Hi Bob,
Your initial experience (neck lump, tonsillar cancer, tonsillectomy) is almost identical to that of my husband's. He too was a non-smoker. He was (as suspected)
HPV+ and was treated at Johns Hopkins.
The chances are very high, but not 100%, that your cancer is also due to
HPV. A recent paper in New England Journal of Medicine (D'Souza et al May 10) showed that of 100 tonsillar/ base-of-tongue cancers at Hopkins, 72% had
HPV+ tumors. If your center does not test for
HPV, Hopkins can do it, see web site
http://pathology.jhu.edu/labservices/hpv.cfm The importance is that it affects prognosis (better) and recurrence rate (lower) rather than treatment.
Secondly, at Hopkins at least, some doctors are reconsidering treatment plans for
HPV+ tumors. However right now, as Brian says, the initial treatment plan does not change --- it is almost always chemoradiation -- but the ENTs are not recommending ND for
HPV+ patients who have shown a complete clinical response to chemoradiation. This is a 180 degree flip from when we first consulted with our ENT, by the way. He says he would still want to do a ND on a smoker. He also told us that ND can give about a 5-10% increase in local control but there is less evidence for improved 5-year survival, study results have been mixed. (There have been few studies published, as Brian says, most are retrospective analyses, and none to my knowledge stratified patients into
HPV+ and
HPV- subgroups, as was strongly recommended by Dr. Maura Gillison in her Dec. '06 J. of Oncology editorial.)
HPV+ cancers are biologically different from those caused by smoking, our RO recently told us that research is showing the cells apparently retain normal "cell death" (apoptosis) signalling when damaged which is why the cancer seems to respond better to treatment.
This is a geat forum, you will get lots of help and encouragement -- but don't neglect looking through the OCF web pages themselves for help with diagnosis, treatment, side-effects etc. The information is invaluable!
Best luck,
Gail
