HPV

Changes in cancer staging: what you should know

Source: health.clevelandclinic.org
Author: staff

When you learn you have cancer, you want to know what to expect: How will doctors treat your illness? How effective is treatment likely to be?

Much depends on the way doctors first classify, or “stage,” your cancer, using the official staging manual from the American Joint Committee on Cancer. Staging guidelines continue to evolve as knowledge about individual tumor growth and innovative technologies come into play.

An ever-evolving system
“Historically, we staged cancers according to tumor size, lymph node involvement and the presence of metastases,” says oncologist Dale Shepard, MD, PhD.

“The latest staging manual incorporates new findings on the importance of changes in molecular DNA and tumor genomic profiling. This will affect many patients going forward.”

Among those most impacted by changes in staging are people newly diagnosed with breast cancer; head and neck cancer caused by human papillomavirus (HPV); or sarcoma.

How staging works
“Staging allows us to stratify patients into groups based on anatomic and other criteria. It gives us a framework for understanding the extent of disease,” Dr. Shepard explains.

Cancers are staged clinically and pathologically:

  • The clinical stage is determined during the initial workup for cancer.
  • The pathologic stage is determined by studying a surgically removed tumor sample under the microscope.

Adds Tumor Registry Manager Kate Tullio, MPH, MS, “Staging helps physicians and other researchers to compare patients with the same types of cancer to each other in a consistent way — so that we might learn more about these cancers and how to effectively treat them.”

Staging allows doctors to determine the best course of treatment for different types of cancer and helps families to understand the prognosis, or likely outcome, of that treatment.

It also allows doctors to offer patients a chance to participate in clinical trials of new therapies targeting their form of cancer.

The impact of DNA changes on breast cancer
In the past, most breast cancer patients with lymph node involvement were automatically classified as stage II or higher, and were often given chemotherapy.

“Previously, physicians considered only tumor size, lymph node involvement and spread of the cancer to distant areas of the body when staging breast cancer,” says Ms. Tullio.

Today, staging has improved with the addition of advanced multi-gene panel testing and specific information on the biology of the tumor.

“This incorporates what we have found clinically: that some patients previously identified with stage II breast cancer did better than others,” says Dr. Shepard. “In essence, patients with HER2-positive disease were more like patients with stage I disease.”

HPV’s effect on head and neck cancers
The classification of head and neck tumors has changed because of advances in genomic profiling.

“We now have a separate system for classifying head and neck cancer caused by HPV infection because we realize that, clinically, it is a different disease,” says Dr. Shepard.

Ms. Tullio notes that patients with head and neck cancers caused by HPV have a better prognosis — living longer, on average, than head and neck cancer patients without HPV.

“Patients with HPV-positive mouth or throat cancers usually respond well to treatment and may need less aggressive therapy than those who are HPV-negative,” she says.

Also new, adds Dr. Shepard, are separate classification systems for soft-tissue cancers called sarcomas. Doctors have found that, based on the primary tumor’s location, sarcomas will behave and respond to treatment differently.

How will these changes affect you?
The impact of these staging changes will be far greater for patients with cancers diagnosed on or after Jan. 1, 2018.

“If your cancer is new, then changes in classification may affect early decisions about your initial care and likely prognosis,” says Dr. Shepard.

If you received a cancer diagnosis before that date, the stage of your tumor will not change, Ms. Tullio notes. However, new data in the manual may allow your doctors to better assess and treat you.

Adds Dr. Shepard, “Talk to your doctor if you have any questions about the new staging systems. It’s important to be sure all the right tests are ordered to accurately assess your cancer.”

Doctors push HPV vaccine, Merck asks FDA to expand Gardasil 9 age range

Source: www.drugwatch.com
Author: Michelle Llamas, Emily Miller (editor)

Doctors, national cancer organizations and 70 nationally recognized cancer centers banded together in June to increase HPV vaccinations and improve cervical cancer screening. But they’re not the only ones pushing for more vaccinations.

HPV vaccine maker Merck requested the FDA expand the recommended age range for Gardasil 9. Gardasil 9 is currently the only HPV vaccination available in the U.S.

Nearly 80 million Americans get HPV infections each year. Of those people, about 32,500 get HPV-related cancers, according to the CDC.

