HPV-related Oropharynx Cancer Discoveries – Mayo Clinic


Papillomavirus-induced tumors
hit a very healthy, young patient population and nobody suspects that they
have a tumor. The first thing to pass on is, if a patient has a lump in the neck
for a long time, don’t ignore it. Don’t think it’s something common like a virus
or an infection think that they might have a tumor and do the appropriate
diagnostic tests. For our practice here at Mayo Clinic, probably 70% of the
cancers that we see are viral associated cancers. If you look at the graphs of the
number of cases per year that have been going up, it is exponential and in fact,
human papillomavirus, oropharynx cancer is now the eighth most common cancer in
men in the United States. And those numbers are continuing to go up, so it’s
very significant. Oropharynx cancers used to be related to heavy smoking and
heavy drinking, but in recent years we found that the majority of our patients
are young otherwise healthy non-smokers. And they tend to have this disease
because of the human papillomavirus. So treatment for HPV cancers is really
evolving, and you know when it was first recognized that they were causing the
cancers we were really still treating them exactly like the smoking and
drinking-related cancers. And now there’s research going on here at Mayo Clinic,
but also around the world, around the country looking at trying to treat them
differently because truly it’s a different disease. So from every
standpoint biologically, what causes it, how they respond to treatment, everything
is totally different from the smoking cancers. We have realized that we do not
need to prescribe the same exact treatment for every single tumor like
we’ve done historically. That we can cone down some of that treatment, giving just
enough treatment to get rid of the tumor. And not going a step beyond that much
treatment because it’s going to have lifelong side effects. One of the
clinical trials that we have available for certain patients, for example with
this type of HPV-related cancer, would be to do a less invasive surgery first with
a transoral robotic technique and if the patient is a good candidate
after we review your case and our multidisciplinary tumor conference, we
will see if you qualify for a trial where you receive half as much radiation
over two weeks rather than the six weeks of radiation therapy that could lead to
swallowing issues and dry mouth. That’s a very successful ongoing trial and that’s
something that would be available that’s unique to the Mayo Clinic. The most
surgery for tumors involve understanding where the boundary of that tumor is and
removing the entire thing. We call that narrow margin surgery. You can only do
narrow margin surgery if you have the help of a pathologist who’s very good at
reading that pathology and saying that’s normal tissue you’re around that tumor,
or no that’s tumor tissue even though it looks normal to your eye you need to go
further. Frozen section pathology was invented at the Mayo Clinic one hundred
years ago and we utilize it every single day for every tumor that we take out. We
have not only the most state-of-the-art radiation techniques where we can
deliver very focused X-ray techniques, but we also have proton beam. There are a whole number of steps, not only in defining the area where you need to
treat and the areas you don’t want to treat, but also things such as, is the
patient set up precisely every day so that we can deliver the same type of
radiation treatment. We have tolerances for example that the patient needs to be
within one to two millimeters of where they were set up when they came in for
treatment planning. Collectively we just have a huge amount of knowledge and
experience with head and neck cancer and so we can appreciate you know when
something is a little bit off, you know what the nuances are. We would love for
every patient we see here to be treated here, but sometimes it’s just not
possible, you know. There’s still families and jobs and things like that, so we also
coordinate all the time with you know physicians at outside institutions. One
of our strengths as well has been getting patients in quickly, getting all
their care coordinated quickly and having their care initiated
quickly. If somebody comes here and they have a suspected head and neck cancer, we can biopsy them and do scans and have a multidisciplinary consultation within
just a couple of days which, potentially could take weeks or months outside.
Exciting frontiers for head and neck cancer is really pushing the envelope to
improve and maximize quality of life. The biggest thing right now going on in
medical oncology would be the field of immunotherapy. You know, so this is the
idea of trying to help the body fight the cancer itself. This is not a new
concept, this has been around for a while, but we actually have drugs that
have been approved to do this and that’s just the tip of the iceberg. Genetic
analysis and typing of tumors is becoming a very important, individualized
medicine topic. One person’s tumor is not exactly like the other. They all have
sort of a unique symbiotic or pathologic relationship with that patient’s body.
And so if we can look at not only the tumor cells, but look at what are the
genetics, what happened to the cellular sort of genetic design here to
make this happen. The disease response is much better to radiation and
chemotherapy. It responds quite well to surgery and it’s a disease that requires
a new approach to both cure and also have very extended and improved quality
of life.

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