How throat cancer treatment is changing

Today, treatment for throat cancer isn’t just focused on removing the cancer. Now that most patients successfully overcome the cancer, doctors are also focusing on developing treatments for throat cancer that limit side effects, including trouble swallowing, struggles with speech and changes to their appearance.

While throat cancer used to occur primarily in older patients with a history of alcohol and tobacco use, that’s changing.  

“Over the past couple of decades, we’ve been seeing more and more throat cancers in patients who are relatively young and have never smoked,” says Neil Gross, M.D., a head and neck cancer surgeon.

According to the Centers for Disease Control and Prevention, more than 70% of throat cancers are linked to the human papillomavirus (HPV). The average age at diagnosis is 61 for men and 62 for women.

We asked Gross about advances in treatment for throat cancer. Here’s what he had to say.

How is throat cancer treated?

That depends on where you go for treatment. Some hospitals rely more on surgery, while others treat primarily with radiation therapy with or without chemotherapy.

At MD Anderson, we specialize in all those types of treatment and select what’s best for each individual patient. We can really choose the right option for each patient based on their tumor size, location and other factors. It’s a real luxury for me as a doctor to be able to offer this variety and a real benefit for patients.

When patients with HPV-related throat cancer come to MD Anderson, they enter a fast-track program that helps patients get in and out quickly. They meet with different members of their care team, including radiation oncologists, medical oncologists, dentists specializing in cancer care, surgeons and speech pathologists.

How has treatment for throat cancer changed?

In the past, treatment was very difficult for patients with lifelong side effects. Now patients not only overcome cancer; they often have the opportunity to enjoy a high quality of life after treatment.

We’ve made advances in nearly all types of treatment for throat cancer in recent years, including work pioneered at MD Anderson. And through clinical trials, researchers are constantly studying news ways to treat the disease. At MD Anderson, we’re currently studying how drugs targeting the immune system can further improve the outcomes of patients with head and neck cancer, specifically HPV-associated oropharyngeal squamous cell carcinoma.

In addition, radiation therapy techniques have changed significantly over the past several decades. Through methods like intensity-modulated radiation therapy and now proton therapy and adaptive radiation therapy techniques, we’re able to tailor how much and where we deliver radiation, reducing side effects for patients. Surgery is one of the areas that has changed the most. For a long time, we had backed off from surgery for throat cancer treatment because it was so invasive  and damaging for patients. But now, thanks to the use of robotic surgery, patients have a much easier time recovering and experience fewer long-term side effects.

How else has robotic surgery changed treatment?

There’s no doubt that robotic surgery is better for the patient than more invasive approaches like traditional – also called open – surgery. At MD Anderson, we’re using a method called transoral robotic surgery (TORS). To do this, we use a highly specialized robot with small and nimble arms designed specifically for operating on the mouth and throat.

Now throat cancer patients can expect to be in the hospital for about two or three days following TORS, mostly to help manage nutrition and pain. Before we used transoral robotic surgery, patients had to be in the hospital for about seven to 10 days. Previously, patients had to deal with major long-term side effects, like a scar on the face, missing teeth and bite problems, as well as tongue and swallowing dysfunction. Now, most don’t experience any of those major side effects, and we’ve found better ways to help patients cope with the temporary swallowing problems they do experience.

How does MD Anderson determine of the best treatment for each patient with throat cancer?

A lot of it depends on when the cancer is diagnosed. If we catch it early, we can simply treat the cancer with surgery alone. That’s considered a home run.

If the patient needs more than just surgery or radiation, then we look at the size and location of the tumor to determine the best overall treatment combination.

We’re also conducting clinical trials to look at other ways to determine the best type of treatment. Curtis Pickering, Ph.D., is exploring genetic biomarkers to improve treatment decisions. This insight can keep our patients from having to endure unnecessary treatments, and consequently, unnecessary side effects.

What kind of support is available for patients undergoing treatment for throat cancer at MD Anderson?

Many patients treated for throat cancer develop difficulty swallowing. So, every patient at MD Anderson is co-managed with a speech and swallowing therapist. Our speech and swallowing team created a comprehensive swallowing regimen for every patient treated at MD Anderson. They have also developed a Swallowing Boot Camp Program for previously treated patients. Since it was started seven years ago, more than 130 patients have completed this stepwise program in which they work with a speech therapist on therapeutic exercises and swallowing practice. Additionally, we have highly specialized dentists, maxillofacial prosthodontists and plastic surgeons who can help our patients with any dental issues, including creating custom prosthetics.

How is the HPV vaccine impacting throat cancer rates?

We’re seeing HPV-associated throat cancer in men in their 50s and 60s, but the disease can affect women and patients older or younger as well.

Patients diagnosed today were exposed to HPV long before a vaccine was developed. That’s why if you didn’t have the vaccine, it’s important to know the throat cancer symptoms and signs so you can catch it early. Throat cancer symptoms include a painless lump in the neck, a persistent sore throat, ear pain, and difficulty swallowing with associated weight loss in more advanced cases.

But HPV-associated throat cancer can be prevented in younger generations. The HPV vaccine is proven to be safe and effective. MD Anderson recommends the two-dose vaccine for boys and girls ages 9 to 14, with a target age to complete the series at ages 11 to 12. Starting at age 15 through age 26, three doses are needed. Men and women ages 27 to 45 should talk to their doctor about the benefits of the HPV vaccine. Health education experts are working hard to inform families about the benefits of vaccination.

I’m hoping that one day, we’ll have such low rates of HPV-related cancers that my job will no longer be needed and I can retire.

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