Studies show the HPV vaccine is effective in protecting against the human papilloma virus. The virus can lead to several cancers. These include cervical, vaginal, vulvar, anal, penile or throat cancers.

HPV vaccination rates in the U.S. remain low. Doctors and cancer centers say low vaccination rates are a public health threat.

“HPV vaccination is cancer prevention,” Dr. Deanna Kepka, assistant professor in the University of Utah’s College of Nursing, said in a statement. “It is our best defense in stopping HPV infection in our youth and preventing HPV-related cancers in our communities.”

Right now, the vaccination rate among teens ages 13 to 17 is 60 percent. Doctors are pushing for an 80 percent HPV vaccination rate in pre-teen boys and girls.

“[Vaccination] combined with continued screening and treatment for cervical pre-cancers … could see the elimination of cervical cancer in the U.S. within 40 years,” Dr. Richard Wender, chief cancer control officer for the American Cancer Society, said in a news release. “No cancer has been eliminated yet, but we believe if these conditions are met, the elimination of cervical cancer is a very real possibility.”

Gardasil 9 requires two to three doses to be complete. Only 43 percent of teens get all required doses.

Studies show the vaccine is safe for most people. The most common side effects are headache, nausea, vomiting and fever.

But, the HPV vaccine may cause rare but serious side effects. The FDA’s Vaccine Adverse Event Reporting System has reports of autoimmune diseases, deaths and premature ovarian failure linked to the vaccine.

The National Vaccine Injury Compensation Program (VICP) has paid out millions to a few people who said the vaccine injured them. Since 2006, VICP has paid out or settled 126 HPV claims and dismissed 157.

Current campaigns urge pre-teens and teens to get the HPV vaccine. Merck wants more adults to get the vaccine, too.

At the beginning of June, the FDA accepted Merck’s application to expand the age range for Gardasil 9. The agency granted it priority review. The FDA originally approved Gardasil 9 for people ages 9 to 26. But Merck wants that age range expanded to include adults ages 27 to 45.

“Women and men ages 27 to 45 continue to be at risk for acquiring HPV, which can lead to cervical cancer and certain other HPV-related cancers and diseases,” Dr. Alain Luxembourg, Merck Laboratories’ director of clinical research, said in a statement.

HPV is a group of about 150 related viruses. Gardasil 9 protects against nine strains. The FDA hopes to reach a decision on the application by Oct. 2, 2018.

Praised West Palm attorney fought for many, but is now fighting for his life

Source: www.mypalmbeachpost.com
Author: Daphne Duret – Palm Beach Post Staff Writer

A knock on a door stopped Richard Tendler mid-sentence. His back straightened almost instinctively in his chair, just as it has at the first sign of every verdict. Two decades as a criminal defense attorney in Palm Beach County have taught the 51-year-old West Palm Beach man to never predict how things will go.

“I’ve had cases I thought I won come back guilty,” Tendler had said hours earlier. “Then there were cases I was sure I lost, and the jury would come back not guilty.”

Another certainty: Tendler knew was that he would go home a free man that night, regardless of his client’s fate. This time was different.

Tendler was seated in an examination room at Moffitt Cancer Center in Tampa, where he is one of 10 patients in an exclusive clinical trial for cancer patients whom other doctors have told to prepare to die. Knocking on the door was Dr. Christine Chung, who is treating Tendler and nine others with an immunotherapy regimen as part of a trial that includes 500 patients in the U.S. and around the world.

Chung, the chief of head and neck oncology at Moffitt, was ready to deliver her own verdict — on the results of Tendler’s third six-week cycle. She greeted Tendler’s larger-than-usual entourage that day with polite handshakes and a tight smile.

After the first two cycles, she said, the treatments have cut in half the size of one lesion on Tendler’s lung and slightly shrunk another. A pair of smaller lesions on his liver remained the same size. That much was welcome — though it’s still early in the treatments.

Regardless of whether it’s good or bad news, Tendler has been here before.

By the time he first felt a lump in his throat in December 2015, Tendler was just several months past one of his most high-profile cases. It ended with what was widely considered a great plea deal allowing Boynton Beach mother Heather Hironimus to escape criminal charges for running away with her then-4-year-old son to prevent his father from having him circumcised.

His previous cases ranged from the most tragic to the most bizarre, earning Tendler a reputation as a survivor of the grueling grind of private practice. Among his clients: People involved in deadly car wrecks, a university gunman in the wake of another college shooting, and a teenager charged with killing a goose.

