Shifts in Causation, Biology and Treatment of Head and Neck Cancer

We are witnessing an interesting epidemiologic shift that has scientific, social and medical implications. In this issue of CURE, we cover several dimensions of oropharyngeal (head and neck) cancer—one of the more common malignancies worldwide. Oropharyngeal cancer has been considered the prototypical cancer highly associated with tobacco and alcohol.

Over the past few years, researchers in the field of molecular epidemiology have uncovered a trend: A growing percentage of oropharyngeal cancers are associated with the human papillomavirus (HPV) as opposed to smoking. At the moment, treatment approaches are generally the same for smoking- and HPV-related cases, but this may change with the maturation of clinical experience and research initiatives in this area. Most disciplines of oncology are involved in the care of oropharyngeal cancer, and this requires a lot of coordination. Our goal is to equip readers with the knowledge to guide them or others through the concepts of treatment and how decisions are made.

Among the spectrum of issues for oropharyngeal cancer, the first line of defense is, of course, prevention. Smoking avoidance and alcohol abstinence or moderation are the obvious low-cost, effective behaviors, but there are now calls for HPV vaccination for both boys and girls. Screening at the time of dentist visits and using dye-containing tests in individuals at high-risk need further exploration. One of the major treatment dilemmas for more advanced but still localized cases is whether to proceed first with surgery or to use chemotherapy, radiation or both, either as the only (definitive) therapy, or before or after surgery.

Among the spectrum of issues for oropharyngeal cancer, the first line of defense is, of course, prevention.

Fortunately, advances in surgical techniques and chemoradiation treatment to minimize surgery have advanced significantly. We discuss these advances in our feature article to inform your decisions, especially when considering issues like long-term side effects of treatment.

What does the future hold for head and neck cancer? The only approved biologic therapy is the epidermal growth factor receptor antibody Erbitux (cetuximab), given with either chemotherapy or radiation. But newer molecular classifications and targeted therapies based on these subtypes are around the corner.