Thomas J. Dobleman, MD, FACS, is a well-versed otolaryngologist with an impressive 25 years of experience in his field. He is a Fellow of the American College of Surgeons with special expertise in head and neck surgery and reconstructive surgery. He serves patients in practice at Ear, Nose & Throat--Head and Neck Surgery,... more
In the 1960s, the surgeon general’s report finally declared that smoking can cause cancer. Since that time, many cancers have decreased in number, including head and neck cancer. This also applied to throat cancer until the 1990s. Since then, throat cancer is on the rise.
The throat consists of the upper throat, the mid throat or oropharynx, and lower throat. The oropharynx is the area in which cancer is rising at an epidemic rate. In fact, cancer of the oropharynx, including cancer of the tonsils and the back of the tongue, is the fastest-rising cancer by incidence in the United States.
This dramatic growth in throat cancer is due to HPV, in particular, HPV 16, the same virus that causes cervical cancer in women. By the year 2020, the number of males with oropharynx cancer or mid throat cancer will exceed cervical cancer in women.
HPV-induced oropharynx or throat cancer is a sexually transmitted disease. Risk factors for the disease include age, sex, tobacco use, and number of sexual partners. Also, spouses with cervical dysplasia and immunosuppressed patients have a higher incidence of developing oropharynx or throat cancer.
The face of throat cancer has changed. You may think of a common throat cancer patient as an elderly male with a long history of excessive tobacco and alcohol abuse. Now, HPV-induced throat cancers are affecting younger patients. Patients are presenting at younger ages with no history of tobacco use and no significant alcohol consumption history. Doctors and dentists are often fooled by this history and do not think to suspect throat cancer in patients who do not smoke or drink alcohol.
It is true that smoking and drinking alcohol are significant risk factors for developing throat cancer, but because of lifestyle changes and patient education, smoking and alcohol consumption as a cause is decreasing. When a patient has HPV, he or she may carry the virus without noticeable symptoms until the cancer develops. Signs and symptoms of throat cancer, no matter the cause, are persistent sore throat, unexplained persistent earache, painful swallowing or difficulty swallowing, and tonsillar asymmetry, a tongue mass and/or enlarged lymph nodes in the neck upon physical examination by a physician.
Patients with HPV-induced throat cancer tend to have a much better long term prognosis than patients whose cancers were caused by tobacco and alcohol abuse.
The public needs to be made aware of this problem. Physicians and dentists must take accurate histories from their patients and carefully examine the region of the throat even during routine physical examination.
At any moment, a significant percentage of both men and women are carriers of the HPV virus. There are many HPV virus subtypes and only certain ones have been shown to cause cancer. Even when patients are carrying the high risk virus, only relatively few patients will develop this malignancy.
Prevention of this potentially devastating and life-threatening disease is critical and this can be done through education of patients, physicians and dentists. Both males and females between the age of 9 and 26 should receive the HPV vaccine after speaking with their physician. It is likely that this will have a significant impact in decreasing the development of throat cancer.
If you have any questions about this disease, you should speak with your physician and dentist. Early discovery of HPV-induced throat cancer can be lifesaving.