Forty-two-year-old Manahawkin, New Jersey resident David Caldarella can recite a long list of dates off the top of his head. The first one starts with the day he found a lump on the right side of his neck while shaving. It was March 23, 2010. Caldarella immediately called his physician.
Caldarella's local otolaryngologist, or ENT, found a growth on his right tonsil. He removed the tonsil and did a biopsy of the growth. Then the news that changed Caldarella's life forever came on April 20, 2010 - he had cancer.
Just two days later, Caldarella met with David Cognetti, M.D., an otolaryngologist and head and neck specialist at Thomas Jefferson University Hospital. After an exam and additional testing, Dr. Cognetti had to deliver even more bad news - the cancer was stage IV squamous cell carcinoma. It was an aggressive throat cancer caused by the sexually transmitted human papillomavirus (HPV). The experience was startling for Caldarella.
Dr. Cognetti, who has had to give similar news to some of his other patients, says unfortunately Caldarella is part of a dramatic increase in the number of patients that he's seen with HPV-related throat cancer. "It's become an epidemic over the past 10 years where HPV-related throat cancer cases have grown rapidly," says Dr. Cognetti. "Traditionally, smoking and drinking have been the main causes of head and neck cancer. But now we're seeing non-smoking, non-drinking patients, and many of them."
The statistics echo what Dr. Cognetti has found. A recent study published in the journal Emerging Infectious Diseases found that cases of oropharyngeal cancer, primarily cancer of the tonsils, increased sevenfold from 1970 to 2007. Researchers found that while HPV caused only 54 percent of oropharyngeal cancers from 1998 - 1999, it caused 84 percent of these cancers in 2006 - 2007.
However, Dr. Cognetti says two things were on Caldarella's side. First, throat cancers are deadly, but survival rates are much better for people with HPV-related throat cancer. It's more treatable and curable. And while people who smoke and drink alcohol have worse outcomes, luckily for Caldarella, he did neither.
Dr. Cognetti first performed a neck dissection, which removed 72 lymph nodes on Caldarella's right side. An egg-sized tumor was also removed during the procedure, as well as the left tonsil.
A week later, Dr. Cognetti performed transoral robotic surgery to remove the remaining cancer cells on the back of Caldarella's tongue and walls of his throat. "Transoral robotic surgery is a new and innovative approach to treating head and neck cancer patients. The technology gives surgeons a higher level of visualization inside the back of the throat, and it gives patients a quicker recovery time, less pain and scarring, and less chance for blood loss."
Caldarella then started seven weeks of radiation and chemotherapy treatments combined. The side effects of radiation and chemotherapy can be severe, says Dr. Cognetti.
"With treatment, patients can have significant difficulty swallowing," says Dr. Cognetti. "Radiation can burn the mouth and throat, sometimes causing blisters. Patients can also suffer from extreme fatigue."
"The treatment caused me to have mouth sores and infections, making it virtually impossible to swallow anything, including water," says Caldarella. "What's more, during treatments I had to be hospitalized for health issues including kidney stones, bronchitis, dehydration and the insertion of a feeding tube."
For Caldarella, the burns, fatigue, and swallowing problem went away with weeks of therapy. But like many patients, Caldarella continues to have dryness of the mouth and throat. That is a common problem, according to Dr. Cognetti. "Radiation kills the tumor, but it also kills the salivary glands."
Caldarella slowly began to feel better in late fall 2010. He gained 15 pounds of the 65 pounds that he lost. And on November 11, he was told he was cancer-free. "I was so thankful. Now I'm beginning to get my life back."
Caldarella says he has a message for others. "HPV-related throat cancer has no signs or symptoms in most cases. When you see or think something may be wrong, act fast. After finding the lump, I saw a doctor right away. Acting fast and having good health helped me."
Dr. Cognetti says the most common symptoms of throat cancer include throat pain, difficulty swallowing, ear pain, bleeding in the mouth or throat, hoarseness, and a lump in the neck. He also says that decades can elapse between HPV infection and the appearance of cancer.
As for prevention, Dr. Cognetti says there are two vaccines currently approved for prevention of HPV-related cervical cancer. "It is not yet known whether the vaccines will protect against throat cancer, but the same HPV strains that cause cervical and vulvar cancer cause throat cancer."
Caldarella, who is single, credits his parents and loved ones for giving him strength. Calling them "David's Army," he says their support was the basis for him to create something positive to help other cancer patients. He is paying it forward with a foundation called "Dream and Believe Cancer Foundation." It started with a pizza party, which raised $15,000. Checks have already been distributed to individual patients as well as to Jefferson's Head and Neck Cancer program.
Thomas Jefferson University Hospital