Comforting his mother
Two weeks before Tendler discovered the lump in his throat, he had consoled his mother, Sonia, through a doctor’s tragic prognosis giving her just two months more to live with end-stage pancreatic cancer.

Her sister, his aunt Vera Muller, noticed the lump when he came to visit his mother at her Miami apartment.

“I said, ‘Oh, my God, Richard’ and he said ‘Shhh!’” she said before Tendler’s visit to Moffitt last month, putting her finger to her lips to mimic the gesture her nephew made back then. “He didn’t want his mother to worry.”

Doctors by then had confirmed Tendler’s suspicion. The lump was cancer, brought on by an illness Tendler didn’t know he, too, would soon be diagnosed with.

According to the Centers for Disease Control and Prevention, 79 million Americans had been infected with human papillomavirus, or HPV, as of last year. With 200 strains, most of which carry no symptoms and go away on their own, HPV is the most common sexually transmitted infection in the nation.

The strain Tendler contracted at some point in his life was the rare variety that caused his cancer, his doctors informed him. Although there now exists a vaccine for the virus that is recommended for teenage girls and boys alike, no such prevention existed when Tendler was growing up.

On Jan. 25, 2016, Tendler’s 49th birthday, he underwent a nine-hour surgery to remove the cancer from his throat. He had to be on a feeding tube for a month and recovered at his mother’s Miami apartment, with aunt Vera playing nurse to both her sister and her nephew.

Now 75, and moving to South Florida from Tendler’s native Venezuela, Vera Muller remembers her sister died six weeks into Tendler’s recovery. She was 68.

With his grief still fresh, Tendler then went through a grueling round of radiation and chemotherapy, which required him to live on the feeding tube for another four months.

“It was worse than the surgery,” Tendler remembered. “I couldn’t drink water. I couldn’t even swallow a pill.”

Three months later, Tendler returned to the courthouse much thinner and scarred from his surgery, but cancer-free according to his tests. His doctor reassured him that the worst was behind him.

“He told me ‘I’ve never had one come back,’” Tendler remembers.

His did.

In May 2017, doctors noticed a spot on his chest, and eventually discovered three cancerous lesions on his liver. The cancer had spread, or metastasized, the doctors told him.

Tendler remembers one oncologist telling him he only had months to live. The doctor suggested, matter-of-factly, that he prepare for his death.

“That oncologist talked to me like a piece of dirt,” Tendler said.

He visited several others, and although they were more gentle in their delivery, their news was largely the same. The sentence for the defense attorney was death, they told him, and it would be coming soon.

A doctor offers cautious hope
That summer, Tendler visited Chung at Moffitt. Having immigrated to the United States from Korea with her single mother and two brothers as a child, Chung went to medical school and decided she wanted to be an oncologist.

Tendler and Chung soon learned that, while in different professions, they shared similar views and experiences. Like Tendler’s clients, Chung’s patients are a varied group, including former smokers and people like Tendler, who contracted throat cancer from a rare strain of HPV. The common denominator: They all have a right to treatment.

“None of us is guaranteed good health tomorrow. It is a gift,” Chung said.

Tendler, like most criminal defense attorneys, believes every person accused of a crime, no matter how heinous, is entitled to a fair and just journey through the legal system.

Chung received grants from a pair of foundations that paid off all her medical school loans, a fact she says makes her believe her work is to serve the public. Tendler, who started his career as a public defender, understands.

And with Chung, he found not just an advocate for his life but a doctor who Tendler said was the first to really treat him like a human being. Tendler says her presence in his life tops the list of blessings he makes a habit of thanking God for daily.

Chung told him they would fight the three lesions with CT ablation, a form of targeted radiation that successfully obliterated the three spots. But soon afterward, two more lesions appeared on his liver, and another pair of cancer lesions were now in his lungs.

Chung is clear, both in her conversations with Tendler and in an interview on the day he receives his test results, that there is currently no cure for Tendler’s cancer. She calls the current clinical trial a form of palliative care, meant to reduce the cancer’s severity and alleviate Tendler’s symptoms in hopes of keeping him healthy long enough for researchers to find a cure.

