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.