Refining Our Treatment Goals for Tonsil Cancer
There has been a dramatic rise in the incidence of squamous cell carcinoma of the oropharynx (tonsils and base of tongue) over the past 20 years, in spite of decreasing rates of tobacco use. These tumors can arise in younger individuals who often have no history of alcohol and tobacco use. The culprit driving this changing demographic is the human papillomavirus (HPV).
It is estimated that the incidence of HPV related oropharyngeal carcinomas will overtake cervical cancer in the coming decade. If there is a silver lining to this emerging epidemic it is that HPV-related cancers of the oropharynx have a much better prognosis than traditional tumors related to alcohol and tobacco. Additionally, vaccination against HPV has the potential to prevent many of these cancers in the coming decades.
According to Aaron Wieland, MD, UW School of Medicine and Public Health assistant professor of surgery and a specialist in otolaryngology, coincident with the emergence of HPV-related oropharyngeal cancers are new treatments that maintain excellent cure rates and lessen overall toxicity profiles. New technologies, such as the use of lasers and robotics, allow surgeons to remove tumors in a minimally invasive fashion by working through the mouth. With these surgical approaches, patients tend to have faster recoveries and shorter hospital stays.
Many of these studies suggest that long term complications, such as gastrostomy tube dependence, may be diminished with transoral surgery. Important trials to reduce radiation treatment volumes and remove cytotoxic chemotherapy from the treatment of patients with favorable prognostic features are also in progress.
These new approaches, says Dr. Wieland, coupled with the overall better prognosis of younger patients with HPV-related cancers, have promoted new clinical trials to study refined treatment approaches incorporating both tumor control and quality of life outcomes. Important randomized controlled trials are in progress and the UW Carbone Cancer Center is participating in several clinical trials evaluating the role of transoral resection and reduced chemotherapy usage. Patients with HPV-related oropharynx cancers have cure rates approaching 90 percent and we must start thinking beyond 5-year survival to address quality of life related to speech and swallowing.
"At the UW Carbone Carbone Center, we use a multidisciplinary team approach to evaluate the optimal treatment for each patient. The weekly Head and Neck Oncology Tumor Board serves as the cornerstone for this multidisciplinary approach," explains Dr. Wieland. "Patients have the opportunity to meet a team of specialists who will be involved in their cancer care and rehabilitation. This inspires great confidence in patients and families as they navigate important treatment decisions, and as they recuperate from complex treatments that can affect not only their physical appearance, but also the way they speak, swallow and breathe. We are committed to providing the most balanced approach to each cancer patient and to participating in state of the art clinical trials and research activities that advance the field of head and neck oncology on behalf of our patients."
For more information about the Head and Neck cancer program at UW Health, please visit our website, or call (608) 262-5223.