We have been told that it's not uncommon for HPV+ SCC patients to not have a discovered Primary when diagnosed as the patients' immune system sometimes clears it after cells break off and lodge in the nodes. A very common HPV+ presentation is BOT or Tonsil Primary with mets to a node or 2 but again sometimes the Primary can not be located. Now radiation is the ONLY treatment that will kill this cancer. Chemo is often added when nodes are infected as the chemo weakens the cancer cells and makes the radiation more effective. You will hear anywhere from 5 to 20 % better kill rates with chemo but chemo alone will NOT stop this cancer from spreading.

Not nearly enough is known about HPV+ SCC but what we do think is that it responds better to the traditional treatment (Radiation and chemo) and therefore has a smaller chance of recurrence than HPV- SCC. Some are trying to determine if a HPV+ patient can be given less radiation or less or no chemo and still achieve the goal which is to KILL the cancer. Unfortunately the standard treatment today for HPV+ patients is the same as HPV- patients. The obvious fear is if you under treat and cancer cells remain, they will continue to grow unabated requiring additional treatment down the road.

So here your husband is with an Occult Primary which MAY OR MAY NOT be eliminated and a infected node which was removed and possibly nodes which are still infected. Clearly if I were his RO I would err on the side of caution and recommend radiation at a minimum. I would also yield to the MO on the chemo decision. But if he decised to stop the ONLY treatment that can kill the cancer cells that still may be present he may well be signing his own death certificate and very painful one at that. This treatment usually only is bad for appx 7 weeks, SEVEN WEEKS is a mere bump in our life's path. Please do not him throw his life away over 7 weeks.