. Karni says.
By the time a lump can be felt, 80 percent of throat cancers have spread to nearby lymph nodes. The first sign of cancer often is a small spot on the tonsil or base of the tongue. Difficulty chewing or swallowing or a change in voice, or a mouth sore that doesn’t heal or increases in size, also may be signs.
TRUE OR FALSE: HPV-LINKED CANCER HAS SIMILAR OUTCOMES TO SMOKING-RELATED THROAT CANCER.
FALSE. The cure rate even for stage 3 and early stage 4 cancers is 80 percent or higher. “That’s a departure from smoking-related cancers, which are unpredictable in their response to treatment and in which overall survival is often much worse,” Dr. Karni adds.
TRUE OR FALSE: TREATMENT OF HEAD AND NECK CANCER SHOULD BE PERFORMED AT A MULTIDISCIPLINARY CENTER WHERE ALL OPTIONS ARE AVAILABLE TO THE PATIENT.
TRUE. There are many important new treatments for oropharynx cancer which can improve survival and decrease side effects. This includes transoral robotic surgery and radiation delivered at lower doses to decrease the side effects to patients. “We give patients as many options as we can and help guide each patient to the best treatment for their individual case,” Dr. Karni says. “Our No. 1 goal at Memorial Hermann is to cure patients, and our No. 2 goal is to get them back to full quality of life.”
Memorial Hermann’s Head and Neck Cancer Program includes specialists in head and neck surgery, radiation therapy, chemotherapy, cancer rehabilitation, clinical trials, and swallow and speech therapy.
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