HPV-related head and neck cancer treatment is improving, but prevention is best

By Jessica Saenz

Head and neck cancers are cancers in the mouth, throat, sinuses and salivary glands. Most often, these cancers develop in the squamous cells lining the nose, mouth and throat.

Head and neck cancers have common risk factors, including tobacco and alcohol use, environmental factors, and exposure to human papillomavirus (HPV). HPV has been linked to cancers that affect the oropharynx, the part of the head and neck that includes the tonsils, the back of the tongue, the soft palate and the side and back wall of the throat.

Katharine Price, M.D., a Mayo Clinic medical oncologist, says that while head and neck cancer treatment has come a long way, prevention is always better. Here's what she wants you to know:

The HPV vaccine can prevent head and neck cancer.

HPV is the most common sexually transmitted infection, and nearly everyone will be exposed to it at some point in their life, according to the Centers for Disease Control and Prevention (CDC). Most of the time, the body's immune system will clear the virus, but it lingers in about 10% of the population without causing symptoms.

HPV is thought to cause about 60% to 70% of oropharyngeal cancer, a type of throat cancer. "The virus incorporates into the body, causing cancer 20 or 30 years later," says Dr. Price.

"People with HPV cancer will ask, 'Is this a new infection?' The answer is no. This is something they were exposed to decades ago."

Dr. Katharine Price

Because it's so common, it's difficult to prevent HPV exposure, but you can prepare your immune system by getting the HPV vaccine. "We use the HPV vaccine to prevent HPV-associated cancers," says Dr. Price. "These vaccines get your immune system to recognize and fight specific antigens. Antigens are how the immune system recognizes something abnormal or foreign."

For maximum effectiveness, the HPV vaccine should be given before people become sexually active. The CDC recommends vaccination starting as early as 9, but it can be beneficial through age 45. HPV vaccine is part of routine recommended childhood vaccinations for all boys and girls ages 11 to 23. If you haven't been vaccinated for HPV, ask your healthcare professional if it's right for you.

Head and neck cancer is often curable, but treatment can have lasting side effects.

Head and neck cancers have high cure rates with proper treatment. However, approaches like surgery, radiation and chemotherapy can have lasting side effects, including dry mouth, altered taste and difficulty chewing, swallowing, or speaking.

When head and neck cancers spread to the lymph nodes, the lymph nodes might need to be treated with radiation therapy or be removed. This can lead to lymphedema, tissue swelling caused by an accumulation of fluid that's usually drained through the body's lymphatic system. It can also cause fibrosis, which is the stiffening of the neck tissues.

Head and neck cancer is often diagnosed after it has spread to the lymph nodes. "About 80% of the time, it will spread into lymph nodes in the neck, and the cancer grows there," says Dr. Price. Head and neck cancer that has spread to the lymph nodes is typically treated with a combination of surgery, radiation therapy and chemotherapy, she says.

HPV-related head and neck cancer will spread to other parts of the body in up to 20% of people who receive the diagnosis.

"We have to tailor treatment based on the person. If cancer has spread to another organ, we usually rely on systemic therapy — a drug that goes everywhere in the body through the bloodstream," says Dr. Price. Examples of systemic therapy include immunotherapy, which uses the body's immune system to kill cancer cells, chemotherapy and targeted therapies that attack specific molecular pathways in cancer cells.

New treatments and research are giving people with head and neck cancer more options.

Dr. Price says immunotherapy has become more widely available and has helped change and improve how head and neck cancers are treated. "The year 2016 was a big pivot point because that's when the Food and Drug Administration approved immunotherapy — pembrolizumab — for the treatment of advanced head and neck cancer," she says. "What's exciting now in research and development is the next generation of immunotherapy drugs. We're getting more creative in engaging the immune system to fight the cancer."

Cancer vaccines are another exciting area of research, says Dr. Price. Some people with HPV-related head and neck cancer have a higher risk of recurrence. David Routman, M.D., a Mayo Clinic radiation oncologist, is leading a study investigating the use of an HPV vaccine with or without immunotherapy before surgery to prevent recurrence of throat cancer.

Distinguishing between HPV-negative and HPV-related head and neck cancer has also improved treatment. "They have a different biology, and HPV-related head and neck cancers respond better to treatment. They tend to have a higher cure rate," says Dr. Price. For example, a new approach developed by Mayo Clinic called de-escalated adjuvant radiation therapy (DART) for HPV-related throat cancer can give patients fewer long-term side effects and better outcomes.

HPV vaccine hesitancy may contribute to head and neck cancers in the future.

Dr. Price says people often relate HPV to cervical cancer and might overlook HPV vaccination for boys, but it's important to vaccinate all children. "If we look at cancers caused by HPV, the single greatest group of people who get HPV cancer in any given year are men with HPV-associated head and neck cancer, so we need to vaccinate boys."

"If we look at cancers caused by HPV, the single greatest group of people who get HPV cancer in any given year are men with HPV-associated head and neck cancer, so we need to vaccinate boys."

Dr. Katharine Price

Also, people who are married or in monogamous sexual relationships might think the vaccine wouldn't benefit them. Still, Dr. Price says having even one sexual partner doubles the risk of HPV, and life circumstances can change. Divorce or the death of a spouse could mean you might go back into the dating pool and be exposed to HPV again. "You might be exposed the second time in the middle part of your life, which could lead to cancer in your 70s. Protecting yourself makes sense because you don't know what's around the corner. Get vaccinated up to age 45 if you haven't already."

Dr. Price says some parents hesitate to vaccinate their children against HPV because they worry it will lead to sexual activity at a young age, but she reassures parents that this is not the case. "Many studies have looked at children who were vaccinated and others who weren't, and they didn't show any increase in high-risk sexual activity or behavior in those who were vaccinated," she says. "This vaccine can prevent cancers that cause a significant amount of death and suffering."

Learn more

Watch this "Mayo Clinic Minute" video to hear Dr. Price discuss HPV-related throat cancer and the importance of prevention with the HPV vaccine:

Learn more about head and neck cancers and find a head and neck cancer clinical trial at Mayo Clinic.

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

Also, read these articles:

• Mayo Clinic Minute: 3 ways to prevent head and neck cancer
• Protecting yourself against HPV
• Innovative technology to treat head and neck cancers
• Protecting kids from cancer with HPV vaccine
• Dear Mayo Clinic: Defining head and neck cancer
• Less is more: The new approach to treating HPV-related throat cancer