The clinical trial, sponsored by Bristol-Myers Squibb, is a blind study in a treatment that involves immunotherapy, a process that stimulates parts of the patient’s own immune system to fight the cancer.

All patients in the study receive doses of the immunotherapy agent Nivolumab. Two-thirds of the patients also receive a second drug, and the others receive a placebo.

No one — not even Chung — knows which patients are receiving the second agent, a secret she says is vital to the research to see if the two agents together work better than the single Nivolumab treatment alone.

Tendler’s lesions are not as severe as some of her other patients, Chung says, and after two cycles, the results are promising.

Although he is on pain medication, his treatment has been a breeze compared to his radiation, he said. And the fight for his life has brought with it an unanticipated life lesson.

Tendler, who for 20 years poured his life into his work, is learning how to celebrate.

The rise of HPV-related cancers in men

Source: www.tmc.edu
Author: Alexandra Becker

Scott Courville admired his full beard and round belly in the mirror: He was ready for the upcoming holiday season. It was November 2015 and Courville, who plays Santa Claus in Lafayette, Louisiana, was too excited about his favorite time of year to worry much about the pain developing in his jaw.

By February, though, the ache had worsened and was accompanied by new symptoms: white spots on his right tonsil, difficulty swallowing and lumps in his throat. He finally made his way to a walk-in clinic where he was diagnosed with tonsillitis and prescribed antibiotics.

“They sent me home and said, ‘In two weeks everything should clear up,’” Courville recalled.

But his symptoms only worsened. Courville made an appointment with a local ear, nose and throat (ENT) specialist who also diagnosed Courville with tonsillitis. The doctor prescribed more antibiotics and steroids, but two weeks later there were no improvements. Courville was referred to a dentist—“In case they see something we don’t”—but that, too, was a dead end.

Courville’s dentist insisted he return to his ENT, where he ultimately had a CT scan that revealed a mass in his throat. That was June 6, 2016. Two days later, Courville underwent a biopsy. When he awoke from the surgery, his doctor was standing over him.

Courville always gets choked up retelling this part of his story.

“The hardest part for me is always remembering when the doctor said, ‘I’m sorry, but you’ve got cancer.’”

Courville was referred to The University of Texas MD Anderson Cancer Center, where doctors confirmed that he had squamous cell carcinoma of the right tonsil. But there was more: Courville learned that his cancer had been caused by the human papillomavirus—HPV.

11 million men
Courville’s story is becoming increasingly common, with the annual incidence of HPV-related cancers of the throat, tonsils and the base of the tongue in men in the United States now outnumbering cases of cervical cancer in women, according to the U.S. Centers for Disease Control and Prevention (CDC). A 2017 research paper authored by scientists at Baylor College of Medicine and The University of Texas Health Science Center at Houston School of Public Health, among others, found the overall prevalence of oral HPV in men in the U.S. to be upwards of 11 million—much higher than previously believed.

“This has implications, because pretty much everyone is exposed to HPV,” said Andrew Sikora, M.D., Ph.D., one of the authors of the paper and vice chair for research and co-director of the Head and Neck Cancer Program at Baylor College of Medicine. “When we’re talking about the prevalence of oral HPV infection, we’re talking about that infection persisting inside the tonsils or on the base of the tongue of these men, and I think that’s what sets you up for cancer later in life—it may happen decades after you were exposed to HPV.”

That lag time, coupled with an absence of symptoms, is part of the reason HPV-related oropharyngeal cancers, also referred to as head and neck cancers, are increasing.

“What makes this cancer interesting is that it’s one of the only cancers in the body that we’re actually seeing more cases of year over year,” explained Ron J. Karni, M.D., who serves as chief of the division of Head and Neck Surgical Oncology at McGovern Medical School at UTHealth and Memorial Hermann-Texas Medical Center. “In the U.S., we can expect a certain number of breast cancer cases and lung cancer cases every year, but this is actually starting to look a bit like an epidemic in that we are seeing more every year. It’s alarming.”

Holy grail
HPV is the most common sexually transmitted disease in the U.S., with an estimated 79 million individuals infected. According to the CDC, HPV is so common that most people who are sexually active will get the virus at some point in their lives if they do not get the HPV vaccine.

