Until the 1980s, throat cancers were relatively rare. They mainly affected older men who smoked and drank alcohol heavily.
Now: These same cancers are appearing more frequently, often in healthy men and women who have never smoked or abused alcohol.
Surprising statistic: In the US, oropharyngeal (the part of the throat just behind the mouth, including the tonsils) cancers caused by the human papillomavirus (HPV) increased by 225% between 1988 and 2004. These cancers are now seen more frequently in younger people, but the risk increases with age and peaks between ages 60 to 70. Men are at greater risk than women.
What’s the explanation for this dramatic increase?
Research shows that about 60% of oropharyngeal cancers are caused by HPV. This sexually transmitted virus has long been known to cause the majority of cervical cancers—and more recently has been linked to the development of throat and oral (on the tongue or inside the mouth) cancers.
Infections from HPV surged in the 1980s and 1990s, in part because more people were having sex with multiple partners. Since it takes years, or even decades, for the virus to damage the DNA in cells, we’re only now seeing an increase in HPV-related cancers, including anal and oropharyngeal cancers. Oral sex is the highest risk factor for HPV-related oropharyngeal cancer.
Every year, approximately 34,000 Americans will be diagnosed with an oropharyngeal cancer, and nearly 7,000 will die from the malignancy.
Most people know that HPV causes genital warts. But only two strains of the virus cause these warts—and if you have them, your cancer risk is no higher because these strains don’t cause cancer.
But at least 15 of the other strains—there are about 150 varieties—can potentially lead to cancer.
Important: Although more than half of American adults are believed to have been exposed to HPV, the vast majority of people infected with it clear the virus within a few months. Their risk of developing cancer is the same as if they had never been infected. It’s only when the infection is chronic that the risk for cancer rises. Chronic infection with HPV increases risk for cancer at the site of infection, when the virus becomes integrated within the DNA of healthy cells.
Most patients who are diagnosed with a localized, stage I or stage II (no spread to the lymph nodes) oropharyngeal or oral cancer will survive the disease. Unfortunately, most of these cancers are detected only at a more advanced stage, when the prognosis is poorer for non-HPV-related cancers.
That’s why early detection is critical. Check the inside of your mouth every month, and see an otolaryngologist if you have any of the following…
Unexplained ear pain. This is among the most common symptoms of oropharyngeal cancer in adults. It’s known as referred otalgia (ear pain) because nerves in the throat that are irritated by cancer cause pain inside the ear. Note: Adults rarely get ear infections. If you have nagging ear pain and your doctor says that the ear canal looks normal, cancer is a possibility.
A lump in the neck, particularly below the ear or on the front of the neck below the jawbone. In adults, a lump in the neck is often assumed to be cancer until proven otherwise through a biopsy.
A sore throat, trouble swallowing and/or hoarseness that does not go away. See a doctor if these symptoms persist after two weeks.
All adults should see a dentist at least once a year—especially if you drink alcohol or use tobacco or if you know that you’ve been exposed to HPV. Dentists routinely check the inside of the mouth for cancer or precancerous changes. They also look at the back of the throat—make sure your dentist looks carefully.
Cervical cancers caused by HPV can be detected by taking a swab of tissue in the cervix (Pap smear) and examining cells under a microscope. There isn’t an equivalent test for oropharyngeal and oral cancer, so the exam is crucial. Also…
Don’t use tobacco. Apart from HPV, smoking and chewing tobacco are the main risk factors for oropharyngeal and oral cancers.
If you drink, do so in moderation. The generally accepted upper safe limit for cancer risk is two alcoholic drinks daily for men and one for women. People who drink heavily are far more likely to get oropharyngeal cancer than moderate drinkers.
Practice “safer sex.” Using a condom can help prevent infection with HPV. However, it’s not a perfect solution because the virus can also be transmitted by unprotected oral sex and even by hand contact with the anal/genital areas.
Two vaccines, Gardasil and Cervarix, prevent infection with cancer-causing strains of HPV. Recommended for preteen girls and boys and young adults prior to sexual activity, either vaccine can prevent the majority of oropharyngeal and oral cancers. However, it’s not recommended for people older than age 26.
For reasons that aren’t clear, oropharyngeal and oral cancers caused by HPV respond more readily to treatments than malignancies caused by smoking and/or drinking.
The five-year survival rate for smoking/drinking-related stage III or stage IV cancers—the stage at which they’re usually diagnosed—is only about 45%. For cancers of the same stage that are caused by HPV, the survival rate is 80%.
Surgery for localized cancer. When cancers are detected at the earliest stage, they can often be removed by a head-and-neck surgeon or treated with radiation.
Surgery plus radiation and/or chemotherapy. Patients with more advanced oropharyngeal or oral cancer require a combination of treatments. Patients will often get radiation and/or chemotherapy first. If the cancer does not respond, surgery is then performed to remove as much of it as possible. Lymph nodes that harbor cancer cells will also be removed.
Source: David M. Cognetti, MD, an otolaryngologist–head and neck specialist at Thomas Jefferson University Hospital in Philadelphia. He is an assistant professor of otolaryngology–head and neck surgery at Jefferson Medical College and codirector of the Jefferson Center for Head and Neck Surgery. He has published numerous articles on oropharyngeal and oral cancers in various professional journals.