According to Fleischmann's letter, on November 23, 2016, Moran woke up and found a dime-size blood stain on her pillowcase, which she initially thought was because she'd bitten her tongue. When the blood on her pillowcase re-appeared several times over the next few weeks, Fleischmann says he finally took a flashlight to look in her mouth to see what was going on. Her left tonsils were incredibly swollen. “I thought it was tonsillitis,” he wrote. The couple went to an ear, nose, and throat doctor, who took a biopsy and diagnosed Moran with stage IV squamous cell carcinoma. Moran underwent radiation and chemotherapy, but the cancer was too aggressive and she died just a few months later. Fleischmann says that the coroner told him that her throat cancer had spread to her spleen and even to her brain. “It got bad so fast,” he wrote.
Throat cancer is on the rise—in large part because of HPV.
Squamous cell carcinoma—the type that Moran had—is the most common type of throat cancer. These cancers make up 90 percent of malignancies in the throat, primarily because squamous cells line the entire inside of the mouth and throat, Ted Teknos, MD, Chair of Head and Neck Surgery at The Ohio State University Comprehensive Cancer Center, tells SELF. The other main type of throat cancer, adenocarcinoma, is less common because they arise from the cells of adrenal glands, and there are fewer of those than there are squamous cells. Most oropharyngeal cancers—cancers of the middle part of the throat, including the soft palate, base of the tongue, and tonsils—are squamous cell carcinomas.
Oropharyngeal cancers used to be rare and always related to chronic smoking and heavy drinking. The throat cancer rate was actually decreasing because the incidence of these habits was going down, but now the cancer rate is going back up—and affecting otherwise-healthy individuals—all because of HPV. Teknos said about half of the patients he sees in his clinic are diagnosed with throat cancer, when it used to be 15 to 20 percent. “We’re at the tip of a big epidemic of HPV-related malignancies,” Teknos said. “To put it in perspective, since the 1980s to the 2010s, [throat cancer] has increased by 228 percent, primarily because of the HPV virus.”
And this increase of HPV-related cancers is going to continue, experts say. “These adults got the virus 20 to 30 years ago. For some reason or another, it sat in their bodies for decades and then turned into cancer for a very small group of people,” Shlomo Koyfman, MD, a radiation oncologist at Cleveland Clinic, tells SELF. We’re now seeing a lot of throat cancer patients who are in their 40s and 50s, Teknos said, but soon we’ll see people who were infected with HPV 50 years ago who, as they reach their 70s, will have a much higher rate of throat cancer.
If you have HPV, don't freak out: It's incredibly common, typically clears on its own, and many strains of it don't actually cause cancer in the first place.
Most people are exposed to the sexually transmitted disease in their teens and 20s, through intimate contact, including sex, oral sex, and even open-mouth kissing. “The more exposures you have, the more susceptible you are to being a carrier of the disease,” Teknos said. “But, it’s incredibly common and the overwhelming majority of people don’t develop a malignancy if they’re exposed.”
HPV is contagious, but usually works its way out of the body. According to the CDC, “Studies have shown that more than 90 percent of new HPV infections, including those with high-risk types, clear or become undetectable within two years, and clearance usually occurs in the first six months after infection.”
And it's also important to remember that not all HPV strains even cause cancer in the first place. Low-risk HPV can cause skin warts, and some strains don't have any noticeable impact at all.
Let's talk about high-risk HPV for a second, though—the kind that does cause cancer.
There are about a dozen high-risk HPV types and two—16 and 18—are responsible for most HPV-caused cancers. According to a report published this month by the Centers for Disease Control and Prevention (CDC), prevalence of high-risk oral HPV was 6.8% in men, and 1.2% in women. To put that in perspective, for high-risk genital HPV, the prevalence rate was 25.1% for men and 20.4% for women. Of those who have high-risk HPV, most will clear the virus without incident—meaning, won't get cancer. A small fraction will not be able to clear it and will get cancer at some point down the line.
Back when oropharyngeal cancers were always related to smoking and drinking, the cure rates were in the 30% rate. Now, with HPV-related cancer diagnoses, the survival rate ranges from 75 to 93%, depending on the severity of the diagnosis. And some cases are definitely severe: There is a small subset of patients whose cancer spreads in strange patterns—like to the liver, lungs, spleen and brain. “Moran’s case is emblematic of very aggressive HPV-related malignancy,” Teknos said, who was not her doctor. “Fortunately, only about 7 to 10 percent [of virus-caused cancer patients] will develop this.” Meaning that only 7 to 10% of people who do develop oral cancer from HPV will experience this aggressive kind.
The good news is that the majority of throat cancers can be treatable if you spot them early enough. Here are the signs the look out for—and how to keep yourself safe.
If you’re out of that age range (especially if you’re 40 or older), the big red flag for throat cancer is a painless lump in the neck that gets bigger over time. “Very often, with virus-caused cancer, it starts small in the tonsils, then spreads to the lymph nodes and neck and gets big,” Koyfman said. If you haven’t had an infection recently—which could explain swollen lymph nodes—the first thing you need to rule out is a head and neck tumor because it’s really rare to have a non-tender lump in your neck, Teknos said. See your GP right away, and if the lump doesn’t improve (the doc may prescribe antibiotics), consult with a head and neck specialist.
As far as prevention: Avoid smoking and heavy drinking, and get the HPV vaccine if you can. High-risk HPV-infected individuals have no way of knowing they have the virus, meaning prevention is key. It’s currently recommended that boys receive the full course of the HPV vaccine before 21 and girls before age 26. It’s possible to get the vaccine after age 26, but you’ll have to pay around $500 out-of-pocket. “I tell women, if they have not had an HPV vaccine, they absolutely should get one,” Lauren Streicher, M.D., an associate professor of clinical obstetrics and gynecology at Northwestern University Feinberg School of Medicine and author of Sex Rx: Hormones, Health, and Your Best Sex Ever, previously told SELF."That means every single woman in a non-monogamous or new relationship, no matter how old you are. It is well worth the money to get vaccinated because it is extremely unlikely that you have been exposed to all nine HPV types covered by the vaccine and will therefore be protected,” she says.
Getting vaccinated and watching out for abnormalities in your neck are the most important things you can do to protect yourself from throat cancer. “People need to realize this is an incredibly common thing and the incidence rate is going up at a really sort of terrifying rate in the public,” Teknos said. “Be aware of it.”