The virus is spread through vaginal, anal and oral sexual activity, and often exhibits no signs or symptoms. In many cases, HPV is cleared by the immune system and does not cause health problems, but it can also persist and show up decades later alongside conditions such as genital warts and cancer—including cervical cancer, anal cancer and oropharyngeal cancers. For reasons not well understood, oropharyngeal cancers predominately affect men.

Currently, there is no annual screening test for men to determine whether they have the virus. Women, on the other hand, are advised to get regular pap smears.

The Papanicolaou test, commonly known as the pap smear, involves collecting cells from inside a woman’s cervix to detect pre-cancerous changes. It is performed during a woman’s annual exam and has been widely credited for detecting early signs of HPV-related cervical cancer and saving countless lives. No such screening test has been successfully developed for oropharyngeal cancer—another reason cited for its steady rise.

“We’re at a huge disadvantage,” said Sikora, who, in addition to his research, treats patients at the Michael E. DeBakey VA Medical Center in Houston. “The pap smear, in terms of global health impact, is probably one of the best, most cost-effective things ever invented in terms of just the sheer number of women who have not had cancers because of it. We have nothing like that for men.”

Sikora explained that anatomy is, in part, to blame. Whereas the cervix is easily sampled, the tonsils are full of “nooks and crannies,” he said, and scientists have yet to develop a reliable technique for obtaining a representative sample of cells inside the throat, tonsils and back of the tongue.

“It’s sort of a holy grail for researchers in the field,” Sikora said. “It would be a game-changer in terms of prevention and early detection of cancer.”

Scientists at MD Anderson, where Courville was treated, may be closing in on some answers. Researchers, including Erich M. Sturgis, M.D., MPH, the Christopher & Susan Damico Chair in Viral Associated Malignancies, are currently conducting a clinical trial for an antibody test that could be used to screen for HPV-related throat cancer.

The HOUSTON study, an acronym for “HPV-related Oropharyngeal and Uncommon Cancers Screening Trial of Men,” is looking to recruit 5,000 men ages 50 to 64 years to provide blood and saliva samples for serologic HPV testing and oral HPV testing, respectively. If a subject is found to have a positive antibody test, he will be asked to participate in a second phase of the study, which includes an intensive screening program run through MD Anderson’s oral pre-cancer clinic.

“A researcher at Arizona State University, Dr. Karen Anderson, developed a serologic test that predicts extremely well the risk for HPV-related oropharyngeal cancer,” Sturgis explained. “We have been able to show that serum antibodies to HPV early proteins, which are rare in the general population, are markers for oropharyngeal cancer. Specifically, we found that those who had antibodies to certain HPV antigens have a greater than 450-fold higher risk of oropharyngeal cancer compared with those who do not have the antibodies.”

The hope is that this study will reveal that serological HPV antibody testing is an effective screening tool for HPV-related cancer in men: the equivalent to a pap smear.

A lump in the neck
If and when HPV-related cancer does develop, men often notice a pain in their jaw or throat, trouble swallowing, change or loss of voice that lasts more than a week or two, a sore spot on the tongue and, most often, a lump in the neck.

“There’s often a very small, primary tumor, which is the tumor that is in the tongue or in the tonsil, and it travels early to the lymph nodes,” Sikora explained. “Depending on what your neck looks like, lymph nodes can get pretty big before they become noticeable. But a lump in the neck is by far the most common symptom, and unfortunately it’s often detected much later than we would like.”

Even more troubling, many individuals who have these symptoms are commonly misdiagnosed and handed antibiotics, as in Courville’s case.

“The most important message I can convey is that if you have a lump in your neck, go see an ear, nose and throat doctor,” Karni said, emphasizing the importance of an informed diagnosis and specialized care.

Treatment for oropharyngeal cancers varies depending on the case and often involves a multidisciplinary team of clinicians, as well as some form of combined modality therapy such as radiation and chemotherapy. In the future, Sturgis sees novel therapies, including immunotherapy options, changing the landscape of treatment protocols.

Karni hopes UTHealth’s dedicated HPV-related throat cancer program will carry patients through the entire arc of treatment by offering minimally invasive robotic surgery for qualifying cases, as well as annual community-wide screening clinics, rehabilitation therapists, and numerous other specialists.

“We want to think about cancer the way Target thinks about shopping or the way the best airlines think about flying,” Karni said. “We designed a program that is patient-centered. We asked, ‘What does the patient need on their fourth week of radiation? What do they need on their third month post-radiation? How can we get that into one clinic space?’ It’s a large team and it’s all centered around this one disease.”

