Tobacco and alcohol use may be the most common cause of head and neck cancers, but a new culprit has come on the scene in recent years.
The human papillomavirus (HPV) is now responsible for more than 60 percent of the cases of oropharyngeal cancer diagnosed at Penn State Milton S. Hershey Medical Center, according to Dr. David Goldenberg, professor of surgery and medicine, and director of Head and Neck Surgery.
Oropharyngeal cancer can affect the back third of the tongue, the soft palate, side and back walls of the throat and the tonsils.
"Infection with certain kinds of HPV is a growing risk for some types of head and neck cancer in those who have never smoked," Goldenberg said.
HPV is the most common sexually transmitted infection—so common that most sexually active people get some variety of it at some point in their lives. There are many types of HPV however, and only some of them cause warts or cancer. Even people who get the type of HPV that can cause cancer may never develop the disease.
In general, head and neck cancers are twice as common among men as women, and most of those are diagnosed in people age 50 and older—with the exception of cancers caused by HPV. Those are showing up in younger people.
Head and neck cancers begin with abnormal changes in the squamous cells that line the moist surfaces inside the head and neck, including the throat, nose and mouth, and swallowing passage. Those who use both alcohol and tobacco heavily are much more at risk than those who only smoke.
"There is a synergistic effect with the combination of alcohol and tobacco together," Goldenberg said.
Head and neck cancers sometimes show up as neck lumps, mouth sores, ill-fitting dentures or loose teeth. In other cases, the cancer is identified by hoarseness, a sore throat or a feeling of something stuck in the throat.
"Unfortunately, many people don't come in until it is very late," Goldenberg said.
Treatment for head and neck cancers includes surgery, radiation, chemotherapy or a combination of these. Actual treatment depends on the location and size of the cancer, and the patient's health and preference. Goldenberg said certain areas are more amenable to surgery, while others are better treated with a combination of chemotherapy and radiation.
Like most cancer, the "garden variety" head and neck cancers have poor prognosis if not caught early, he said. HPV-induced cancers however, have a much better prognosis. For all types, Goldenberg said, early diagnosis is the key.
Regular dental checkups can help with early detection, as can paying attention to symptoms such as sores, ulcers, lumps, sore throat or hoarseness that last more than two or three weeks. Eliminating tobacco use and reducing alcohol consumption can reduce the risk as can good oral hygiene practices.
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