Author: Steve Hendrix – The Washington Post
Hearing the word “cancer” in a doctor’s office is bad enough. Hearing “stage 4” invokes even more dread. When I learned I had stage 4 HPV-related oral cancer, I didn’t know exactly what it meant, but I knew there wasn’t a stage 5.
Doctors use the standardized staging system to describe the location, size and extent of a cancer and its spread throughout the body. Using data on the treatment and survivability of each particular kind of cancer, clinicians combine these factors to produce a number from stage 1 (a small tumor confined to one spot) to stage 4 (a cancer that has spread, either to a single adjacent lymph node or to distant organs).
My cancer was stage 4A, a small tumor at the base of my tongue that had spread to a single lymph node in my neck.
My doctor immediately tried to soften the blow. There were problems with the staging rules as they applied to this kind of cancer, he said. HPV oropharyngeal cancers, while potentially fatal, were far more treatable than other oral cancers, particularly the ones related to tobacco and alcohol use that were used to define the staging standards.
He was right. A study published in the Lancet early this year found that the current guidelines lead to needless panic for the newly diagnosed. “At the present time, most patients with HPV+ oropharyngeal cancer are told they have (stage 4) disease, but the reality is that their outlook is similar to that of patients with the most curable malignant diseases,” the study authors wrote.
This month, the American Joint Committee on Cancer is releasing new guidelines for HPV-positive oropharyngeal cancer staging that will ease patient fears and make it easier for doctors to offer less-invasive treatment options.
“It’s remarkable,” said my own physician, Arjun Joshi of George Washington University. “Under the new system, you would only be a stage 1.”