HPV: A dramatic change in the profile of head and neck cancer patients
Head and neck cancer is the sixth most common cancer with more than 500,000 cases annually worldwide.
In addition to the main risk factors, smoking and alcohol, oropharyngeal cancer has shown an increased association with the human papillomavirus (HPV) in recent years. While the oncogenic role of HPV infection in cervical cancer has been known since the mid-1970s, the carcinogenic effect of these viruses in the head and neck region has only been the subject of careful study since the late 2000s.
Related studies demonstrate that this new form of cancer constitutes a completely separate entity in terms of clinical presentation, biological behavior characteristics, response to treatment and patient prognosis.
Younger patients without a history of smoking or a particular relationship with alcohol consumption resort in most of these cases to the ENT doctor due to a cystic swelling in the neck or due to mild pain when swallowing that persists despite the use of common analgesics.
The common otolaryngological examination demonstrates the oncological problem and paves the way for further diagnostic tests (endoscopy of the upper digestive and respiratory system with biopsy, cervical ultrasound, cervical and chest CT scan), which clearly define the nature and extent of the disease.
It is noteworthy that in several cases, the primary tumor in the oropharynx is extremely small in size so as not to cause symptoms, giving primacy of the clinical picture to large, usually cystic nature, metastases in the cervix!
The good news: As the cancer is usually diagnosed at an early stage and the patients are younger and in good general condition, oncologically adequate surgical treatment (interoral resection of the tumor in the pharynx in combination with removal of the cervical lymph nodes) as monotherapy or in combination with radiotherapy (chemo)therapy promises very high cure rates and a remarkable post-therapeutic quality of life for patients. In more advanced stages, adequate-dose radiotherapy (chemo)therapy guarantees an excellent prognosis of the disease.
The oncologically adequate treatment of these cases requires medical experience and the infrastructure of a well-organized and equipped Center, such as the Inter-Balkan Medical Center of Thessaloniki. The favorable biological behavior of this disease creates favorable ground for new therapeutic protocols of targeted therapy as well as de-escalation of treatment in the future.
However, since, according to Hippocrates, prevention is better than cure, it is worth mentioning the possibility of minimizing the risk of contracting this disease through preventive vaccination with the multivalent vaccine against 9 subtypes of the HPV viruses. The mass implementation of vaccination of girls and boys from the age of 9 and in any case of adolescents before the start of sexual life, creates reasonable hopes for reducing the frequency of this disease as well as other HPV-related cancers in the future!
