Published: May 11, 2026
When Hannah McKinley walked into her local emergency department in July 2017 struggling to breathe, she was 26 years old. She lived a fairly carefree life, working in customer service and hanging out with friends on weekends. She received a diagnosis that would redefine her life. A CT scan revealed a mass in her throat. She was transferred to Norton Healthcare, where she was diagnosed with Stage 4 oropharyngeal squamous cell carcinoma — HPV-associated, aggressive and in a young woman who had never expected it.
She was under the care of Paul A. Tennant, M.D., head and neck surgical oncologist with Norton Cancer Institute.
“There were several [ear, nose and throat specialists] around, and Dr. Tennant told me the truth,” Hannah said. “I appreciated that he didn’t sugarcoat it.”
Hannah’s story is a case study in complex throat cancer treatment, along with the importance of direct, transparent clinical communication.
Hannah believes she had been symptomatic for about a year before her diagnosis — having trouble swallowing, significant unintentional weight loss and a persistent cough, which she attributed to common illnesses such as a cold. By the time imaging confirmed the mass, it had grown to roughly the size of a small strawberry on her vocal cord, effectively occluding her airway.
At 26, she was among the youngest patients Dr. Tennant had seen with oropharyngeal cancer of this severity. The etiology, confirmed via bloodwork and tissue analysis, was HPV — not tobacco use, though Hannah was a smoker at the time. Her cancer was attributed to an HPV strain not covered by the Gardasil vaccine she had received in adolescence. This highlights both the limitations of current prophylactic head and neck cancer coverage and the growing clinical burden of HPV-associated head and neck cancer, particularly in younger populations.
Research suggests HPV-related oropharyngeal cancers now account for the majority of oropharyngeal squamous cell carcinoma cases in the United States, with incidence rising steadily over the past two decades. While the disease is more prevalent in men, Hannah’s case reflects a lesser-discussed reality: HPV-related cancers in women extend well beyond the cervix.
Within days of diagnosis, Hannah underwent tracheostomy placement, percutaneous endoscopic gastrostomy tube insertion, central venous port placement and extraction of her wisdom teeth — all in the same week, in anticipation of the irritation expected from concurrent chemotherapy and radiation.
Hannah declined surgical laryngectomy in favor of organ-preservation therapy and began a simultaneous radiation therapy protocol in August 2017.
“My thought was, ‘I’m only 26. You’re not going to shut me up yet,’” Hannah said.
She received radiation five days a week for six weeks alongside chemotherapy and was also enrolled in a clinical trial involving an investigational agent — now Food and Drug Administration-approved — in addition to standard therapy.
Side effects were significant: severe nausea, fatigue, cervical edema and profound mucositis that prevented oral intake. Hannah used medical cannabis throughout treatment to manage nausea and vomiting. Her last chemotherapy infusion was in late September 2017 — significant for the end of her treatment and for the day her future husband proposed.
By December 2017 — fewer than six months from diagnosis — imaging and clinical examination confirmed the absence of cancer.
Hannah had been counseled prior to treatment about the reproductive risks of chemoradiation and offered egg preservation, which she declined. Eight months after achieving remission, she conceived naturally. Her son, Easton, was born and is now approaching his 7th birthday.
“He’s the light of my life,” Hannah said. “I never thought I even wanted kids, but now I’m a mom and a stepmom. I wouldn’t want it any other way.”
Hannah’s clinical course did not end with remission. In 2024, approximately seven years after treatment, she developed a fistula in her upper airway — a known risk after of radiation to the head and neck — that caused progressive narrowing of the airway and necessitated reinsertion of the tracheostomy. She currently remains tracheostomy-dependent. Removal depends on tissue healing and resolution of radiation-induced fibrosis.
She continues surveillance endoscopy every six months via flexible nasopharyngoscopy. To date, she remains free of recurrent disease.
Hannah hopes to have the tracheostomy removed so she can return to some sense of normalcy.
“I never thought I would miss work,” she said. “But I want to get back to work and back to my life. I want to be there for my kid.”
Hannah’s case illustrates several important considerations for clinicians managing head and neck cancer:
HPV strain specificity matters. Standard prophylactic vaccination does not mean protection against all oncogenic HPV strains, and a vaccination history should not be used to rule out HPV-associated malignancy.
Late radiation toxicity is a long-term management challenge. Radiation-induced fibrosis and fistula formation can emerge years after treatment completion, requiring ongoing multidisciplinary surveillance even in patients who appear to be thriving.
Fertility counseling is essential, even when patients decline intervention. Hannah’s case — a spontaneous pregnancy following chemoradiation in a patient who had been counseled on reproductive risk — is clinically notable and should not be generalized, but reinforces the importance of individualized reproductive counseling prior to treatment.
Patient-centered communication drives engagement. Hannah cited her physician’s direct, unambiguous communication style as a significant factor in her trust and treatment adherence. Clinicians managing complex diagnoses may find value in reflecting on how candor and transparency affect the therapeutic relationship.
Hannah is now focused on decannulation, returning to work and being present for her family. She regularly refers people in her community to her care team when they or their loved ones face head and neck cancer diagnoses.
“He’s very thorough,” she said of Dr. Tennant. “Go get set up with a plan. Go get set up with what you need to do.”