Author: staff, WVU Medicine News
Head and neck surgical oncologists at WVU Medicine, the WVU Cancer Institute, and across the country are seeing increased incidences of tonsil cancer.
“The majority of tonsil cancers, nearly 70 percent, are caused by human papilloma virus (HPV),” Meghan Turner, M.D., head and neck surgeon in the WVU Medicine Department of Otolaryngology, said. “In the last 10 years, tonsil cancer caused by HPV has become more common than cervical cancer caused by the same virus.”
In most cases of HPV infection, the body fights off the virus like it would the common cold. In other cases, the virus remains in the body, increasing the risk of both tonsil and cervical cancer.
Unlike cervical cancer, there is no regular screening for tonsil cancer. Most commonly, tonsil cancer is first diagnosed as a nontender mass in the neck.
“Another common presentation for tonsil cancer is actually recurrent or persistent tonsil pain in spite of treatment for a throat infection,” Dr. Turner said. “This happens between the ages of 50 and 60. It may seem like recurrent strep throat, but it is uncommon for people in that age range to develop recurrent strep throat. If you’re having pain that isn’t resolved after a course of antibiotics, you should ask your doctor if it could possibly be something like tonsil cancer.”
It is also regularly discovered during routine dental visits, appearing as asymmetrical tonsils.
Those who have had their tonsils removed by tonsillectomy are not immune to tonsil cancer because they still have lingual tonsil tissue in the base of the tongue, where cancer is more difficult to detect.
If tonsil cancer is suspected, a biopsy of the tonsil or neck mass can is easily performed in the office to look for cancer. Determining whether the cancer is related to HPV can be done in two ways: using special stains on the biopsy tissue and/or a blood test. The blood test can be drawn after treatment to monitor the patient for recurrence.
“The test looks for circulating tumor DNA, which is DNA produced by the virus in your tumor,” Turner said. “When a patient comes to me for surgery to remove tonsil cancer, I will test their blood before surgery and again three-to-six weeks after to see if the DNA level goes from detected to undetected. We can then continue to use circulating tumor DNA during surveillance visits to identify any recurrence of the cancer.”
Patients have options for the treatment of tonsil cancer. Surgery, radiation, and chemotherapy all have a role. Some patients will be candidates for surgery, with either minimally invasive transoral robotic surgery and neck dissection, while others might still require open surgery and complex reconstruction. The approach to treatment will vary depending on the location and stage of the cancer, the patient’s health history, and previous cancer history.
The HPV vaccine has contributed to a recent decline of cervical cancers caused by HPV, but tonsil cancer rates are still on the rise. It is more prevalent in men because the HPV vaccine was marketed toward young women when it was first FDA approved in the prevention of cervical cancer. However, HPV vaccines are now available and FDA approved for both men and women up to age 45 for all HPV-related cancers, including tonsil cancer.
“There have been studies showing that patients who get the vaccines have less HPV in their system,” Turner said. “By getting the vaccine, you are also protecting others because you shed less virus through your oral secretions. Also, it may target your immune system and improve its response to HPV-related cancers. The vaccine primes your body to clear the virus.”
In recent years, people have been marrying later in life and having multiple intimate partners while they are working and establishing their careers. This increases the incidence of exposure to HPV, with most, around 90 percent, being exposed by the age of 21. Having as few as five oral sex partners in one’s lifetime is associated with a significantly increased risk of tonsil cancer.
“There should be no stigma around HPV infection because around 90 percent of us have had it,” Turner said. “Some patients are concerned because it is spread through sexual activity, and they are afraid it implies risky sexual behavior. But, we are humans, and human papilloma virus is spread by human behavior.”