47th in the nation
In 2006, an HPV vaccine named Gardasil hit the market. It was originally intended to prevent HPV in females and, ultimately, HPV-related cervical cancer. But as scientists learned more about HPV—first that males could be carriers and later that it causes cancer in men, as well—public health professionals and clinicians unanimously recommended the vaccine to everyone. The CDC recommends all young women through the age of 26 and all young men through age 21 receive two doses for the vaccine to be effective.

And it is. A recent report published in May by Cochrane, a global independent network of clinical researchers and health care professionals, concluded that the HPV vaccine protects against cervical cancer in young women, especially when they are vaccinated between the ages of 15 and 26.

Which begs the question: Will the vaccine protect young men against the development of oropharyngeal cancers?

“There is a lot more data on cervical cancer in women and the vaccine than there is on head and neck cancer in men and the vaccine, but what data exists suggests that it is going to be a very effective intervention,” Sikora said.

Yet despite scientific evidence that prophylactic HPV vaccination of children and young adults will drastically reduce HPV-related cancers, vaccination rates in the U.S. remain alarmingly low—and Texas ranks 47th. Even more, several generations did not have the vaccine available to them and are currently at risk for HPV-related cancer.

As Karni said, it is alarming.

“Because the median age of oropharynx cancer related to HPV is about 55 and, in some studies, 60, and because the vaccine does not seem to work in individuals who have already been exposed, the benefits of vaccination on HPV-related cancer will not be realized for several decades,” Sturgis said. “Even if we vaccinate 100 percent of our boys and girls tomorrow, we have a whole generation or two who are at risk for this cancer and cannot do anything about it.”

Courville endured six rounds of chemotherapy and 33 daily rounds of radiation to treat his cancer. He lost a year of his life, 100 pounds, his taste buds and salivary glands, and can no longer grow his full beard— but his therapy was successful. He has now made it his life’s mission to inform the public about the importance of the vaccine as well as ongoing advocacy and research surrounding HPV-related cancers.

“If you can educate the public and educate the parents, they will vaccinate their kids,” Courville said. “And if we can vaccinate this generation, we could eliminate these types of cancers.”

Restaging raises hope against HPV oral cancer

Source: atlantajewishtimes.timesofisrael.com
Author: Cady Schulman

Jason Mendelsohn was diagnosed with Stage 4 tonsil cancer from HPV in 2014 after finding just one bump on his neck. He survived thanks to a variety of treatments, including a radical tonsillectomy and neck dissection to remove 42 lymph nodes, seven weeks of chemotherapy, radiation and a feeding tube.

But if Mendelsohn’s cancer had been discovered today, just four years later, it would have been classified as Stage 1. That’s because HPV-related oral cancers now have a high survival rate through a better response to treatment, said Meryl Kaufman, a speech pathologist specializing in head and neck cancer management who worked for Emory University’s department of head and neck surgery for 10 years.

“Cancer staging is taking into account the HPV-related cancers,” said Kaufman, who now owns her own practice. “It was kind of all lumped together. The survival rates for people who have HPV-related cancers are much higher than the typical head and neck cancers associated with smoking and drinking.”

For Mendelsohn, finding out that patients with HPV-related cancers likely face easier treatments and higher success rates made him extremely happy.

“If I was diagnosed and I heard Stage 1 instead of Stage 4, while it’s still cancer, it would make me feel like I could beat it,” said Mendelsohn, who made a video for his children a month after his diagnosis with advice for their lives after he was gone. “When I hear Stage 4 to Stage 1, I think people have hope they can beat it. My hope is that it will give people hope that they can beat this.”

As a cancer survivor, the Florida resident wants to give hope to other patients. He talks to people throughout the world every month and is creating a worldwide survivor patient network to connect cancer survivors with patients.

“While cancer is scary, Stage 1 is a lot less scary than Stage 4,” Mendelsohn said. “Stage 4 was overwhelming. When I was looking for information, there was nothing out there that made me feel like I was going to be OK. What I’m trying to do is give people hope and let them know that it’s all temporary.”

Another way Mendelsohn is trying to reach those affected by cancer is through his website, supermanhpv.com. He shares his story, news articles featuring him and oral cancer caused by HPV, and information for survivors, patients and caregivers.

