HPV related throat cancer rates are rising

Richard you haven’t needed a website for twenty years, why do you need one now?’ It’s a good question. There are three parts to the answer but they all come down to one thing; getting accurate information about the changing face of head and neck cancer to patients, carers and health professionals.

  1. The emerging HPV throat cancer epidemic

In 2013 actor Michael Douglas told a reporter that his throat cancer was caused by HPV contracted through oral sex. The reaction was incredulous. Even the reporter thought he had misunderstood. Douglas was right, but the world was not ready to hear about human papillomavirus (HPV) related oropharyngeal cancer. Douglas ended up apologising and withdrawing the details of his diagnosis after a response from his ex-wife who complained that it suggested she was promiscuous. An unfortunate situation because not only was her interpretation incorrect, it also sent the discussion of HPV related oropharyngeal cancer underground. Society’s general embarrassment in regards to sexual health helps explain why Western countries, including the media, the general population, and health professionals, are finding it hard to acknowledge, discuss and accept this epidemic.

Because it is an epidemic. The rise of HPV related cancers in the oropharynx correlates to an increase in oral sex within Western cultures over the past fifty years, referred to by researchers as the “sexual revolution of the 21st century” . These cancers are on the rise. We know that four out of five Australians have contracted at least one type of HPV at some time in their lives. In August 2018 the US Centre for Disease Control announced that HPV related oropharyngeal cancer diagnoses have now overtaken cervical cancer diagnoses.

The same thing is happening in Australia. I am seeing more and more patients, both men and women, with this HPV related cancer. It develops in tonsillar tissue often years, even decades, after patients first contract HPV.

HPV stand for human papillomavirus. It is one of, if not, the most common sexually transmitted disease in the world and it affects both men and women. There are more than 100 types of HPV. Most types of HPV are harmless but others can cause cervical, some vaginal, vulval and anal cancers. Most of you will have heard of HPV in relation to cervical cancer and the development of the Gardasil vaccine which can successfully immunise against some of the more dangerous types of HPV.

I have been treating patients with Head and Neck cancer for twenty years and this disease epidemic has shown us that the typical head and neck cancer patient is changing. Head and neck cancer patients are no longer typically heavy smokers or drinkers. Furthermore, HPV related throat cancers have an extremely high cure rate so now we have to think carefully about the side effects of treatment and patients need to be informed when considering different treatment options. This change is happening very rapidly and is outside the training experience of most General Practitioners.

  1. Trans oral robotic surgery (TORS) a treatment option

Fortunately minimally invasive (MI) transoral robotic surgery (TORS) is becoming available to more and more patients. HPV oropharyngeal related cancers occur in the tonsillar tissue at the back and sides of the throat, and don’t be misled into thinking you’re safe if you’ve had your tonsils out, your lingual tonsils will still be in place. In the past, surgical treatment for cancers of the oropharynx required open surgery which involved splitting the jaw, releasing the tongue and excising the tumour. This often caused problems with talking, swallowing, eating and drinking. In addition, patients still often required extra treatment with radiotherapy. Treatment recommendations changed in response to these complications and we saw a swing towards chemoradiotherapy. In the first few years post treatment this certainly appeared to be a better option. But the combination of high dose radiotherapy and chemotherapy is particularly toxic. So years further down the track we started to see patients who had been successfully treated with chemoradiotherapy for their cancer develop additional, often more serious problems related to their treatment. It is worth remembering that radiotherapy destroys the blood supply to tissue which can make it very difficult to make surgical repairs in the treatment area even after the patient is cured of cancer. As practitioners we found ourselves between a rock and a hard place – surgery cured cancer but created immediate complications, many lasting a lifetime, and chemoradiotherapy cured cancer but led to further, more serious complications further down the track.

Robotic surgery has changed all of this. The da Vinci robot allows me to insert instruments into the mouth and remove the tumour without splitting the jaw or necessarily lifting the tongue. Robotic surgery is not for all HPV related oropharyngeal cancer patients but it can be a fantastic treatment option and goes a long way towards reducing the long term complications which often haunt head and neck cancer patients after they are successfully cured of their cancer. Not every head and neck cancer patient is suitable for robotic surgery but it should be considered as an option and I firmly believe that every Head and Neck Multidisciplinary Team (MDT) should include a robotic surgeon.

  1. Patients and referrers want to be able to find me online

Another major change we have seen in the health field in Australia in recent years is patient access to health information online. Not only is there an increase in medical information available to patients, we are also seeing the rise of TripAdvisor style medical practitioner rating sites. If patients are referred to a specialist then it is understandable that they and their loved ones may want to go online and learn more about the doctor they are about to see. If, on the other hand, patients are doing their own research about which specialist they want to see and which treatment options are available for their diagnosis, then the areas of expertise and experience of medical specialists need to be easy to find.

So there you have it. My reasons for creating a website are three fold; to raise awareness of HPV related oropharyngeal cancer, to raise awareness of transoral robotic surgery (TORS) as a treatment option, and to give potential patients and referring doctors information about who I am, what I do, and how I do it. I look forward to adding more information to the website as it develops and, as always, I welcome your feedback.