About one in every 60 men, and one in every 140 women is at risk of a HPV-related mouth and throat cancer, but that number could be on the rise if we aren't careful because of how common HPV is. Peter Vosler, MD, a head and neck cancer and microvascular surgeon with First Physician's Group discusses these rare cancers and their prevention and treatment.
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- From Sarasota Memorial and the Deb Cavanaugh Multimedia Studio, this is HealthCast, a healthy dose of information from experts you can trust.
- Hi everybody, welcome to HealthCast. I'm Allison Godder Meyer. Thank you so much for joining us today as we talk about HPV related mouth and throat cancers. Our guest today is Dr. Peter Vosler, a head and neck cancer and microvascular surgeon with First Physician's Group here in Sarasota. Dr. Vosler, thank you so much for joining us.
- Well thank you for having me.
- Dr. Vosler, how common are these HPV related mouth and throat cancer?
- Well fortunately, these are very uncommon cancers. Right now it's about a 1.7% chance for men to have it, or one in 60 men, and a 0.7% chance for a woman to have it, or one in 140 women. So it's very uncommon.
- Has there been any change in that? Have we seen them on the rise at all?
- We have seen on the rise over the past two decades. From 1988 to 2004 it increased 225%. And right now we're seeing an annual increase of 5%.
- How often are people actually exposed to HPV which could cause these cancers?
- HPV is very common in our society. Approximately, 65 to a hundred percent of people are infected with HPV, especially if you've had more than four sexual partners. The chance at that point is over 99%.
- How long after an HPV infection would it take for someone to develop one of these cancers?
- It usually takes a long time. The virus has to, one, stick into the the tonsil tissue in the back of the throat, and then it takes some time to transform. And it's usually at least 10 years, but it's probably in the order of 20 to 30 years before people who get the virus have a cancer from it.
- So it's not necessarily because of a recent sexual partner.
- It's definitely not because of a recent sexual partner. And patients will often ask that, especially if the spouses I'll say, what would, did someone go outside of the marriage or the relationship to and get this? And so no it's probably something that happened when they were in their 20s.
- Do all oral HPV infections lead to cancer?
- No. The vast majority of oral HPV infections do not lead to to cancer. There is one subtype of HPV, HPV 16, which accounts for about 90% of the cancers, and it's usually about 1% of people who have this type of virus.
- And would someone know that they have that?
- No. There are no good screening tools for this unfortunately, especially because it is such a rare cancer.
- So what should someone look for? Are there symptoms or how would someone know?
- Well, fortunately the symptoms are pretty benign. Most people develop a asymptomatic neck mass, so most men develop, figure out, find out that they have a mass when they're shaving, and then it just doesn't go away. And so that's usually the initial symptom. Now if they have let it grow for a little while then they can have symptoms from the tumor in the back of the throat, either difficulty swallowing pain with swallowing, or ear pain.
- So where do most of these HPV related cancers present in the mouth or throat? They mainly present in the back of the throat, in the tonsils, the base of tongue, and the soft palette
- Who is at greatest risk?
- So men in their 40s to 60s usually non-smoker and high socioeconomic status, and people who've had more than four sexual partners
- That's not normally who you would think of as at high highest risk of a certain type of cancer.
- No, especially not head and neck cancer. Most head and neck cancers you associate with smoking and drinking. This is completely the opposite of what we see with the smoking drinking population.
- Interesting. How is it spread?
- So it is spread through sexual contact, usually oral sex from a man on a woman.
- And that is the HPV itself, not the cancer.
- The HPV itself. And most of the HPV that's acquired through sexual contact is cleared by the immune system. So again, it doesn't create cancer or cause cancer in most people because the body's being able to get rid of the virus.
- What does a workup look like to determine if someone does notice that mass while they're shaving, for example, what does a workup look like to determine if it is in fact cancer?
- Well, if the mass doesn't go away, sometimes primary care doctors will prescribe antibiotics. If it doesn't go away within one to two weeks, then you should be seen by a head and neck cancer surgeon. Now if you see me I will do a quick focused history of the present illness. I'll do a physical exam looking in the mouth looking the tonsils and feeling the base of tongue a flexible laryngoscopy to visualize the back of the tongue. And then you do, I will do an ultrasound in the clinic and see if there's a mass that can be biopsied, and I can do an ultrasound guided biopsy in the clinic. Now if I can find the primary tumor site, 'cause the tumors never primarily coming from the neck. It came from somewhere else. And it's usually the back of the throat, like I said, the tonsils the face of tongue, or the soft palette. If I can find it in the clinic and it's comfortable enough to be biopsied, then I'll do a biopsy right there and then. If I can't find it or it's not comfortable for the patient to biopsy, then I'll take 'em to the operating room and do a biopsy.
