Monday 23 April 2018

'I was diagnosed with throat cancer caused by HPV'

HPV can cause cervical cancer, but also many other types of the disease. our reporter talks to throat cancer survivor John Cassidy, who urges everyone to visit their GP as soon as they have any health concerns

John Cassidy, pictured outside his home in Sandymount, Dublin. Photo: Damien Eagers
John Cassidy, pictured outside his home in Sandymount, Dublin. Photo: Damien Eagers

Arlene Harris

Human papilloma virus (HPV) is the name for a large group of related but different viruses, the most well-known of which is responsible for the common warts on hands and feet. Approximately 18 types of the virus are known to cause cancers of one type or another - with types 16 and 18 responsible for seven out of 10 cervical cancer cases.

But it can also be the reason behind other cancers, including those of the head and neck, and while it is often associated with women, it can also affect men and can strike at any age.

John Cassidy from Dublin has survived cancer of the tonsils and says that although he didn't notice anything untoward for quite some time, as soon as he spotted a swelling on his neck, he went straight to his GP.

"Towards the end of 2015, I seemed to have a persistent catch in my throat," he says. "I thought it was a cold so didn't do anything about it, but a few weeks later when I was shaving I noticed a bit of a swelling in the side of my neck. A friend of mine had recently been diagnosed with cancer, so although I didn't think it was anything serious, I made an appointment with the doctor just to be on the safe side."

John was prescribed a course of antibiotics and told to come back a week later, which was December 23, 2015. At this point the swelling had not reduced in size at all, so his GP referred him to a consultant and he was given the first available appointment in January 2016.

"I went to see the specialist with my wife Finola, who is very much a straight talker," says the father-of-three. "She asked him, on a scale of one to 10, how serious my condition was - but when he said eight or nine, we were both shocked.

"Up to this point I hadn't been worried, but I knew I was in a bit of bother. I was told I had to have a biopsy done and was holding out for some good news, but a week later when results showed that I had cancer of the tonsils, I was very upset - it was an extremely difficult time.

"But there was worse to come as he said that it was looking likely that I would need surgery which would involve opening up my face - and at that point I almost fainted with the shock."

Luckily for John (60), the consultant met with a multi-disciplinary team to discuss his case and after much deliberation, it was decided that a course of chemotherapy in tandem with 35 radiotherapy sessions would probably be strong enough to destroy the tumour at the back of his throat.

"Once the surgery was off the table, I felt great and it actually sounded funny when I was telling people how delighted I was to be having chemo and radiotherapy," he recalls. "I started treatment in March 2016 and this carried on until July of last year. It was a tough time all round and although I started off alright in the beginning, after three or four weeks, I began to feel really bad and couldn't eat anything. I then had to be hospitalised so I could be fed, as throughout the course of the treatment, I lost two stone.

"Four months after I began, I had a PET scan which came back with a positive result and three months after that, I had another scan which gave me the all-clear - I was absolutely thrilled. They say that being clear for 12 months is a good indication that the cancer will not return and to date, I have been 15 months cancer-free so the chances of it coming back are very low - I can't tell you how relieved I am."

According to Dr Sinead Brennan, radiation oncologist at St Luke's Hospital in Dublin, the incidence of tonsil and other types of oropharyngeal (throat) cancer is rare, but it is becoming more common because of the human papilloma virus.

"The HPV virus affects younger adults more than other types of head and neck cancer, which are often related to smoking and alcohol use," she says.

"As a result of this virus, the incidence of HPV-related oropharyngeal cancer is expected to exceed that of cervical cancer.

"But thankfully this type of cancer responds extremely well to treatment, which usually involves radiotherapy and sometimes chemotherapy. The most common symptoms are a persistent sore throat or lump in the neck."

Dr Robert O'Connor is head of research at the Irish Cancer Society. He says most people will get some form of HPV during their lifetime and while in most cases it will not become cancerous, vaccination is the best way of preventing it.

"HPV is readily transmitted by any form of intimate or sexual contact and is so common that nearly all sexually active men and women will get at least one type of HPV at some point in their lives, and many people will be infected multiple times," he says.

