The increase in HPV (Human Papilloma Virus) related cancers of the throat has resulted in much younger patients presenting to see me in the Head and Neck cancer clinics. These patients are often aged in their early 40s - 50s. There are certainly older age groups affected but it is certainly more intense dealing with a young patient who is far from retirement and often with a young family to boot.
The traditional methods of managing these patients are borrowed from the evidence based approach of treating cancers of the throat not caused by HPV but by smoking and alcohol related lifestyles. These treatments include chemotherapy and radiotherapy, in a combination that lasts six weeks should one intend to treat radically (i.e. with the intent to cure). Unfortunately, with radical treatment, especially chemotherapy, comes significant side effects. These side effects are classified into early and late onset effects. For younger patients, they can preclude timely return to work and thus, the ability to earn a living; Life changing consequences such as dental problems, deterioration in hearing, difficulty swallowing, etc. Nonetheless, oncologists find that the HPV related throat cancers (specifically those found in the tonsils and base of the tongue) respond brilliantly to this treatment The question is if this sledge hammer approach is indeed necessary. With this dilemma in mind, several studies have sprung up, the most popular (in the United Kingdom) of which is the PATHOS study. These studies exist to create a strict protocol under which young patients with HPV related disease can be randomised to have the usual treatment or to have the intensity of their treatment de-escalated. This means not giving them all chemotherapy and if at all, offering lower doses of chemotherapy and radiotherapy. The patients are followed up for several years and several analysis made. These include documenting tumour recurrences, post-treatment symptoms, quality of life, swallowing outcomes, survival without disease and overall survival.
One of the key elements of this trial is that patients are offered surgery first - Trans Oral Surgery. This means taking out the tumour in the throat through the mouth and also removing any spread (metastasis) in the neck. The Trans Oral Surgery may be done by LASER surgery or Robotic surgery.
Having a HPV related tumour in the throat can impact on one’s personal life. Patients are concerned they may pass the virus on to their partners and worry about sexual intercourse. Thankfully, the Throat Cancer Foundation have put together a leaflet entitled HPV & Throat Cancer which has answers to common questions which patients (and their relatives) may sometimes be embarrassed to ask. Click on the link below to find out more: