Around 54,000 Americans will be diagnosed with oropharyngeal cancer, commonly known as throat cancer this year. Due to a lack of screening mechanisms for throat cancer, it is likely at a more advanced stage by the time a patient receives a diagnosis. Early detection is critical. Dr. Rachel Sizemore, Director of the Office of Oral Health, recently went on AFMC TV to discuss the importance of early detection in fighting the disease, what risk factors to look for, and ways to prevent oral cancer.
Increasing the proportion of oral and laryngeal cancers detected at the earliest stage is one of the U.S. Department of Health and Human Services’ Healthy People 2030 objectives. Why would this specific cancer be on their objectives list? Because oropharyngeal cancer (cancers that affect the lips, cheeks, gums, throat, and tongue) is one of the most preventable cancers if detected early. Oropharyngeal cancer is also unique in that it is the only cancer that can be prevented with a vaccine.
Signs and Symptoms
Oropharyngeal cancer can occur in the oral cavity, nose, pharynx, larynx (voice box), trachea or esophagus. Sometimes, more than one cancer can form at the same time.Because early detection is the biggest key to preventing oropharyngeal cancer, it’s important to be aware of the warning signs. “Typically, concerning legions are going to present [in the mouth] as red, white, or red and white,” Dr. Sizemore says. “Really, though, you want to look out for anything that looks out of place, meaning that its color or consistency is different from the texture around it on the oral mucosae.” Any of these signs would be a good reason to refer a patient to an oral health professional for further investigation. You may also need to refer some patients to an oral surgeon for a biopsy.
Malignant oral cancers appear most commonly on the floor of the mouth or the tongue, which is why dentists now perform oral cancer exams. “What we do is take a 2 by 2 square of gauze, pull the tongue out, and look down both sides,” Dr. Sizemore says. “If you happen to notice something on the lateral tongue, that would be a reason to refer the patient for further investigation.”
Additionally, unexplained hoarseness or a sore throat without an obvious cause could point to oropharyngeal cancer. “Oral cancers are often detected due to a swollen lymph node, so doing those tactile exams in the head and neck region and feeling for any swollen lymph nodes is an important part of a preventive exam,” Dr. Sizemore says.
Risk Factors
While there are several risk factors for oropharyngeal cancer, smoking and chewing tobacco are the most well-known. “One thing that may be lesser known about oral cancer is that melanomas can cause oral cavities,” Dr. Sizemore says. “So, traditional risk factors for melanoma, such as sun exposure, may also pose a risk to oral tissues.” One of the most pressing risk factors for oropharyngeal cancer is oral infection from human papillomavirus (HPV). While HPV is linked to other types of cancer, including cervical cancer, HPV type 16 is the type most commonly linked to cancer of the oropharynx, especially in the tonsil and on the tongue. HPV DNA is found in nearly 2 out of 3 oropharyngeal cancers. “Oropharyngeal cancer is currently the most common HPV-related cancer in Arkansas,” Dr. Sizemore warns.
Oropharyngeal cancer is currently the most common type of HPV-related cancer in Arkansas
Prevention is Critical
It’s important to realize that both men and women can contract HPV-related oropharyngeal cancer. “In Arkansas, however, men are diagnosed four times more frequently than women,” Dr. Sizemore says. Because there is no way to effectively screen for HPV-related oropharyngeal cancer, it’s often in a more advanced stage at the time of diagnosis. This further emphasizes the need for medical professionals to promote HPV vaccination and spread the word about the risks and warning signs of oropharyngeal cancer.
Because there are no screening mechanisms for HPV-related oropharyngeal cancer or HPV infection (for men), prevention is critical. “Thankfully, there is a vaccine available to prevent HPV infection. In turn, the vaccine prevents a large percentage of HPV-related oropharyngeal cancers,” Dr. Sizemore says. “The vaccine is recommended for anyone between the ages of 9 and 26. However, you can continue to get the vaccine all the way up to age 45 with shared clinical decision-making.”
HPV vaccination boasts what other vaccinations cannot: cancer prevention
In a state with high vaccine hesitancy, acceptance and widespread HPV vaccination can be difficult. “What’s important to remember, though,” Dr. Sizemore says, “is that HPV vaccination boasts what other vaccinations cannot at this point: cancer prevention.” That could be the information professionals need to convince their patients to get the vaccine. The HPV vaccine is currently the only known vaccine approved by the FDA for preventing a type of cancer. “If we can help patients (and their parents, if the patient is under 18) understand the serious ramifications of HPV-related oropharyngeal cancer that can be prevented with a simple vaccination series, that will go a long way to promoting public health and cancer prevention,” Dr. Sizemore adds.
For more information on treating oropharyngeal cancer, visit the National Cancer Institute’s Oropharyngeal Cancer Treatment page.
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