Treating head and neck cancers with multi-d
Date: November 30, 2010
When the 64-year-old found a couple of lumps on his neck while shaving, he knew that he needed to have them checked out. But the diagnosis of squamous cell carcinoma with no identified primary tumor was a surprise.
He didn’t drink or smoke, the two biggest traditional risk factors for head and neck cancer. But further investigation identified the primary site of his cancer to be in the base of his tongue, as well as the cause: human papilloma virus (HPV), a culprit long known to trigger cervical cancer in women but now identified as a growing cause of head and neck cancers in both women and men.
Patients diagnosed with HPV-associated head and neck malignancies do not fit the typical profile of head and neck cancer patients, says otolaryngologist and head and neck surgeon Sara Pai, who recently launched a multidisciplinary clinic at Johns Hopkins focused solely on treating patients with HPV-related disease. Like the 64-year-old patient, they often don’t drink or smoke. While most of the traditional head and neck cancers strike people over 50, HPV-associated head and neck cancers often occur at a significantly younger age, sometimes affecting adults in their early 20s.
The good news, says Pai, is that HPV-associated head and neck cancers often respond well to treatment and tend to have a better prognosis as compared to non-HPV-related head and neck cancers. Since these cancers respond so well to traditional treatments, physicians are evaluating whether patients can afford to receive lower doses of chemotherapy and radiation in order to minimize the side effects of these treatments while maintaining their good outcomes.
“Because these patients are younger when they’re diagnosed and their cancers respond so well to treatment, treating them less aggressively can help them avoid potential lifelong side effects such as problems swallowing, dry mouth and tooth decay,” says Pai. “Our goal is to maintain their quality of life.”
Pai and a team of colleagues, including other head and neck surgeons, medical oncologists, radiation oncologists and speech language pathologists, meet each patient as a group to review their medical history, perform a physical examination and develop a plan for treatment—all in the same clinic visit.
“At this one clinical visit, the patient meets all the subspecialists, and we review all potential therapeutic options, which allows us to formulate a patient-specific treatment plan,” Pai says.
The comprehensive care continues while treatment is ongoing. For example, the speech language pathologist provides long-term monitoring to catch any problems with swallowing before they progress. The clinic also provides counseling to help patients deal with emotional or social issues related to their diagnosis, such as potential social stigmas or how the virus might affect their partners.
After the 64-year-old patient visited Pai’s multidisciplinary HPV clinic, her team developed a treatment plan based on his less aggressive cancer type and expected a good prognosis: several months of radiation, but no surgery or chemotherapy. He recently concluded his treatment and is waiting for his next checkup in a few weeks—feeling good and anticipating a healthy life ahead.
To refer a patient or learn more, call 410-955-2309 or visit hopkinshpv.org.