Oropharyngeal Cancer and HPV

Jennifer Bruening, MD, surgical oncologist, talks about oropharyngeal cancer. 

Oropharyngeal cancer is a type of throat cancer that affects the back of the mouth. It can include your tonsils or your soft palate, the back side of your tongue or the very back of your throat behind your tonsils.

Jennifer Bruening, MD, surgical oncologist, talks about the leading causes of oropharyngeal cancer. 

The most common type of cancer that occurs in the oropharynx is squamous cell carcinoma. Historically, the leading cause of oropharyngeal cancer was tobacco and alcohol use.

Today, however, the leading cause is human papilloma virus (HPV). HPV causes other cancers, such as cervical cancer. Other types of cancers that can occur in this area include lymphoma, salivary gland cancers and other rare cancers, like sarcomas.

Jennifer Bruening, MD, surgical oncologist, explains oropharyngeal cancer can develop and become noticeable within months and lists early-stage and more advanced symptoms including pain and problems with swallowing and breathing. 

It can take months for an oropharyngeal cancer to develop and become noticed and diagnosed. Early stage cancers usually present with a neck mass, but can sometimes have throat pain or ear pain or unexplained weight loss.

With larger, more advanced tumors, patients usually have sore throat and can have difficulty swallowing or breathing.

Jennifer Bruening, MD, surgical oncologist, explains oropharyngeal cancers treatment outcomes. 

Oropharyngeal cancer is curable. HPV-related oropharyngeal cancers have a much better prognosis and the five-year survival rate is upward of 85%. HPV-negative tumors do not respond as well to treatment and can have much poorer outcomes with a survival rate of around 30% for very advanced tumors.

Jennifer Bruening, MD, surgical oncologist, describes  various oropharyngeal cancer treatments, including surgery, radiation, chemotherapy and immunotherapy. Early-stage tumors can be removed with minimally invasive techniques, while advanced tumors require more extensive treatment. 

Oropharyngeal cancer treatment can include surgery, radiation, chemotherapy or immunotherapy (the newest technique). Early-stage oropharyngeal cancers can be treated with surgery or radiation alone.

More advanced cancers usually require a combination of treatments, including surgery plus radiation or radiation plus chemotherapy. In very advanced tumors, some patients need all three — surgery, radiation and chemotherapy.

Surgery usually involves removing the cancer from the throat. Early-stage tumors can be removed with minimally invasive techniques, such as using endoscopes, microscopes or a special robot in a technique called transoral robotic surgery (TORS).

More advanced tumors might require us to remove the tumor through the neck and often require us to remove the lymph nodes of the neck as well. The lymph nodes are the first location these tumors tend to spread to. That procedure is called a neck dissection or lymph node dissection.

Jennifer Bruening, MD, surgical oncologist, explains the different survival rates for HPV-related and HPV-negative oropharyngeal cancers.

The survival rate for oropharyngeal cancer depends on the type of cancer. If it is one of the HPV-related cancers, these patients tend to do very well, and survival can be above 85% at five years.

In HPV-negative cancers, these patients do not respond as well to treatment. Very advanced tumors can have survival at five years around 30%.

Survival statistics are based on a large number of patients to obtain an average survival compared to the normal population. Keep in mind that each patient is different and can exceed or go below the predicted survival outcome.

Stuart Wong, MD, medical oncologist, explains human papillomavirus (HPV): what it is, who has been exposed and how the virus is spread. 

Human papillomavirus (HPV) is a virus that is actually omnipresent. It is estimated that 80% of the U.S. population has been exposed to the virus and has evidence of exposure in the blood. There are documented occurrences where the virus can be spread through household contact, although we typically associate the virus being related to causing cancer in relationship to sexual transmission.

Stuart Wong, MD, medical oncologist, explains human papillomavirus (HPV) associated cancers that may result from the virus. 

HPV is associated with a number of different cancers, including cervical cancer anal canal cancer — in addition to HPV-associated cancer in the throat. The HPV vaccine is exceedingly effective in preventing HPV-associated cancers, although this is dependent on making sure one takes the full set of vaccination, which would be two doses for young teens or the the full three-set for older teens and adults.

Stuart Wong, MD, medical oncologist, describes the symptoms that are commonly associated with human papillomavirus (HPV) cancers.  

The most common symptoms of HPV-associated cancers are pain in the throat or swelling in the neck. The most important aspect is the persistence of those symptoms.

It is quite common for patients to have a sore throat or swollen glands. These are commonly associated with head colds. If you have these symptoms, and they persist or come and go, that is a sign that you should see your primary care physician.

HPV-associated cancers are frequently hidden, so you may not see anything in your mouth or your throat. They are often associated with swelling in the neck that one might notice when you are shaving, and you actually might feel a lump in your neck. In the mouth or throat, sometimes you may see a swelling in your tonsils or a swollen area in your tongue. It's the hidden symptoms that are probably most common, rather than what you would see in the mirror.

Stuart Wong, MD, medical oncologist, explains human papillomavirus (HPV) as a virus and that cancers related to it often happen later in life. 

There is evidence that HPV-associated cancers happen in what we call a bimodal distribution — an earlier stage in the 50s and then another peak in the 70s. This may be associated with a rise in incidence of the infection happening early in the life and then in midlife.

Stuart Wong, MD, medical oncologist, explains that HPV-related cancers require a team of head and neck cancer specialists for the most effective treatment and control of related side effects and symptoms. 

The treatment for HPV-associated cancers typically is what we call multi-modality therapy. There are some instances where the cancer could be cured with just a single modality — such as surgery or radiation. For the most part, though, these are cancers that require a team of specialists. Here at the Froedtert & MCW health network, we are committed to providing multi-disciplinary care — which is not just the cancer treatment, but treatment for the related side effects and symptoms

Stuart Wong, MD, medical oncologist, explains the treatment of cancers associated with human papillomavirus (HPV).

HPV-associated cancers typically wax and wane, so that they can have more symptoms, then calm down and then get worse. Frequently, a primary care physician might try a course of antibiotics, and this may temporarily improve symptoms, but the cancer itself will never go away. In order to make the cancer go away, you need definitive treatment with a cancer specialist.

Stuart Wong, MD, medical oncologist, explains why human papillomavirus (HPV) associated cancers have a high cure rate.

HPV-associated cancers have a high curability rate because these cancers have a very specific cause associated with the virus. That means that they are frequently easy to kill off, but this requires a team approach.

We have surgeons and radiation oncologists and medical oncologists who all team together to treat these cancers. Fortunately, if these cancers are diagnosed early, the likelihood of cure is quite good. And even for those patients with very advanced cancers or where the cancer has spread or come back elsewhere in the body, these cancers typically have a more favorable prognosis — especially with the newer therapies that we have.

Stuart Wong, MD, medical oncologist, talks about Gardasil^®, the vaccine used to prevent the human papillomavirus (HPV).

The Gardasil vaccine has been shown to be very effective, as well as safe. It has approval by the FDA for children starting as young as nine and has minimal side effects. There may be typical side effects of swelling or redness at the injection site, but very few — if any — serious side effects.

Stuart Wong, MD, medical oncologist, explains when to get vaccinated for human papillomavirus (HPV).

Once a patient is exposed to the HPV virus, vaccination has not been shown to be effective. The best use of vaccination is for young individuals before they have a chance for exposure to the HPV virus.