2016 Head & Neck Cancer Report

Human Papilloma Virus (HPV) is the most common sexually transmitted infection. Most sexually active people are infected at least once in their lifetime. Most infections are self-limited and asymptomatic. However, some infections may persist and cause cellular changes which can to lead to cancer.

HPV causes approximately 5% of all cancers worldwide. Almost all cervical cancers are caused by HPV. Among other HPV associated cancers, approximately 90% of anal cancers and 70% of oropharyngeal (tonsil and base of tongue) cancers are caused by HPV.

The incidence of oropharyngeal cancers is increasing, particularly in men in their 40’s, 50’s, and 60’s, and is not associated with smoking. Most present with advanced disease but fortunately the prognosis is excellent with treatment.

Similar to national trends, Marin General Hospital has seen an increase in the number of oropharyngeal cancers over the past decade. Between 2013 and 2015, 77% of these cancers were associated with HPV. The majority were diagnosed at an advanced stage (77% stage IVA). Per national guidelines, patients with stage IVA disease were treated with combined radiation and chemotherapy, unless older age and poor health precluded chemotherapy. For patients treated with curative intent with combined radiation and chemotherapy, early outcome data suggests an excellent outcome. Ninety percent had a complete response (resolution) of their disease. As a reference, the 3 year survival of HPV associated stage III or IV oropharyngeal cancers treated with combined radiation and chemotherapy on a national clinical trial (RTOG 0129) was 82%. Although not directly comparable, the data suggests an excellent outcome for these patients.

Click here to view an image of the report chart.

Given the excellent survival of these patients and significant side effects of treatment, ongoing research is aimed at reducing the intensity of treatment to reduce side effects while maintaining the high cure rate. Among other clinical trials, Marin General Hospital is participating in NRG HN002, a phase 3 national clinical trial investigating a shorter course of radiation and chemotherapy versus radiation therapy alone.

At Marin General Hospital, we have a coordinated multidisciplinary team of head and neck surgical oncologists, radiation oncologists, medical oncologists, radiologists, pathologists, endocrinologists, oncology nurses, nutritionists, speech, swallowing, and physical therapists, social workers and patient navigators. To support patients through treatment, recovery and long term survivorship, we have a survivorship program and variety of holistic healing programs through our Center of Integrative Health and Wellness (CIHW). We also are supporting prevention efforts (HPV vaccination) in the community.