HJBR May/Jun 2021

HEALTHCARE JOURNAL OF BATON ROUGE I  MAY / JUN 2021 47 Andrew Fuson, MD Otolaryngologist Mary Bird Perkins – Our Lady of the Lake Cancer Center OROPHARYNGEAL CANCER SCREENING, HPV PREVENTION AND THE HPV VACCINE While there are well-established screen- ing recommendations for HPV in the cer- vix, there are no current recommenda- tions for HPV screening in the mouth and throat. Regular examinations by a dentist or primary care doctor are vital to early di- agnosis. In addition to traditional safe sex practices including dental dam and con- dom usage, the HPV vaccine holds signifi- cant promise in decreasing the occurrence of HPV-related oropharyngeal cancers. There are currently three HPV vaccines approved for use in the U.S., all of which protect against the most common strains of HPV that cause oropharyngeal cancer. The CDC recommends vaccination for both boys and girls as early as age nine, and up to age of 26 in all cases. Between the ages of 27-45 an HPV vaccine can be considered but is less likely to benefit as most people have been exposed to HPV by this age. After rigorous study, there has been no documented increased risk of ad- verse events following HPV vaccination. While there is currently no data confirm- ing the efficacy of the HPV vaccines in preventing oropharyngeal cancers, there is a growing body of evidence suggesting their remarkable efficacy against cervical cancer and precancerous lesions. DIAGNOSIS, STAGING AND TREATMENT Oropharyngeal cancer frequently has no symptoms and is sometimes discovered first in a lump on the neck. When oropha- ryngeal cancer does cause symptoms, it can cause a prolonged sore throat, pain or dif- ficulty swallowing or unexplained weight loss. When these symptoms are noted by a primary care physician or dentist, an ear nose and throat doctor should be consult- ed for further assessment. Oropharyngeal cancer is diagnosed by biopsy — either with a needle biopsy of a lump on the neck or a biopsy of the back of the throat. After cancer is diagnosed, the first step is to perform a staging workup. This usu- ally includes a CT (computed tomography) scan of the head and neck to assess the size and extent of the cancer and draining lymph nodes, and a PET (positron emission tomography) scan to be sure the cancer has not traveled to the rest of the body. There are currently no blood tests routinely used to detect oropharyngeal cancer. After the staging workup is complete, we collaborate with radiation oncologists, medical oncol- ogists and speech language pathologists to formulate a treatment plan. Oropharyngeal cancer is treated in sev- eral different ways. Traditionally, cancers of the back of the throat were treated with radiation, sometimes with the addition of chemotherapy. Surgery can also be used to remove the cancer in combination with radiation therapy. In the last 15 years, robotic surgery has gained popularity in the treatment of care- fully selected cancers in the back of the throat. There are also many clinical trials for the treatment of HPV positive oropha- ryngeal cancer, a vital resource in a rapidly developing field. With the availability of so many excel- lent treatment options for oropharyn- geal cancer, it is vital to have a team of physicians working together to develop the best treatment plan for each patient. This works best when head and neck sur- geons, radiation oncologists, medical on- cologists and speech language pathol- ogists meet regularly for tumor board meetings to discuss treatment plans for individual patients. FOLLOW UP, SURVEILLANCE AND SUPPORT After the treatment is completed, wheth- er primarily with radiation or surgery, pa- tients are followed very closely. Speech language pathologists teach and reinforce swallowing exercises while the patient recovers from surgery or radiation thera- py. The head and neck surgeon surveilles for any return of the cancer and monitors for side effects of therapy. Comprehen- sive cancer centers also offer many other resources for patients. These include in- house dieticians, social workers, licensed psychologists and counseling services. CONCLUSION The diagnosis of any head and neck cancer is a life altering event. With young- er, healthier patients being increasingly affected by HPV-related oropharyngeal cancer, multidisciplinary management and treatment selection has become in- creasingly important. Our focus in surgical oncology must remain on individualized treatment to ensure the best outcome for each patient. n Andrew Fuson, MD, is an otolaryngologist at Mary Bird Perkins – Our Lady of the Lake Cancer Cen- ter. Fuson attended Louisiana State University as an undergraduate while working as a nurses’ as- sistant at The Neuromedical Center. Fuson then received a medical degree from Louisiana State University School of Medicine at Shreveport and then completed the Otolaryngology – Head and Neck Surgery residency at The George Washing- ton University in Washington, D.C. He went on to receive additional training in head and neck oncology, transoral robotic surgery and micro- vascular reconstructive surgery at The University of Alabama at Birmingham. Fuson specializes in and is board certified in otolaryngology-head and neck surgery with a particular interest in transoral robotics and head and neck reconstruction.