Treatment

Head and Neck Cancer Is on the Rise

Chew on this: This year alone, more than 64,000 new cases of head and neck, or oropharyngeal, cancer will be diagnosed in the United States, resulting in more than 13,000 deaths.
Head and neck cancer, which can occur in any of the structures of the head and neck—the voice box, tongue, salivary glands—“is an under recognized and certainly misunderstood cancer,” said Michael Gibson, M.D., medical director of the head and neck team at the University Hospitals Seidman Cancer Center in Cleveland, Ohio. “It’s common, and it warrants our attention.”
But this cancer doesn’t benefit from the splashy headlines, and awareness is low. That means far too few people know the two major risk factors are alcohol and tobacco. Or that most recently, HPV has been linked to oropharyngeal cancer cases. In fact, the fastest-growing segment of oral cancer patients is young, healthy, nonsmoking individuals, many of them men.
“What people don’t realize is that we’re experiencing an HPV epidemic in men,” said Lois Ramondetta, M.D., a professor in the department of gynecologic oncology and reproductive medicine at the University of Texas MD Anderson Cancer Center. “At MD Anderson, we see more cancers related to oropharynx than cervical cancer.”
“There is no good screening test at this point for oropharyngeal cancer,” she continued. “Like the Pap smear, where you can sample the small amount of cells, you can’t do the same with oropharynx. It’s too far back. These cancers start in the base of the tonsils, which are too hidden. There’s no known pre-invasive state, no effective screening test.”
And, equally troubling, no real symptoms. “A lot of the symptoms can be caused by non-cancer things,” said Dr. Gibson. “[When there are symptoms], they tend to be related to site: voice box: hoarseness, tongue: may be painful or difficulty with chewing or speaking.”
Or men may notice a lump in their neck while shaving, but by then the cancer has already spread to the lymph nodes.
That’s the bad news.
The good news comes on the treatment front. “Opdivo, an immunotherapy, has been approved by the FDA,” said Dr. Gibson. The side effects from it aren’t that common, he said, and can be treated if they arise. In addition, a number of therapies are being studied in clinical trials, some of which Dr. Gibson expects to develop into proven therapies.
“Oropharyngeal is one of the most curable of the cancer subsets,” he said. “Therapies are improving, as well as survival, so there’s a tremendous amount of hope.”

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