The Killer Inside Me 

Five years ago, I became one of the thousands of men diagnosed every year in the U.S. with HPV-related throat cancer.

click to enlarge PHOTO BY LANCE YAMAMOTO
  • Photo by Lance Yamamoto

In 2013, I had just returned from Europe. My marriage had ended and I was 43, frustrated, and sad. After spending a decade in Hollywood as an actor, I decided to move to the East Bay, where my brother was raising two kids in Berkeley. I remember getting a rankling cold that summer and after a week of hissing and hawking, my symptoms slowly began to fade. What remained was a single, swollen lymph node. It was a painless lump that settled and slowly flourished on the right side of my neck beneath my jawline. It concerned me in the way that lumps tend to. As it swelled, so did my anxiety about it.

It would occasion two visits to a local clinic, a dentist, and the emergency room — where it was chewed over, prodded, pricked, and biopsied — before an Ear, Nose and Throat doctor wordlessly placed a sheet of paper in front of me. It read: Metastatic Squamous Cell Carcinoma.

"What does it mean?" I asked, with a fresh lump in my throat.

"It means it's cancer."

Until that time, the only person I knew of with throat cancer was Michael Douglas, who declared he'd been stricken as a result of his enthusiastic and breathless devotion to the art of cunnilingus. His revelation was only part truth. (Douglas later said he actually had tongue cancer.) The new wave of throat cancers in men is a hidden outgrowth of a particular strain of the human papillomavirus (HPV) that is both undetectable and untreatable.

According to the CDC, nearly all sexually active people will get HPV at some point in their lifetime. P. Daniel Knott, the director of Facial Plastic, Aesthetic and Reconstructive Surgery in Otolaryngology-Head and Neck Surgery at UCSF Medical Center, notes, "There are over 150 different types of HPV, and certain types can lead to cancer — albeit with a very long and innocuous incubation period of more than 20 years." Ordinarily, HPV is cleared by an able immune system, but those with a high-risk strain of oral HPV can develop oropharyngeal cancer — meaning the back of the throat, including the base of the tongue and tonsils. "Persistent infections are the most problematic, and smokers and immunosuppressed individuals are particularly susceptible, although anyone can develop a persistent infection," said Knott. Oral HPV is more prevalent among men than women, and is believed to be spread largely via oral sex. It's estimated that HPV is responsible for 70 percent of oropharyngeal cancers in the U.S., and while the risk remains relatively low, the number of oropharyngeal cancer cases is expected to outnumber cervical cancer ones by 2020.

Historically, oropharyngeal cancers signaled a death knell. For this newer strain, I was told that my chances were more optimistic but that the treatment was "pretty brutal." My prognosis was 50/50.

If I was wondering before in which direction I wanted my life to go, it was now clear: away from death.

Trauma is, for the brain, like a tattoo. It scars and can last forever. As time passes, it fades and sometimes becomes distorted. There is one thing from that day that I remember with absolute clarity. My diagnosis was heralded by an instant, booming rain.

I was told that the first order of business would require the removal of my right tonsil, which would be sent to a lab for testing.

"We'll have to take out all those lymph nodes, too."

To illustrate, the doctor made a yanking motion like he was firing up a chainsaw. He then stepped outside to take a call. He discussed his lunch with fervor. I walked over to a mirror that hung on the opposite wall and had a look at myself. Flushed and unplugged, I stared at the hulking gobstopper that now had a name and a function.

What will become of you?

I scheduled the tonsillectomy and stepped out into a dripping courtyard.

Over the next few days I passed along the news to family and a few friends. These talks were mostly just plain sad. But at the center of each was a soft warmth. Wagons were circled as were dates on the calendar. There was an appointment with an oncologist, a radiation oncologist, and an oral surgeon.

When the tonsil was tested and shown to be non-malignant, a PET scan was scheduled to find out if the cancer had spread to other parts of my body. I lay still on a platform while a scanner clicked and droned around me. It would be three days before my radiology oncologist notified me that the scan revealed a small spot at the base of my tongue. Rather than surgery, I was prescribed radiation treatment with supplemental chemotherapy. Five days a week for six weeks I would receive a mega dose of radiation to my head and neck. Once a week I would endure an infusion of nuclear sludge (Cisplatin). I was told that during this time I should expect that my taste buds would fizzle out, my saliva glands would wither and fail, and my throat would be become a dry, dusty cranny. I would also lose a swath of hair along the back of my neck and my beard would fall out. At this same visit, I was tattooed and fitted for a mask that would be placed over my head and shoulders and clamped onto a table to immobilize me during the radiation treatments.


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