HealthONE - April 01, 2021

Cancer of the head and neck is a relatively rare form of cancer that develops from the lining (mucosa) of the mouth, sinuses, nose, and throat. Most commonly, people affected by head and neck cancer have a significant history of alcohol and tobacco use (smoking and/or chewing tobacco) and are older— aged 60-90 years.

However, during the last several decades, there has been a well-documented increase in cases among patients who do not have a history of tobacco and alcohol use, and who are much younger— some as young as in their 30s. These patients instead have a virally induced cancer as a result of the human papillomavirus (HPV).

“HPV-induced cancers of the head neck typically develop in the oropharynx. This area includes the base of tongue (the part of the tongue you can’t see), tonsils, and soft palate,” explains Paul van der Sloot, MD, a head and neck surgeon with the Sarah Cannon Cancer Institute at Swedish Medical Center. “HPV has become the leading cause of oropharyngeal cancer in the United States, replacing alcohol and tobacco use.”

What is HPV?

Human papillomavirus (HPV) is an extremely common sexually transmitted infection (STI), encompassing more than 150 variants. HPV 16 and 18 are the strains that account for virtually all virally induced cancers including oropharyngeal cancers. Of those infected, most are asymptomatic but still may be able to transmit the virus. After infection, some people will clear the virus from their bodies. In other people, the virus remains latent within the tissues. Those patients with latent virus can develop oropharyngeal cancer, usually 15 to 30 years following initial infection.

“We have known for many years that HPV is a significant cause of cervical, penile and anal cancers,” Dr. van der Sloot details. “In more recent years, we have seen a rise in cases of HPV causing oropharyngeal cancer, possibly due to an increase in the prevalence of oral sex.”

What is Oropharyngeal Cancer?

Oropharyngeal cancer is the abnormal growth of cells found in the tissue of the oropharynx. The oropharynx is part of the throat and includes the sides and walls of the throat, the back of the tongue, the tonsils, and the soft palate (back part of the roof of your mouth). The type of cancer is called squamous cell carcinoma. It arises in the lining of the throat referred to as the mucosa.

Squamous cell carcinoma, whether virally induced or not, can occur anywhere there is mucosa in the head and neck area including the oral cavity, nasal cavity, sinuses, larynx (voice box), and esophagus. Of these sites, the oropharynx is now the most common as a result of these HPV-induced cancers. However, head and neck cancer, in general, accounts for only about four percent of all cancers in the United States.

“As with any type of cancer, survival rates increase greatly when the disease is discovered at an early stage,” Dr. van der Sloot emphasizes. “With the rising number of cases and younger populations, it’s important to educate everyone about symptoms and risk factors to help lower incidence and increase survivability.”

What are the symptoms of head and neck cancer?

Dr. van der Sloot encourages people to be on the lookout for an unusual lump in the neck or sore in the mouth that doesn’t heal as expected. Other symptoms of head and neck cancer include changes to the voice (hoarseness); swallowing problems and/or pain with swallowing; persistent earache; bleeding in the nose, mouth, or throat; or continuous congestion. “Your dentist may be the first to notice an unusual patch in your mouth, cheeks, throat,” Dr. van der Sloot explains. “Most dentists have been trained to recognize these early signs of cancer. Your provider will bring the spot to your attention and can refer you for further diagnosis and treatment—just another reason to keep up with your regular dental visits!”

How can I reduce my risk for head and neck cancer?

The two greatest risk factors for most types of head and neck cancer are tobacco and alcohol use. Tobacco use includes smoking cigarettes, cigars or pipes; and chewing tobacco (snuff). Using tobacco and alcohol together further increases your risk of developing this type of cancer. By quitting tobacco and consuming alcohol in moderation, your overall health will improve and your risk for head and neck cancer will decrease. If you need help quitting tobacco, contact the Colorado QuitLine.

HPV infection also increases your risk for head and neck cancer. To reduce your risk of becoming infected with HPV, practice safe sex and, if you are eligible, get the HPV vaccine. The Centers for Disease Control (CDC) recommends the HPV vaccine at age 11, or up to age 26. For those older than 26, the benefits of the vaccine decrease as the likelihood of already having contracted HPV is high. However, even some patients age 27-45 may benefit from the vaccine. Talk to your physician about whether the vaccine is right for you or your child.

“It is important for people to know how to reduce their risk factors: quit smoking, drink alcohol in moderation, practice safe sex, and, if you can get vaccinated,” Dr. van der Sloot encourages. “Generally, try to live a healthy life and schedule regular checkups with your dentist and primary care provider to stay aware of any early symptoms. And, of course, we are here to help if you need further testing and treatment.”

Paul van der Sloot, MD, is a head and neck oncologic and reconstructive surgeon with the Sarah Cannon Cancer Institute at Swedish Medical Center. Dr. van der Sloot believes care for patients with head and neck cancer begins at the moment of diagnosis and includes not only the physical but the psychological, social, and spiritual care of the patient. His comprehensive head and neck cancer care team approach helps the patient navigate through the transitions of care from comprehensive, efficient pre-treatment evaluation to effective cancer treatment to optimal functional and cosmetic outcomes following treatment. Dr. van der Sloot believes long-term survivorship and quality of life issues are essential parts of head and neck cancer care.