Head and Neck Cancers: Latest on Prevention, HPV and Other Risk factors

So-called “head and neck cancers” don’t involve the brain and spine, but everything else “above the collarbone” is covered by this category, explains Geoffrey Young, M.D., Ph.D., chief of head and neck surgery at Baptist Health’s Miami Cancer Institute.

These types of cancers are further categorized by the area of the head or neck in which the cancer begins. April is Head and Neck Cancer Awareness Month, a time set aside by cancer specialists to highlight the top risk factors, which are tobacco, alcohol, sun exposure and HPV (human papillomavirus).

HPV has been making headlines over the last few years. That’s 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.

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

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.

“HPV currently causes as many deaths each year as measles caused in the pre-vaccine era,” says Dr. Young. “At Miami Cancer Institute, about 80 percent of oropharyngeal cancers diagnosed are caused by HPV. These cases have been increasing at epidemic levels over the past several years.”

Oropharyngeal cancers can be prevented by the HPV vaccine, although it’s total effectiveness won’t be known for decades. That’s because teens and young adults who have been vaccinated against HPV need to be studied to see if they develop cancer over their lifetimes.

“There is good evidence to suggest that the HPV vaccine will help prevent future cancers,” says Dr. Young. “We don’t see as much of the HPV viruses that cause cancer circulating among the people who’ve gotten the vaccine.”

There is no standard or routine screening test for head and neck cancers. A dentist or medical doctor may examine your oral cavity during a routine check-up. The exam will include looking for lesions — or areas of leukoplakia (an abnormal white patch of cells) and erythroplakia (an abnormal red patch of cells). Leukoplakia and erythroplakia lesions on the mucous membranes may become cancerous.

Overall, head and neck cancers include the: nasal cavity/sinuses; oral cavity (mouth, tongue, palate); oropharynx (tonsils and base of tongue); larynx (voice box), as well as the salivary glands, thyroid and skin.

Here’s more from Dr. Young on symptoms, screenings, risk factors and treatment associated with head and neck cancers:

Question: What are cancers of the head and neck?

Dr. Young: “Head and neck cancer is really anything above the collarbone except the brain and spine.  These mainly come from the mucosal lining of upper aero-digestive tract, including nasal cavity/sinuses, oral cavity (tongue, palate, gums, etc.), pharynx (back of the throat) and the voicebox (larynx).  We also treat salivary gland cancers, skin cancers and thyroid cancers.”

Question: When it comes to symptoms, some may develop hemoptysis, or the coughing up of blood or blood-stained mucus. Can this be mistaken for bleeding gums, which is common with gingivitis or gum disease?

Dr. Young: “Oral bleeding doesn’t mean you have cancer. However, if you have blood in your saliva, you may want to see a doctor or dentist. It can be hard to tell where the blood is coming from. Could it be the gums? Somebody’s flossing, and all of a sudden, they bleed and it stops — that’s obviously not something to worry about. But for somebody who wakes up and coughs in the morning, and there’s blood in their saliva, that may be a different story.”

“Head and neck cancers usually present as a mass in the neck; a lesion that can be seen inside the mouth or in the back of their throat that wasn’t there before; changes in voice; difficulty swallowing; or pain in the jaw or behind the ears.”

Question: Who is most at risk for developing head and neck cancers and how are most patients screened? 

Dr. Young: “Historically, it has been people who consume tobacco products and/or consume high amounts of alcohol. Now, we are seeing a massive epidemiological 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. 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.”

Question: Other than the HPV vaccine, are there any preventative measures that people can take against head and neck cancers?

Dr. Young: “I want to clarify that 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. 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.”

Question: The detection of thyroid cancers has increased significantly over the past two decades with the development of more precise ultrasounds. What should we know about thyroid cancer?

Dr. Young: “As much as 10 percent of the population may be walking around with a thyroid cancer by the time they’re in their 80s. But thyroid cancers are slow growing. There have been studies that monitored people with thyroid cancer for 10 to 20 years without intervention, and it tends not to be fatal. Because we improved our method of detection (ultrasound) over the past 20 years, we are finding more and more thyroid cancers.

“We’re actually starting to rethink how we treat this disease. The American Thyroid Association revised guidelines to indicate that if the cancer is less than four centimeters, we may not have to remove the entire thyroid gland… we can leave half the gland, potentially reducing surgical complications and possibly avoiding thyroid replacement hormone therapy. Some very small incidentally found tumors may even be able to be observed without intervention in the right setting. This disease tends not to be fatal, so we are learning when we can be less aggressive in treating it.”

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