Head and neck cancer is on the rise among young adults in their 20s to 40s. It’s caused by strains of the human papillomavirus (HPV) that can develop into head and neck cancer years after infected individuals engage in oral sex. Among sexually active adults, HPV infection is nearly universal – approximately 79 million teens and adults in their 20s in the U.S. currently have HPV, and most have no symptoms or long-term impact. But in some people, HPV causes head and neck cancer.
Parents today have the option to vaccinate their preteens against HPV – and essentially against cervical, anal, vulvar, and vaginal cancers that are related to HPV infection. However, adults on the dating scene today are in the highest-risk group for developing HPV-related head and neck cancer. Most already have been exposed to HPV, and the vaccination is not yet approved by the Food and Drug Administration (FDA) for head and neck cancer.
Cancer and cancer treatment can lead to many physical and emotional side effects, including negative changes to a patient’s appearance and self-esteem. But we must also consider the interpersonal effects of cancer, particularly when it comes to dating and sex. In that regard, head and neck cancer is one of the most socially awkward cancers given its effects on a person’s appearance and voice, and its more recent association with a sexually transmitted virus.
"Cancer and cancer treatment can lead to many physical and emotional side effects, including negative changes to a patient’s appearance and self-esteem. But we must also consider the interpersonal effects of cancer, particularly when it comes to dating and sex. In that regard, head and neck cancer is one of the most socially awkward cancers given its effects on a person’s appearance and voice, and its more recent association with a sexually transmitted virus."
Our doctors provide advanced treatments that take these social factors into account. At UT Southwestern, we focus on reducing the intensity of therapies to find the sweet spot of effective treatment and minimized long-term side effects. Our research trials have advanced treatment for HPV-related head and neck cancer, particularly through targeted radiation therapy and transoral robotic surgery.
Advanced treatments to minimize social effects
Targeted radiation therapy
The traditional treatment for HPV-related head and neck cancer has been radiation therapy and the chemotherapy drug Cisplatin. However, we know today that both therapies can cause significant side effects that can worsen over time, including scar tissue and functional issues.
To reduce these effects, we’re working to offer more localized therapies instead of systemic drugs such as chemotherapy that pass through the entire body. We’re also reducing the volume of radiation that we administer. In the past, we radiated the majority of tissue in the head and neck to reduce the risk of recurrence. Today’s techniques are very focused. In fact, we’re enrolling patients in a phase two clinical trial that we started in order to reduce radiation volumes further by targeting just the tumor and sparing all the healthy tissue in the head and neck.
Transoral robotic surgery
This technique has been one of the most exciting advances to reduce treatment side effects in patients with HPV-related head and neck cancer. Transoral robotic surgery allows the surgeon to remove certain tumors through the mouth rather than cutting into the head or neck. This is the most effective way to remove tumors and potentially avoid chemotherapy and radiation altogether – as well as the unpleasant side effects. After transoral robotic surgery, most patients have few, if any, signs of surgery because it is so focused and targeted.
HPV-related head and neck cancer is a very slow-growing disease. However, as with many types of cancer, treatment is most successful when we catch the cancer early. Also, we must consider the risk of the cancer spreading (metastasizing) to other areas of the body. The head and neck are close to the brain and lungs, as well as numerous lymph nodes.
Outcomes for patients with HPV-related head and neck cancer are much better than cancers related to smoking, drinking, or genetic factors because of these advanced therapies. And even if an HPV-related cancer spreads to the lungs, we’ve found that the metastasized cancer is more treatable than a typical lung cancer.
Life after treatment
After treatment, using advanced imaging scans, we follow patients for several years to look for traces of cancer. If a cancer should return, we want to know right away so we can treat it early with minimal side effects.
Most patients can return to life as usual without having to adhere to specific diet or lifestyle changes aside from the “exercise, eat a healthy diet, and don’t smoke” protocol all of us should follow. However, some patients worry that they could potentially spread HPV-related head and neck cancer to their sexual partners. I understand why they’re concerned, because HPV is a sexually-transmitted infection. However, many research studies have verified that it’s not possible to pass the cancer to a partner.
Individuals should not blame themselves if their partners develop HPV-related head and neck cancer because nearly every sexually active adult has been exposed to HPV. Likewise, the partners of patients who have or have had HPV-related head and neck cancer are not at increased risk for developing the disease.
Today’s patients benefit from a more socially conscious – and also more effective – approach to head and neck cancer treatment. Our goal is to remove the cancer and help patients continue to enjoy healthy dating and social lives for years to come. In the meantime, we recommend that all eligible preteens, teens, and young adults receive all recommended doses of the HPV vaccine. With awareness and a strong effort, it’s possible that one day we will eliminate the risk of HPV-related head and neck cancer in future generations.