"In fact, most people never know that they have been infected and may give HPV to a partner without knowing it.

"Gardasil 4 is the HPV vaccine currently used in the national HPV vaccination programme. It provides protection against the two dominant cancer-causing strains and two most common causes of genital warts and it is most effective if given before contact with the virus, so before sexual activity occurs.

"In total, HPV causes approximately 420 cancers - resulting in 130 deaths - in Ireland every year. Vaccination can stop this.

"Generally, nine out of 10 HPV infections go away by themselves within two years. But some will persist and greatly increase the risks cancers and other diseases."

HPV can cause:

• Abnormal growths in the female cervix. These pre-cancers are picked up by cervical cancer screening and are so common that approximately one in 10 Irish women will need painful invasive treatment to remove these growths and reduce the cancers of later cancer development

• Cancers of the cervix, vagina, and vulva;

• Cancers of the penis;

• Cancers of the anus and back of the throat, including the base of the tongue and tonsils (oropharynx) in women and men;

• Other strains of HPV can cause warts, including genital warts, in men and women.

Dr O'Connor says: "A superior immune response has been demonstrated at the age it is offered to girls under the HSE's vaccination programme.

"The vaccine schedule varies depending on the age of the person and those under 15 need two doses, while those 15 and older need three doses, with all doses given over a six-month period."

While vaccination is currently available free of charge to teenage girls, boys are not eligible, and the oncology specialist says this is something which should change.

"HPV vaccines have been shown to be effective in preventing infection in men as well as women," says Dr O'Connor.

"When the vaccine was originally developed, HPV was known to cause cervical cancer.

"In the intervening years, science has found that HPV can cause other cancers of men and women, but it takes time for the evidence to amass, showing that vaccination can reduce HPV infections in men too.

"As this evidence gets disseminated, the health systems of more and more countries are adopting a policy of vaccination of boys and girls - a universal or gender-neutral vaccination."

Currently, the Health Information and Quality Authority is assessing whether the vaccine should be made available for free to boys, and will make a recommendation to the Department of Health on the matter in 2018.

"While 335 women are diagnosed with cancers caused by HPV each year, it is also important to note that 85 men in Ireland annually develop a cancer, which could potentially be prevented by a simple and safe vaccination," says Dr O'Connor.

"The Irish Cancer Society believes it is time for the Government to invest in the extension of the national HPV school vaccination programme to boys, so that as many lives as possible can be saved."

While John Cassidy, who works for Irish Rail, was well beyond vaccination age, he says fast action most likely saved his life, and he encourages others to ensure they pay attention to their bodies, not to ignore anything suspicious, and not to be afraid to go to the doctor.

"I am extremely fortunate to be where I am today," he says. "I am the sort of person who doesn't leave things to chance and if I hadn't gone to my GP when I did, it could be a different story today. As it is, my energy levels are affected and I have damaged saliva glands, but that's a small price to pay for my life.

"I would advise anyone who is worried about any aspect of their health to just go and see the doctor straight away - don't sit on it as it won't go away.

"I know lots of people don't like going to the doctor, but I am proof that you need to just take the matter in hand and deal with it - it is worth it in the end."

* For more information, see cancer.ie

SO WHAT IS HPV?

HPV - human papilloma virus - represents a family of very common viruses that are passed on during sex.

Most people will get HPV infection in their lifetime and it usually clears up by itself. If you smoke, it can prevent the infection from clearing up. Some forms of the virus can also cause genital warts.

Every year in Ireland, around 420 people are diagnosed with a cancer caused by HPV.

For women, ongoing HPV infections can cause abnormal changes in the lining of the cervix. These changes, if left untreated, can lead to cervical cancer.

Most cervical cancers are caused by the HPV virus. HPV has also been strongly linked to a number of other cancers in men and women including cancers of the anus, mouth and throat, vulva, vagina and penis.

The HPV vaccine works in the same way as other vaccines. The body reacts by making special proteins, called antibodies, which help the immune system fight and clear the HPV infection so it can't cause cancer.

The vaccine works best for girls and boys who have not been exposed to the virus through sexual activity, although it can also be given to adults up to 26 years of age.

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