The site also features Mendelsohn’s blog, putting himself out there so people can see that someone who, just four years ago, was diagnosed with Sage 4 cancer is now a Peloton-riding, travel-loving cancer advocate.

“People see me and say (they) can’t believe (I) had cancer three to four years ago,” Mendelsohn said. “I was in bed 18 hours a day for a month. I was choking on my saliva for a month. I was consuming five Ensures a day and two Gatorades a day through a feeding tube in my stomach. If people going through that can see me working out, going on the bourbon tour in Louisville. I’ve been on an Alaskan cruise. I’ve been to the Caribbean. I’ve been to the Grand Canyon.”

Mendelsohn, who started his campaign to raise awareness of HPV and oral cancer by raising money for the Ride to Conquer Cancer in Washington, now serves on the board of the Head and Neck Cancer Alliance. The organization’s goal is to advance prevention, detection, treatment and rehabilitation of oral, head and neck cancers through public awareness, research, advocacy and survivorship.

“I feel like it’s gone from me raising money for a bike ride to me on two boards helping create awareness and raise inspiration and creating a survivor patient network,” Mendelsohn said. “Now it’s not about me and my three doctors. Now it’s about helping people with diagnosis globally. There are great doctors. I think we’re going to do great things.”

One way to help prevent children from getting cancer caused by HPV when they grow up is the Gardasil vaccine, which protects against HPV Strain 16, which causes oral cancer. Mendelsohn said 62 percent of college freshmen and three-quarters of adults by age 30 have HPV.

But he doesn’t tell people to get the vaccine. Instead, he advises parents to talk to their kids’ doctors about the benefits and risks.

“I talk about the importance of oral cancer screenings when they’re at the dentist,” he said. “And if you feel a bump on your neck, go to your ENT. I had no symptoms and just a bump on my neck, but I was diagnosed with Stage 4. I’ve had so many tell me that they didn’t know the vaccine is for boys. They thought it was just for girls.”

Kaufman said that the HPV vaccine is recommended for use in boys and girls and that it’s important for the vaccine to be given before someone becomes sexually active. The vaccine won’t work if a person has already been exposed to HPV, as most sexually active adults have been, she said.

Men are much more likely to get head and neck cancer from HPV.

“Usually your body fights off the virus itself, but in some people it turns into cancer,” Kaufman said. There hasn’t been specific research that the HPV vaccine will protect you from head and neck cancer, she said, “but if you’re protected against the strains of HPV that cause the cancer, you’re probably less likely to get head and neck cancer.”

Treatment for this cancer isn’t easy, Kaufman said. Radiation to the head and neck can affect salivary glands, which can cause long-term dental and swallowing issues. Treatment can affect the skin, taste and the ability to swallow.

“A lot of people have tubes placed,” she said. “It’s not easy. It depends on how well you respond to the treatment.”

While getting the vaccine can help protect against various cancers, awareness about head and neck cancer is the key. And knowing the signs and symptoms — such as sores in the mouth, a change in voice, pain with swallowing and a lump in the neck — is important.

“If one of those things lasts longer than two weeks, you should go to your doctor,” Kaufman said. “This can affect nonsmokers and nondrinkers. It’s not something that people expect. The more commonplace it becomes and the less stigma, the better.”

Doctors paying for sons to have cancer jab

Source: www.bbc.com
Author: Anna Collinson, Reporter, Victoria Derbyshire programme

Doctors and health professionals are regularly paying hundreds of pounds for their teenage sons to receive a vaccination against cancer that girls already receive for free on the NHS, the Victoria Derbyshire programme has been told. Is boys’ health being put at risk?

“Had the HPV vaccine been available when I was a boy, I believe I would not have developed throat cancer more than 30 years later,” said Jamie Rae, 53.

“I’m basing this on the overwhelming majority of research I have seen over the years and countless experts I have spoken to.

“That’s why I’m desperate for boys to be able to receive it.”

HPV is the name given to a large group of viruses. It is very common and can be caught through any kind of sexual contact with another person who already has it. Doctors say 90% of HPV infections go away by themselves – but sometimes infections can lead to a variety of serious problems. For boys, this includes cancer of the anus, penis, mouth and throat.

