The journey
/My family tree is fairly littered with doctors—my great grandfather, grandfather, and uncle were surgeons; my brother-in-law is an internal medicine physician; and my niece is a resident head and neck surgeon who specializes in cancers of that region. I’m pretty sure my mother, who was always eager to diagnose and prescribe for her family, also claimed a medical background to those unwary enough to take her advice at face value. So perhaps it’s not without cause that I focus overly much on my health.
On balance, health anxiety (what was once termed hypochondria) offers few rewards. There’s the resulting anxiety, which, if you’ve never experienced it, is something I wouldn’t recommend taking up in your off hours. And then there’s the reputation you earn through routine visits to your doctor for your many illusory ailments—a waste of time for the doctor and only a fleeting dose of reassurance for the afflicted.
I have discovered one benefit, however. Though any good medical professional will warn you away from the practice because it fuels rather than relieves anxiety, you develop the inclination and ability to conduct thorough research of rare diseases. Sometimes the sources of the resulting research are even reputable—websites not designed to increase your paranoia or provide testimonials from the untrained, but rather the CDC, NIH, Mayo Clinic, and international cancer centers.
I turned to these sites when something clearly wrong cropped up in my neck.
I looked into maladies that might cause a lymph node to swell over time when there were no accompanying signs of infection. In short order, I narrowed the possibilities before seeing the ENT my primary care physician had referred me to. I hoped that I was wrong—again—but if not, I was prepared.
Although those with health anxiety can take a certain grim I-told-you-so satisfaction in finally saying “I have cancer,” I would have preferred the embarrassment of panicking over nothing. But no, this time it was real. An ultrasound, up-close-and-personal nasoscope examination, and surgical biopsy confirmed that I had an HPV (human papillomavirus) related cancer.
While HPV is sexually transmitted, over a lifetime pretty much everyone who’s engaged in sexual congress has one form of it or another. In most cases, your immune system takes care of it, as it does with so many viruses, and you exhibit no ill effects. Any ill effects that do result are typically warts on your more intimate parts. Just freeze ’em, burn ’em, or medicate ’em and they’re gone.
There are umpteen strains of HPV and most cause no lasting harm. It’s the rare strains (HPV 16 and 18) that can result in cancer—again in the intimate areas. In women it most commonly affects the cervix, and in men, the back of the throat. (I needn’t go into gross detail about how it gets there—suffice it to say that I term it the “cancer of consideration” and we’ll leave it at that.)
HPV-related cancers are more common in men, partly because early signs of disease are detected in a woman’s PAP smear and dealt with before things head south. Dental hygienists now routinely check the inside of your mouth for signs of this stuff, but they can’t see the tongue root and surrounding tissues, where it commonly takes hold. For this reason it often remains undetected until it’s spread to a neighboring lymph node.
This form of cancer incubates for a very long time. The tumor on my tongue was the result of indiscretions of my youth rather than something planted in the last couple of decades. As such, we’re seeing increased occurrences of this stuff in men in their 60s—post sexual revolution/pre-AIDS, when STDs were an annoyance rather than life-threatening.
This helps explain why the relationship between oral cancer and HPV was established only within the past 15 years or so. Previously, these cancers were almost entirely attributed to tobacco and alcohol use. Suddenly, men in my age group who had no history of abusing these substances started showing up with tumors in their mouths and throats. As it was known that HPV was a cause of cervical cancers, it wasn’t a great leap to posit that it could also cause cancer elsewhere.
To the extent that there’s good news, HPV-related cancers are easier to treat and that treatment offers far brighter prognoses than the old-fashioned kind. As my niece put it, “If you’re going to have a cancer of the head and neck, this is the one you want.”
Yay? Yes, but it’s still a serious thing. Thankfully there’s a vaccine, which is routinely given to girls around the age of 12, and less commonly to boys of the same age—the idea being that you want to vaccinate before the child becomes sexually active and when their immune system is at its best. The vaccine is administered in two doses, spaced months apart. Older children and adults typically receive three doses.
Girls receive the vaccine more commonly because it was originally targeted at preventing cervical cancer. But, as I can clearly attest, given the connection to oral cancer in men, it’s something parents of boys should also consider.
Sure, if you’re going to have a cancer of the head and neck, this is the one you want.
I’m fine, and will be fine, but seriously, given the choice, you don’t want it. I’ll tell you why over the next couple of weeks.
