Head and Neck Cancers: Understanding Risk Factors, Advances in Treatment and the HPV Vaccine

The classification is known as “head and neck cancers” — but these cases don’t involve the brain and spine. They do involved just about everything else above the collarbone. April is Head and Neck Cancer Awareness Month, when cancer specialists take extra time to remind the public of the top risk factors: tobacco, alcohol, sun exposure and HPV (human papillomavirus).

Geoffrey Young, M.D., Ph.D., chief of head and neck surgery at Miami Cancer Institute.

It’s also the time of year when specialists relay the importance of screenings and healthy living. That’s because head and neck cancers are preventable, said Geoffrey Young, M.D., Ph.D., chief of head and neck surgery at Miami Cancer Institute, part of Baptist Health.

Head and neck cancers are more treatable today. “There are been significant developments in surgery, radiation therapy and systemic therapy,” explains Dr. Young. “These include transoral robotic surgery, targeted proton radiation, and immunotherapy. All are changing the face of head and neck cancer with new protocols and clinical trials coming out every day.”

Head and neck cancers can involve the mucosal lining of upper aero-digestive tract, including nasal cavity/sinuses, oral cavity (tongue, palate, gums), pharynx (back of the throat) and the voicebox (larynx). Head and neck cancer specialists also treat salivary gland cancers, skin cancers and thyroid cancers.

“The treatment of head and neck cancer is very complex and multidisciplinary consultation with head and neck surgery, medical oncology, and radiation oncology is often necessary,” adds Dr. Young. 

The HPV Vaccine

Over the last few years, HPV has been making headlines because of the promising development of the HPV vaccine. An estimated 20 million people in the U.S. currently have an active HPV infection, and 80 percent of people — about one in four — will be exposed during their lifetime. HPV cancers include cancer of the cervix, vulva, vagina, penis, and anus. Additionally, HPV can infect the upper aero-digestive tract, and cause cancers of the oropharynx (back of the throat, including the base of the tongue and tonsils). These are collectively called “oropharyngeal cancer” — a subset of head and neck cancers. HPV is thought to cause 70 percent of oropharyngeal cancers in the United States.

At Miami Cancer Institute, approximately 80 percent of oropharyngeal (back of the throat, including the base of the tongue and tonsils) cancers we diagnose are caused by HPV. These cases have been increasing at epidemic levels over the past years and cause as many deaths each year as measles caused in the pre-vaccine era.

“Although we see increased risk with alcohol, tobacco and HPV exposure, everyone is at risk for head and neck cancer,” emphasizes Dr. Young. “The best way to prevent head and neck cancer is not using tobacco products, limiting alcohol consumption, limiting sun exposure and getting vaccinated for HPV.”

The HPV vaccine is expected to prevent oropharyngeal cancers (back of the throat, including the base of the tongue and tonsils). But it has not been officially proven yet. Explains Dr. Young: “That’s because all the people that have been vaccinated – would not be likely to develop cancers for 30 or 40 years. So, in theory, it may be decades before it is proven. However, we don’t see as much of the HPV viruses that cause cancer circulating among the people who’ve gotten the vaccine and I strongly recommend the vaccine to anyone who is eligible. As far as other preventive measures, quit smoking now — and reduce alcohol consumption.”

Potential Signs or Symptoms

A mass or lump in the throat or the neck, difficulty swallowing, voice changes, blood in saliva, and pain in the ears are among the symptoms that may require testing by multidisciplinary exerts in head and neck cancers, said Dr. Young.

A concerning trend has been the increase of HPV-related throat cancers that tend to occur in men, ages between 40 and 70. The majority of those patients will present with metastatic disease, but remain curable.

“They’ll present with a lump in their neck because they don’t sense the primary tumor in the back of their throat,” said Dr. Young. “We’ve seen more and more of that over the past decade. That’s been observed in multiple institutions and multiple publications. Most patients are screened for head and neck cancers in the oral cavity by their dentist. They will look in the mouth and move around the tongue.

“Once a year, your primary care provider will usually look in the back of the throat during your physical. At this time, there is no standard screening test for head and neck like we have for breast cancer, prostate cancer and cervical cancer.”