Head and neck cancer: 300% increase in oropharyngeal cancer due to HPV

Over the past 30 years, oropharyngeal cancers, especially those of the pharynx, have increased by 300%, due to infection with HPV, the human papilloma virus. Head and neck cancers account for 17% of all cancers worldwide. Frightening data but which can be looked at with some glimmer thanks to the progress made both in early diagnosis, in therapies and in robotic surgery. The World Congress of the International Federation of Head and Neck Oncology Societies, now in its seventh edition (7^th World Congress of the International Federation of Head and Neck Oncologic Societies, IFHNOS). The event, which takes place every 4 years, is held for the first time in Italy and brings together 1500 experts from all over the world until 25 June in Rome.

The risk factors

The causes of head and neck tumors are varied depending on the location of the neoplasm. Besides smoking and alcohol, the other major risk factor is HPV infection. “They are very difficult pathologies to cure due to the variety of histological types, the site of onset and the aesthetic and functional implications of the affected organs. They can affect the nose and paranasal sinuses, facial skin, soft tissues, salivary glands, thyroid, oral cavity and lips, pharynx, larynx, cervical oesophagus, neck, i.e. all neoplasms above the clavicle excluding cerebral ones”, he explains Joseph Spriano, head of Otolaryngology at the IRCCS Humanitas Clinical Institute in Rozzano (Milan), director of the School of Specialization in Otolaryngology of Humanitas University and president of the Congress. “If we consider all head and neck cancers – continues Spriano – over 70% is caused by smoking and alcohol. The effect of the two factors is synergistic: the risk multiplies and is eighty times higher than in those who do not smoke and do not drink alcohol for oral cavity cancer and twelve times for that of the larynx”.

A lesson against HPV

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The importance of an early diagnosis

While tumors caused by ‘smoking’ affect patients between 60 and 75 years of age, those caused by HPV affect younger people and are transmitted sexually. “When the disease is identified at an early stage – underlines Spriano – the chances of recovery vary from 75% to 100%. Too often, however, diagnoses occur at an advanced stage, especially due to an underestimation of symptoms, such as burning or lesions in the oral cavity, sore throat, tongue pain, lowering of the voice, painful and annoying swallowing or swelling in the neck. In the presence of one of these signs, which persists for more than three weeks, it is important to undergo an otorhinolaryngological examination to ascertain the nature of the disorder”.

Papilloma virus tumors, have you booked the vaccine?

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The role of HPV vaccination

Unfortunately, the reduction in incidence linked to the benefits of HPV vaccination will take decades and only after 2060 will there be a decrease. “In Italy, 40% of oropharyngeal tumors are attributable to HPV infection. Hence the importance of an effective weapon such as vaccination, capable of eliminating related HPV cancers. Immunization has been recommended and offered free of charge by the National Health Service since 2008 to girls and boys aged 11 and over”.

The immuno-chemotherapy combo lengthens survival

Clinicians today have several effective options for controlling head and neck cancer. In about 40% of patients who receive late-stage diagnosis, immunotherapy achieves long-term survival. “In the advanced stage, five-year survival is around 40%” says Spriano. “In cases showing PD-L1 protein expression, drug treatment is based on the combination of chemotherapy and immunotherapy. If PD-L1 expression is very high, immunotherapy alone may suffice. The latter, either alone or in combination with chemotherapy, offers a significant increase in median survival which is around 15 months. There is also a proportion of patients, approximately 40%, who achieve long-term survival. In patients who do not show PD-L1 expression, the treatment is based only on chemotherapy, which is better tolerated than in the past and more personalized, thanks also to the translational approach which allows the results of the research to be brought directly to the patient’s bed. laboratory”.

Less invasive, but personalized interventions with robotic surgery

And, thanks to the advances in robotic surgery, it is possible to avoid mutilating operations and protect the quality of life. Small mechanical arms are introduced that replicate the movement of the surgeon’s hands, removing the tumor through the mouth, without the need for external surgical access. In the past, treatments could leave very evident consequences on the patients’ faces, leading to serious problems from the point of view of the perception of one’s body and social relationships. “In many cases – says the president of Congress – the quality of life was compromised, due to difficulties in speaking and eating. The results of the most recent scientific studies with the use of innovations in surgery (laser, robotic, reconstructive), radiotherapy and medical oncology are presented at the Congress. Robotic surgery allows you to remove, through the mouth, tumors that in the past were removed through external incisions with the advantage of preserving the tissues, reducing aesthetic and functional damage, shortening hospitalization times by about a third, and promoting rapid resumption of family and work life. Even radiotherapy today is increasingly personalized, powerful, precise and less toxic. In particular, hadrontherapy uses radiations different from the traditional ones, with charged particles (hadrons, protons and carbon ions), endowed with very high precision and very effective in tumors such as those of the salivary glands and paranasal sinuses”.

The World Congress in Italy

The most important experts in the world in this field of oncology are present in the IFHNOS Congress. More than 500 members of the international Faculty are invited to give reports on progress in research and treatment. Panels, symposiums, training courses, round tables, debates, lectures and video surgery sessions are organized in 8 conference rooms. 30 symposiums of IFHNOS affiliated companies are planned with the presence of the top management of the scientific society: the CEO, Jatin Shah (Memorial Sloan Kettering Cancer Center in New York), the Director General, Claudio Cernea (University of Sao Paulo Brazil), and the Secretary General, Pankaj Chaturvedi (Tata Memorial Hospital, Mumbai). “The choice of Italy as the seat of the world assembly is the acknowledgment of the great value of our country’s research in head and neck cancers, which are the territory par excellence of multidisciplinarity – concludes Spriano. “In addition to otolaryngologists, who deal with the surgical part, medical oncologists, pathologists, radiation therapists, radiologists, nutritionists, psycho-oncologists, nuclear doctors are also involved in modern diagnostics and therapy. To promote the uniformity of education in head and neck cancer, IFHNOS organizes the ‘Global on Line Fellowship’ addressed to young specialists. Furthermore, to raise awareness among citizens, clinicians, patients and institutional representatives, every year IFHNOS promotes the ‘World Head and Neck Cancer Day’ on 27 July”.