- Now do you know for certain if a cancer that presents in the throat or the neck is in fact HPV related?
- You don't know a hundred percent, and that's why you need the biopsy. The biopsy is to determine that it is squamous cell carcinoma which is the type of cancer that HPV causes. And to also do tests to make sure that it's caused by HPV. 'Cause that'll affect the prognosis and it'll be a factor in how we treat this.
- Is this in fact a treatable cancer if it's detected?
- It is a very treatable cancer. About 90 to 95% of patients that have this are successfully treated, and have a five year overall survival rate of 90, 95%. So very highly treatable.
- What does treatment look like for those patients, and and what specialists are involved in that treatment?
- So the treatment involves either surgery or a combination of radiotherapy or radiation therapy and chemotherapy. Now if it's a small tumor that has only one node involved then surgery is a good option. However, if it's a larger tumor and there's multiple lymph nodes that are involved then radiation and chemotherapy are probably preferable.
- Now these are some very sensitive areas of our bodies that we use every single day. So how important is it to actually see a a specialist who, who is familiar with these areas?
- That's an excellent question. I think it's incredibly important to see somebody that specializes in head and neck cancer care. So you need to have a head and neck cancer surgeon, as well as a radiation oncologist that's familiar with the anatomy, and a chemotherapy specialist or medical oncologist. So everybody who has oral pharynx cancer should be seen by head and neck surgeon, radiation oncologist, medical oncologist, and speech pathology. And at The Brian D. Jellison Cancer Institute we have all those specialties, and we meet on a weekly basis at a multidisciplinary tumor conference to go over all the patients to make sure that we have the appropriate treatment plan for everybody and make sure that we have a consensus among our specialists.
- And can you talk about how important it is to have something like The Brian D. Jellison Cancer Institute where you have all those specialists meeting regularly working together with that multidisciplinary approach for cancers like this at a community hospital?
- Well, I think that's incredibly important because it, we create an environment of collaboration among the specialists. So we all know what we're thinking, we all know what the best treatment options for the patient are. We all come to agreement on it. And the patients can see that kind of collaboration. We know that we're working together knowing they're getting the best possible care.
- And for many of those patients not having to leave to go to another cancer center far from their home is so important.
- Yeah, the convenience is very important for patients. People don't want to travel for, especially for radiation oncology treatments for six to seven weeks, five days a week. Or if they're recovering from a surgery, they wanna be close to home where they can be seen by their loved ones.
- So I wanna circle back to these HPV related cancers because a question that has often come up that I have heard about is if someone has an HPV related cancer, is their spouse or partner also going to get it?
- So it is very unlikely that the spouse or partner will get this type of cancer. We know that people who have this cancer do not transmit the cancer, and it's likely that they acquired the virus decades ago. So then they're no longer infections.
- And just because even if they were with their partner or spouse at that time, it doesn't mean their partner who may have had the same HPV will get the same cancer, correct?
- That's correct. If a partner's a woman then should undergo regular gynecological exams. And if that's the case, then they've already done proper screening. There's nothing more they need to do.
- Will the HPV vaccine help prevent these type of cancers?
- We're optimistic that the HPV vaccine will help prevent these cancers. However, it will take decades before we see that manifest. Because right now children are getting vaccinated. People up to age 45 are getting vaccinated, but it's probably gonna take another 20 or 30 years before we see a decline in the overall instance of this cancer
- Are there any other preventative measures to take?
- Unfortunately there aren't any other preventative measures. We just have to screen for, well not even screen, we have to just do physical exams on patients if they have concerning symptoms like a neck mass then to get 'em to the appropriate person to do a proper workup.
- Is there anything else you want the community to know?
- No, I think that's about it. I think it's really important that anybody with a neck mass that doesn't go away within a couple of weeks as an adult, this is cancer until proven otherwise. And need to be seen rather urgently to make sure you get the appropriate workup.
- And to put patients at ease also, how often do you see people who have concerns and it's not actually cancerous?
- Well there, so as a sub-specialist, I often have people that are screened prior to seeing me. So a lot of my patients will have concerns. But if it's a regular neck mass, it's unlikely to be cancer.
- But it's still important to get looked at?
- Yes.
- Dr. Vosler, thank you so much for joining us today. As always, we encourage everyone in our community to visit smh.com for the latest from Sarasota Memorial. Have a great day.