by Dr. Susan Anderson
OPEN UP AND SAY Ahhhhhhh!
April is Oral, Head and Neck Cancer Awareness month.
What Is Head and Neck Cancer?
As its name implies, head and neck cancer includes cancer of the: Lip, tongue, gums and oral cavity, salivary glands, tonsils, throat (pharynx), voice box (larynx), lymph nodes in the neck, nasal cavity, sinuses and ear.
Worldwide, head and neck cancer accounts for more than 550,000 cases and 380,000 deaths annually. In the United States, head and neck cancer accounts for 3 percent of all cancers, with approximately 63,000 Americans developing head and neck cancer annually and 13,000 dying from the disease.
The Changing Face of Head and Neck Cancer?
Classically, head and neck cancer was found in older patients (typically men in their 60’s and 70’s) who had a significant history of tobacco use. Alcohol and tobacco use are the two most important risk factors for head and neck cancers, especially cancers of the hypopharynx(tissues near the voice box), and larynx. Those who use both tobacco and alcohol are at greater risk of developing these cancers than people who use either tobacco or alcohol alone.
In the past 10 years there has been a marked shift in the profile of patients being diagnosed with head and neck cancer and the location of the cancer within the head and neck. Patients are younger (35-55 years old) and cancers involve the oropharynx (most commonly the tonsil or base of tongue). Over the past decade, there has with a steady increase of oropharyngeal squamous cell carcinoma (OPSCC) and a decline in cancers of the larynx and hypopharynx. This change has been observed in parallel with a decrease in cigarette smoking and the identification of exposure to certain strains of human papillomavirus (HPV) as a risk factor for development of OPSCC.
What is Human Papilloma Virus (HPV)?
The human papillomaviruses or HPVs are a group of more than 150 related viruses. The most common types are found on the skin and appear as warts seen on the hand. More than 40 of these viruses can be easily spread through direct skin-to-skin contact during sex. HPV can also infect the genital areas of males and females. There are at least 40 HPV types that can affect the genital areas. Some of these are low-risk and cause genital warts while high-risk types can cause cervical or other types of genital cancer. The high-risk HPV types may also cause head and neck cancer.
More than half of all sexually active people contract one or more types of this virus at one time, making it the most common sexually transmitted disease in the U.S. In fact, oral, head and neck cancers associated with HPV are on pace to overtake the incidence of cervical cancer by the year 2020. The risk of getting HPV-related cancer goes up with the number of sexual partners a person has, the risk is lower when there are less than five. Having more than 20 sexual partners, increases your risk to around 30 percent of having a type of HPV that causes cancer. More men than women – a ratio of 3 to 1 – tend to get HPV-related head and neck cancer. There are two main kinds of HPV –types 16 and 18 – that cause cancer; type 16 is the main cause of head and neck cancer.
Signs and Symptoms of Head and Neck Cancer
- A lump in the neck
- Lump or sore in mouth or throat
- Hoarseness or change in voice
- Swallowing problems or pain
- An earache that doesn’t go away
- Bleeding: nose, mouth or throat Who is at risk for HPV infection and head and neck cancer?
- HPV is a sexually transmitted infection and the number of lifetime sexual partners is an important risk factor for the development of HPV-associated head and neck squamous cell carcinoma. Research has shown that:
- The odds of HPV-positive head and neck cancer doubled in individuals who reported between one and five lifetime oral sexual partners.
- The risk increased five-fold in those patients with six or more oral sexual partners compared with those who have not had oral sex. It is important to know that HPV-positive head and neck squamous cell carcinoma has also been reported in individuals who report few or no sexual partners. Other traditional risk factors include history of tobacco or alcohol use, history of oral lesions, family history of thyroid cancer, and history of radiation therapy.
What is the long-term prognosis for head and neck cancer?
While the prevalence of head and neck cancer derived from HPV is steadily increasing, data suggest that it responds well to treatment. Patients with HPV-induced oropharyngeal cancer have a disease-free survival rate of 85-90 percent over five years. This is in contrast to the traditional patient population of excessive smokers and drinkers with advanced disease who have a five- year survival rate of approximately 25- 40 percent.
Are there ways to prevent HPV associated Cancer of the Head and Neck?
Consistent and correct use of condoms can reduce the transmission of HPVs between sexual partners, but because there are areas not covered by a condom, infection may still occur. It is recommended that girls and women between 9 and 26, and boys and men between 9 and 21 years of age should be vaccinated for HPV. Currently, there are vaccines approved for the prevention of HPV such as Gardasil®9. The vaccines are safe and highly effective in preventing infections with HPV types 16 and 18. These vaccines are one of the best ways parents can prevent cancer in their children. With use of vaccinations the incidence of HPV associated head and neck cancer is likely to decline for future generations.
Head and Neck Cancer alliance (www.headand neck.org)
Mayo Clin Proc. n March 2016;91(3):386-396 n http://dx.doi.org/10.1016/j.mayocp.2015.12.017
www.mayoclinicproceedings.org n ª 2016 Mayo Foundation for Medical Education and Research