Less is more: The new approach to treating HPV-related throat cancer

By Sharon Doering-Domanus

Almost all sexually active men and women get human papillomavirus (HPV) during their life. In many cases, your body clears the infection. In some cases, HPV can cause cancer years or decades after infection.

HPV-related throat cancer, also called oropharynx cancer, is now the most diagnosed head and neck cancer in the U.S. The average age at diagnosis is 64, but one in five diagnoses occurs in people younger than 55.

"This cancer tends to appear most often in two age groups: first, in people in their 30s and 40s, and then again in people in their 60s and 70s," says Eric Moore, M.D., a Mayo Clinic head and neck surgeon.

While traditional throat cancer treatment leads to high cure rates, it frequently results in unwanted side effects like difficulty swallowing and open sores. “Radiation drives most of the long-term side effects,” says Katharine Price, M.D., a Mayo Clinic oncologist.

Health care professionals at Mayo Clinic's Oropharynx Cancer Clinic have developed a new way to treat HPV-related throat cancer that successfully kills cancer cells while providing improved quality of life. It's known as de-escalated adjuvant radiation therapy.

Fewer side effects, better quality of life

De-escalated adjuvant radiation therapy (DART) involves half the traditional radiation dose and lasts only two weeks compared to conventional radiation therapy’s six weeks.

“Many of our HPV-positive throat cancer patients are young and otherwise healthy,” says Dr. Price. “With de-escalated therapy, patients see less disruption to their lives.”

Research conducted at Mayo Clinic has shown that people who received DART had excellent overall survival — 98.7% at two years — and similar health outcomes compared to traditional treatment. DART benefits included fewer side effects, improved swallowing function and better quality of life.

"It minimizes the long-term side effects that can accompany treatment of head and neck cancers, such as difficulty with swallowing, eating and speaking; dry mouth; and neck stiffness and pain," says Dr. Moore.

Lower cost improves access, advances health equity

Research conducted at Mayo Clinic also showed that DART was associated with a 33% reduction in cost for radiation therapy and a 21% reduction in overall treatment cost compared to traditional therapy.

Lower-cost cancer treatments increase access to cancer care for all. "The benefit of a two-week course of therapy instead of a six-week course of traditional treatment is tremendous, especially for those with limited social and financial resources," says Dr. Price.

“We want to strike a balance between cancer outcome and quality of life,” says Dr. Price. “With de-escalated treatment, patients spend less time in treatment, recover more quickly, and get back to their lives faster and with fewer side effects.”

Better awareness means better outcomes

Dr. Moore says early symptoms of HPV throat cancer are uncommon. Most people don’t get an evaluation until the disease has spread to their lymph nodes and they find a lump just below the jawline in the upper neck. Occasionally, people may have the sensation of something stuck in their throat or a lump that doesn’t go away, which triggers an evaluation and leads to a diagnosis.

As awareness of HPV-related throat cancer rises, it’s becoming more common for dental professionals to detect it during an office visit. Many dentists now look and feel for tumors when they do their exams. Because these tumors tend to be under the skin's surface, they aren't easily visible. However, if a dentist feels the back of the tongue and the floor of the mouth, the dentist usually can detect these tumors, which have a distinctive, acorn-like feel.

Throat cancer caused by HPV is highly treatable, even when it’s spread to nearby lymph nodes. "After treatment, the outlook for people with HPV-related throat cancer is excellent. More than 95% of these tumors are cured with early detection and treatment," says Dr. Moore.

Prevent throat cancer with the HPV vaccine

New cases of throat cancer have been rising for decades. Infection with HPV is the most common cause. HPV infection is often symptomless and can lead to cancers of the throat, cervix, vagina, vulva, penis and anus.

"The HPV vaccine has proven to be a safe and effective way to prevent HPV infection. That, in turn, protects against cancers caused by HPV, including HPV-related throat cancer," says Dr. Moore.

A vaccine for HPV has been available since 2006. More recent updates protect against additional cancer-related strains of HPV, including nine total subtypes. Several HPV subtypes are associated with cancer, while others can cause genital warts.

The Centers for Disease Control and Prevention (CDC) recommends the HPV vaccine for females and males ages 11 to 26. The vaccine protects against HPV infections and reduces the likelihood of getting HPV-related cancers and genital warts.

The Oropharynx Cancer Clinic at Mayo Clinic recommends the HPV vaccine for all adults up to age 45 who are not already vaccinated. If you’re between 27 and 45, talk to your health care professional about the vaccine’s potential benefits.

Learn more

Learn more about throat cancer and find a throat cancer clinical trial at Mayo Clinic.

Join the Head and Neck Cancer Support Group on Mayo Clinic Connect.

Also, read these articles:

• “Dear Mayo Clinic: Adults up to age 45 and at risk for HPV infection can get the vaccine”
• “Head and neck cancers are becoming increasingly common”