2023-08-30 08:10:43
by Health Editor
Cases of oropharyngeal cancers have grown 300% in the last 30 years, but now there is a vaccine against the sexually transmitted virus
Every year in Italy about 10,000 people are diagnosed with head and neck cancer, a group of malignant neoplasms that can affect the upper aero-digestive tract (oral cavity, tongue, lips, throat, larynx and organ of the voice), salivaries, nasal cavities and paranasal sinuses. In most cases the disease is discovered late, at an advanced stage, when the therapies must be more invasive and the chances of recovery are less. Mainly to blame for the fact that these types of cancer, as various international surveys have shown, are little known and the symptoms are underestimated. The causes are many depending on the location of the tumors, in addition to smoking and alcohol in the last 30 years there has been a 300% increase in oropharyngeal (i.e. mouth) tumors, especially of the tonsil, due to HPV infection , the human papilloma virus – underlines Giuseppe Spriano, president of the IFHNOS (International Federation of Head and Neck Oncologic Societies) world congress held in Rome -. The reduction in incidence linked to the benefits of HPV vaccination will take decades and only after 2060 will there be a decrease.
The therapies
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. 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 explains Spriano, head of Otorhinolaryngology at the IRCCS Humanitas Clinical Institute in Rozzano (Milan) and director of the School of Specialization in Otorhinolaryngology of Humanitas University. These pathologies are very difficult to cure due to the variety of histological types, the site of onset and the aesthetic and functional implications of the affected organs. 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 the quality of life was compromised, due to difficulties in speaking and eating. Today much has been done to improve the quality of life of patients, even if many difficulties remain in the event of a late diagnosis.
Robotic surgery, radiotherapy and drugs
The results of the most recent scientific studies were presented at the congress with the use of innovations in surgery (laser, robotic, reconstructive), radiotherapy and medical oncology – says the expert -. 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. In advanced stages, the five-year survival of patients is around 40%: In cases that show the expression of the PD-L1 protein, the pharmacological treatment is based on the combination of chemotherapy and immunotherapy – he continues -. 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 an estimated 40% of patients 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 that allows the results of laboratory research to be brought directly to the patient’s bed .
Tobacco, alcohol, Papilloma virus and symptoms not to be overlooked
Approximately 75% of head and neck cancers can be attributed to the consumption of tobacco and alcoholic beverages: the effect of the two synergistic factors and the risk multiplies and is higher, compared to those who do not smoke and do not drink alcohol, by eighty times per cancer of the oral cavity and twelve times for that of the larynx. The surge in cases of cancer of the mouth, then, largely attributable to Papillomavirus infection, which is transmitted sexually and is well known to be responsible for various forms of cancer: of the uterine cervix (the first cause), but also of rarer types that affect the vulva, vagina, penis and anus. And of carcinomas affecting the mouth and throat. Precisely as a consequence of these damages, the HPV vaccination is offered free of charge in Italy to all males and females at the age of 12 (but also useful for adults). While “smoking” tumors affect patients between 60 and 75 years of age, those caused by HPV affect younger people and transmission occurs sexually – concludes Spriano -. When the disease is detected at an early stage, the chances of cure 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 signals, which persists for more than three weeks, it is important to undergo an otorhinolaryngological examination to ascertain the nature of the disorder.
August 30, 2023 (change August 30, 2023 | 08:10)
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