This Saturday is “World Head and Neck Cancer Day”.
As well as including skin cancers, cancers of the nasal passages, salivary glands and other areas, the “head and neck” group also includes oropharyngeal cancers – those that affect the middle part of the throat.
Oropharyngeal cancers definitely aren’t well known, but numbers of people affected by them are growing at an alarming rate – and the consequences of these cancers can be devastating.
The oropharynx is the part of the throat directly behind the mouth and is made up of the tonsils, the back and side walls of the throat, the soft palate or roof of our mouth and the base of our tongue. Its role is to allow air to pass from the nose and mouth, through the windpipe and voicebox into the lungs, and to push food and drink from the mouth, down the oesophagus to the stomach.
* Can we eradicate cervical cancer in New Zealand?
* Free HPV vaccinations offered to boys, young men
* New study shows HPV vaccine has reduced rates of genital warts
* 10 years on, HPV vaccine halves cervical cancer rates
* HPV screening better cancer detector than Pap test, researchers find
Cancers that occur in the oropharynx are notoriously difficult to detect and, as a consequence, are often only discovered in advanced stages. Symptoms will often be very mild initially and will depend on where exactly the cancer is situated, how big it is and how far it has spread in the body. Symptoms can include:
* A persistent sore throat
* A lump in the throat or neck (sometimes the only sign that something is amiss)
* Coughing up blood or noticing blood coming from the nose
* Difficulty swallowing, breathing, moving the tongue or opening the mouth
* Noisy breathing
* Ear or jaw pain
* Voice change
* Unexplained weight loss.
I spoke with Dr Andrew Miller, a GP from Northland, who has survived oropharyngeal cancer and his experience reflects how innocuous these symptoms can seem at the beginning – for months, he noticed very occasional blood-stained mucous from his nose whilst running, but didn’t really think much of it.
The next symptom that prompted him to seek help was a slight numbness in one of his teeth, but a dental check-up and x-rays reassured him all was well. Even an ear, nose and throat specialist checked him over and felt that things were fine. It was only when an area of tissue was biopsied (sampled to look at the cells) that the cancer was diagnosed and, by then, things had progressed, with spread into the nearby bone.
His treatment was extensive and gruelling – removing a large part of his mouth, nose and face to completely excise the tumour, followed by radiotherapy, chemotherapy and finally reconstructive surgery using a bone from his leg to recreate his face. His tenacity and courage, as well as the skill of those treating him, enabled him to get back to work within 16 months – and eventually get back to one of his passions, running.
Fifty-years old at the time he was diagnosed, Miller was fit, preparing to run a marathon, he was a non-smoker and didn’t drink a lot. However, what he did have, unbeknownst to him, was a high-risk strain of the Human Papilloma Virus (HPV), which we now know is the cause of the majority of oropharyngeal cancers.
HPV is a very common virus passed on via all types of sexual contact and almost every person who ever has sex (vaginal, oral or anal) will likely be exposed to it. HPV is a bit of a “lucky dip” really: many of us who are infected will eliminate the virus from our systems, some of us will retain the virus but have a low-risk strain that may lead to visible genital warts, whilst others, like Miller, may have the high-risk strain and develop devastating cancers decades later, having never known about the original infection.
As well as being linked to this type of head and neck cancer, HPV infection can also cause cancer of the cervix, vulva, vagina, penis and anus – and unfortunately condom use during sex doesn’t reliably prevent transmission of this virus.
Although this all sounds very scary, the really great news, especially for young people, is that vaccinating against HPV is an incredibly effective way to prevent exposure to the virus – and hence prevent the risk of cancers later in life. The HPV vaccine available in New Zealand is known as Gardasil-9 as it vaccinates against nine strains of the virus, including those most linked with cancer formation. It is free for females and males from 9-26 years of age; people outside of this age range should discuss with their doctor whether it would benefit them as well.
As the vaccine programme is aiming to prevent the acquisition and transmission of HPV, the ideal time to have the vaccine is before any type of sexual contact, hence the decision for schools to offer this at intermediate age (about 12 years old) – the later it is left, and the more sexual contact someone has had, the lower the efficacy is likely to be because the person may have already become infected.
Over the last 12 years, Gardasil has been used extensively all over the world, and we have many studies to demonstrate its effectiveness and safety. After almost 20 years of research, we know that Gardasil is so effective that cervical cancer (the first cancer target of this vaccine) can be wiped out. We also know that other than the usual minor reactions associated with any vaccine, there are no serious adverse events caused by it. Around three people per million will have an allergic reaction to Gardasil, but this is similar to the rates for other vaccines and being monitored for a short time post-injection means that if this were to happen, it can be effectively treated.
We also now know that younger people (14 and under) actually mount a better immune response to this vaccine so only require two doses in total, as opposed to those in the 15 years and over group who will need three injections.
New Zealand is lucky – we are one of the few places where boys and young men are part of the funding and, as Miller states, had this been available in his day, his story would be very different.
So, on Saturday, as the world acknowledges the impact that head and neck cancers have on so many lives, I’d urge you to talk to the young people in your lives – if they haven’t had their Gardasil immunisations, encourage them to do so. As Miller says, “it’s an absolute no-brainer. If I had children – and declined vaccination on their behalf – I would struggle to explain that decision to them later on in life if they were facing the diagnosis that I have had to”.
* Dr Cathy Stephenson is a GP and mother of three. For more information on Gardasil injections and HPV infection, see the NZ HPV Project website hpv.org.nz , or Just The Facts (justthefacts.co.nz). For information or local support for head and neck cancer sufferers, see the Cancer Society’s website cancernz.org.nz