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Head and neck cancers usually start in the squamous cells lining the mucosal surfaces of the mouth, nose, throat, voice box and salivary glands.

“While head and neck cancers make up only about 5% of cancers, they can be particularly devastating because they can affect speaking, swallowing, breathing and appearance,” said Laurence DiNardo, M.D., Darlene and George P. Emerson, Jr. Professor and Chair of the Department of Otolaryngology/Head and Neck Surgery at VCU Health.

Use of tobacco products and alcohol have long been linked to an increased risk of head and neck cancer, but increasingly these cancers are associated with the human papillomavirus (HPV). HPV now causes most oropharyngeal cancers, an area which includes the base of the tongue and tonsils. It occasionally also affects the oral cavity as well as other mucosal-lined structures.

“While historically cervical cancer has been the most often linked to HPV, oropharyngeal cancer has actually surpassed cervical cancer in incidence,” said DiNardo.

HPV research at VCU

HPV vaccination, which was approved by the FDA in 2006, has the potential to prevent more than 90% of HPV-attributable cancers. The CDC recommends that 11- to 12-year-olds receive two doses of the vaccine; adults up to age 45 could also be recommended if they are unvaccinated. However, uptake remains low, with just 54.5% of adolescents aged 13-15 receiving 2 or 3 doses as recommended in 2020.

Researchers at Massey Cancer Center and across VCU are working to understand and address this public health issue. For instance, a recently published study by Shillpa Naavaal, B.D.S., M.S., M.P.H., associate professor of Dental Public Health and Policy and member of the Oral Health Services Research Core at the Philips Institute for Oral Health Research at the VCU School of Dentistry, examined adults’ perceptions about the importance of the HPV vaccine in preventing oropharyngeal cancers and dentists’ role in HPV education.

Sunny Jung Kim, Ph.D., co-director of the Health Communication & Digital Innovations shared resource at Massey, recently published research on how to best fight misinformation about HPV vaccines and promote vaccination online. And in the area of developing new scientific approaches toward HPV, Iain Morgan, Ph.D., member of the Cancer Biology research program at Massey, was recently awarded more than $2.8 million in funding to better understand HPV replication and discover new targets and therapeutics that could help prevent or treat HPV-related cancers.

Screening and early detection

Men are four times as likely as women to get HPV-related head and neck cancer, and twice as likely to get any head and neck cancer in general. While there is no regular screening test for head and neck cancers, symptoms in the mouth or throat may be identified by dentists or primary care providers in a regular exam.

Early detection of head and neck cancer is key for a successful treatment. DiNardo recommends people look out for symptoms including unexplained hoarseness that lasts more than two weeks, non-healing ulcers in the mouth or throat, swallowing difficulties, unusual bleeding in the mouth, throat or ear pain, or a painless lump in the neck. If you are experiencing one of these symptoms, you should seek the advice of a doctor.

Advances in treatment

While HPV-associated cancers are on the rise, they tend to respond better to treatment than those cancers related to tobacco or alcohol use, says DiNardo. “At Massey, we offer the standard top-level treatment – chemotherapy, radiation and surgery – and we’re enrolling in several clinical trials to test newer chemotherapy agents for targeted therapy.”

“We’re also running trials for HPV-associated cancers since we do get such a good response, to test the efficacy of a decreased dose of chemoradiation therapy,” he added.

Erin Alesi, M.D., medical oncologist and member of the Developmental Therapeutics research program at Massey, co-chairs the disease working group for head & neck cancer clinical trials with DiNardo. “The goal is to open clinical trials to meet the needs of our patients,” she said. Massey offers trials for every stage of head and neck cancer with several of these trials focused on the benefit of immunotherapy and other targeted therapies.

“Immunotherapy is one of the newest types of treatment for various types of solid tumors that has come about in the past several years – there’s a lot of excitement about what it can do in all areas in addition to head and neck cancer,” said Alesi.

Patients are evaluated by a multidisciplinary tumor board, which identifies appropriate clinical trial options. Alesi added, “We’re always looking for how we can better treat these cancers and improve our rates of cure and control, and that’s what these clinical trials are offering.”

Written by: Annie Harris