Head and Neck Cancers and HPV: Is There a Connection?

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Topics include: Treatment

Dr. Jeffrey Houlton is an otolaryngology surgical oncologist - also known as Head and Neck cancer – at Seattle Cancer Care Alliance (SCCA) and the University of Washington Medical Center.  Traditionally, head and neck cancers have been difficult to treat due to the invasive nature of the treatments.  However, the changes occurring are extremely positive: cancers that are linked to risky behavior are decreasing, an HPV vaccine is indicative of future health policies, and, due to improved reconstructive surgical techniques, patient quality of life has dramatically improved.  Dr. Houlton is excited to be a part of head and neck cancer medicine because treatments are “well suited to get good outcomes for patients and are only going to improve in the future.”

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Please remember the opinions expressed on Patient Power are not necessarily the views of Seattle Cancer Care Alliance, its medical staff or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

Andrew Schorr:

Hello and welcome to Patient Power.  I'm  Andrew Schorr.   This program is sponsored by the Seattle Cancer Care Alliance. Head and neck cancer traditionally has been difficult to treat, but progress is being made. Joining us to help us understand where we are now and where we’re heading is a leading surgical oncologist, and that’s Dr. Jeff Houlton from the Seattle Cancer Care Alliance. Dr. Houlton, welcome to Patient Power. 

Dr. Houlton:

Thank you, Andrew.  It's a pleasure to talk to you today. 

Andrew Schorr:

Dr. Houlton, I understand that with head and neck cancer with some causes, the incidence is going down. But with other causes, the incidence is going up.  Help us understand that. 

Dr. Houlton:

Yeah.  So it's pretty interesting.  Head and neck cancer includes a diverse set of tumors or cancers, mouth cancers, tonsil cancers, throat cancers, larynx cancers, and they often kind of get lumped together, but there are all—all these sub-sites behave a little bit differently.  And traditionally many of the cancers were associated with risk factors such as smoking was the major one, oral cancers, larynx cancers, throat cancers, tonsil cancers, and like many of the smoking-related cancers we've seen a dramatic decrease in the incidence of those cancers as patients have—fewer and fewer patients have been smoking. 

However, over the course of the last two decades, we've seen an increase in a virus-related tumor.  We often call those HPV-positive tumors, because they're associated with the human papillomavirus, and that virus actually sets up a local environment that sets up tonsil and base of tongue tumors, and we've seen an increase in that incidence over the last 10 and 20 years. 

Andrew Schorr:

Dr. Houlton, now, of course, we’ve had an HPV vaccine now for a few years.  And when it comes to prevention, the hope is that that can be more widely used and make a difference. But if I’ve got it right, what we’re dealing with now with actual cases of head and neck cancer is from the virus going back many years.

Dr. Houlton:

Exactly.  So really when you look at HPV and its ability to cause cancers, that's most notably seen in the cervical cancer literature.  And this was first noted in the ‘60s with cervical cancers, that they are actually being caused by changes from the HPV virus. 

But what we knew is that those changes take sometimes 30 and 40 years. And in head and neck cancers, it may take 10 or 20 years from a patient having been exposed to a virus actually having the cancer. 

And early data, although this is early, would—would seem to correlate that if you had the vaccine, that would then prevent you from getting the virus and ultimately prevent you from having the tumor, but that may—that's kind of a 20-year time lapse. 

And so people that were vaccinated now, say, at the 10-year-old age, wouldn't see the effects of that for, say, 30 or 40 years.  So while vaccine—vaccination is very promising for the future as a future health policy, it won't affect the rates of cancers that we see for several decades. 

Andrew Schorr:

I know you, Dr. Houlton, are very dedicated to a patient’s quality of life. So you work with a team—you as a surgical oncologist, medical oncologists, radiation oncologists.  It’s really team medicine isn’t it to help a patient do better?

Dr. Houlton:

Well, I appreciate you mentioning that, Andrew, and we are very dedicated to really understanding our patients' priorities and goals.  And one of the major goals that we hear from our patients is quality of life.  And so because it's one of our patients' goals, it's our goals as well.  And I'd say that is one of the trends that—it's also continued to evolve over the course of several decades. 

So say in the ‘70s and ‘80s the highest priority that surgeons kind of put on cancer treatment was cure, and that often led to fairly aggressive surgeries.  Sometimes those surgeries are still necessary today, but we try to work with a team of radiation oncologists, medical oncologists in order to combine therapies to allow us to really treat with the least toxic option possible. 

And so, for example, as we were talking about kind of HPV-positive tumors, those tend to be in the tonsils or the base of tongue.  Approaches to those involve treating patients with chemotherapy and radiation together, or frequently we're able to offer a kind of a minimally invasive surgery with the use of the DaVinci robotic system.  And if we do a minimally invasive surgery as opposed to kind of older approaches that was much more invasive and therefore leading to swallowing dysfunction and pain, we are able to limit patients' morbidity with treatment.  And each individual patient really uniquely presents us a challenge and both an opportunity to both give them the highest possible cure rate while preserving the highest possible function. 

Andrew Schorr:

Dr. Houlton, let’s talk just a minute about cancer that affects the salivary glands.  I understand that you and your team have been involved with real progress there. 

Dr. Houlton:

Yeah.  So as you alluded to, one unique thing here as being part of the SCCA and the University of Washington is that with our head—with our team of head and neck cancer surgeons we also all have unique interests in reconstructive surgery.  So not only are we able to remove tumors, but we're also able to reconstruct those, and that allows us to be both the reconstructive surgeon and the oncologic surgeon and really combine those principles with surgery. 

In terms of salivary surgery, one of the very unique challenges of salivary surgery is that tumors of the parotid gland here in the facial area are often frequently intimately involved with the facial nerve, which is how we are able to blow kisses, blink our eyes, things like that that are just inherently intimate to our quality of life and that we probably take for granted a little bit. 

Over the last decade, we've been able to develop techniques where we're able to save that nerve more frequently largely because we rely on our radiation oncology colleagues to use a special form of radiation called neutron radiation in order to remove any tumor cells that are left behind by preserving that nerve function. 

Andrew Schorr:

So certainly we still have a long away to go. But do you feel that you can help patients with head and neck cancer live better? 

Dr. Houlton:

I actually think that, you know, this is an exciting time to practice medicine.  We're fighting head and neck cancers on multiple fronts, and we've never before been so invested in a team approach as we are now.  So our radiation oncologists have new forms of radiation.  Proton therapy has some exciting new implications for decreasing the morbidity of radiation.  Our medical oncology colleagues have new types of chemotherapies. Some of them are called immunotherapies, which are targeted molecules that fight cancers. 

And we as surgeons are offering more advanced not only oncologic techniques to remove tumors, but as you mentioned we have better and more robust reconstructive techniques to allow us to preserve the form and function of our patients. 

So to answer your question it's a very exciting time to be a part of head and neck cancer treatment, and we are very well suited at this point to get good outcomes for our patients, and it's only going to improve in the future.

Andrew Schorr:

Dr. Jeffrey Houlton, surgical oncologist at the Seattle Cancer Care Alliance, thank you for your devotion patients and for being with us on Patient Power. 

Dr. Houlton:

Well, thank you so much.  It was an honor to speak with you today, Andrew, and I certainly appreciate your time. 

Andrew Schorr: 

I'm Andrew Schorr.  Remember, knowledge can be the best medicine of all. 

Please remember the opinions expressed on Patient Power are not necessarily the views of Seattle Cancer Care Alliance, its medical staff or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

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Page last updated on April 8, 2016