This is currently my third week in ENT and so far, I’ve learned that it DOES NOT only involve the head and neck. Other organ systems that may play a role in ENT disorders includes but not limited to: dermatology, pulmonary, neurology, psychology, pulmonary, GI, and even GYN or urology.
Today, I had the opportunity to observe a neck dissection and mass removal. The case was supposed to be followed by a transoral robotic surgery (TORS) radical tonsillectomy (in other words, removal of the tumors on the tonsils). Unfortunately, given the size and location of the tumor, the surgeon decided it was in the patient’s best interest to go through radiation instead of having her tonsils remove. Removing the tonsils would also mean removing the superior aspect of her hard palate causing such great defect that she will never be able to swallow again. **Sometimes, just because YOU can do something, does that mean you SHOULD?**
So that ties into my first statement. How does ENT and in this case, GYN come together? For years, you’ve probably heard of advertising of promotion for Human papillomavirus (HPV) vaccine (Gardasil). Did you know that 70% of oropharyngeal cancers (cancers that affect the middle part of the throat, soft palate, base of tongue and tonsils) are caused by the HPV!? More than ½ of oropharyngeal cancers are linked to HPV type 16.
Let’s take a step back and learn about Human Papilloma Virus (HPV). It is a common sexually transmitted infection that affects the skin and the lining of the mouth, throat, genitals, and anal areas. The majority of those infected with HPV will appear to be asymptomatic (without symptoms), and their immune system will take care of the virus without any treatment. When the body cannot get rid of the infection, the virus invades the cells causing a tumor to grow and become cancerous.
Now there are multiple strains of HPV, the MC type being cervical cancer (part of what is screened when women get a pap smear), but slowly we’re finding out that HPV oral related cancers are surpassing incidence rates of cervical cancer. Risk factors for oropharyngeal cancer greatly increase with the use of smoking cigarettes and alcohol
They say the rate of oropharyngeal cancer have increased 200% during the last decade. Patients from the baby boomer age are at the greatest risk and the effects 1 in 4 Americans. Unfortunately, the majority of these cases goes unnoticed and diagnosis is made after the cancer spreads and appears as a mass in their neck or a swollen lymph node.
Currently, there are no specific tests to screen for oropharynx HPV, but new research is taking place. Hopefully, in the near future, we will have the ability to detect and prevent HPV-associated oropharyngeal cancer.
It’s an exciting time to be in medicine! Don’t you agree?