Since 2008, girls aged 12 to 18 across the UK have been offered HPV vaccinations as part of the NHS childhood vaccination programme. It is currently not offered to boys of the same age, but it can be done privately, costing several hundred pounds.

Mr Rae founded the Throat Cancer Foundation after the treatment he received in 2010. He said at the time there was little information on HPV and he did not want anyone to go through his experience.

“I had radiotherapy for 35 days except weekends. I felt extreme burning in my neck and mouth and I was covered in sores. The pain was excruciating,” he explained. “It’s a lengthy recovery time. You have to teach yourself to swallow again and you get a dry mouth all the time.”

His foundation is part of HPV Action – which represents more than 50 groups and charities that are calling for both genders to receive the vaccination on the NHS.

‘Indefensible’
Mr Rae said the current disparity between boys and girls was “appalling”.

“Lots of doctors are having their boys vaccinated because they can afford it, as are those who are better informed,” he said. “But what about those who can’t afford it? Cases of throat cancer are soaring. It’s indefensible.

“Every day that goes past where boys are not being vaccinated condemns them to a whole host of diseases that we could prevent.”

HPV Action says around a dozen countries including Australia, Canada and the US are already vaccinating boys or are planning to do so in the near future. The government’s vaccination advisory committee is currently reviewing whether boys should receive the HPV vaccination.

A spokesperson for the Department of Health and Social Cares says it will carefully consider its advice once they’ve received it. Campaigners hope there will be a decision this year, possibly as soon as June. A debate is taking place on Wednesday at Westminster Hall about the issue.

The argument for vaccinating boys against HPV:

  • About 15% of UK girls eligible for vaccination are currently not receiving both doses, a figure which is much higher in some areas
  • Most older women in the UK have not had the HPV vaccination
  • Men may have sex with women from other countries with no vaccination programme
  • Men who have sex with men are not protected by the girls’ programme
  • The cost of treating HPV-related diseases is high – treating anogenital warts alone in the UK is estimated to cost £58m a year, while the additional cost of vaccinating boys has been estimated at about £20m a year

Source: HPV Action

With oral cancer on the rise, dentists can play an important role

Source: http://exclusive.multibriefs.com
Author: Tammy Adams

Today’s dental professionals routinely see and deal with many issues and conditions that were not so common just a few short decades ago. For example, there has been a marked increase in the incidence of oral cancer in the United States, sparking the need for regular oral cancer screening as part of a preventive dental checkup. This additional screening is now routinely performed in many dental practices across the nation.

The American Cancer Society estimates that around 50,000 Americans are infected with oral cancer each year. In past generations, oral cancer was mostly linked to smoking, alcohol use or a combination of the two. But even as smoking rates have fallen, oral cancer rates have risen (especially in men), and researchers have concluded that this is likely caused by the human papillomavirus (HPV), a sexually transmitted disease.

Early diagnosis makes a difference
Oral cancer is often only discovered when the cancer has metastasized to another location, most commonly the lymph nodes of the neck. Prognosis at this stage of discovery is significantly worse than when it is caught in a localized intraoral area.

According to the Oral Cancer Foundation, the best way to screen for HPV-related oral and oropharyngeal cancer is through a visual and tactile exam given by a medical or dental professional, who will also perform an oral history taking to ask about signs and symptoms that cover things that are not visible.

Most of the symptoms of a developing HPV-positive infection are discovered by asking questions, using a test, a light or other device.

ADA supports dental industry with this growing challenge
In 2017, a panel of experts convened by the American Dental Association (ADA) Council on Scientific Affairs published a clinical practice guideline called the “Evidence-Based Clinical Practice Guideline for the Evaluation of Potentially Malignant Disorders in the Oral Cavity.”

The goal of this guideline is to inform dentists, orthodontists and other dental professionals about triage tools for evaluating lesions, including potentially malignant disorders, in the oral cavity. If you’re a dentist or an orthodontist, the ADA offers the following considerations concerning the diagnosis of oral and oropharyngeal cancers:

  • Clinicians should obtain an updated medical, social and dental history as well as perform an intraoral and extraoral conventional visual and tactile examination in all adult patients.
  • For patients with suspicious lesions, clinicians should immediately perform a biopsy of the lesion or refer the patient to a specialist.
  • Salivary and light-based tools are not recommended for evaluating lesions for malignancy.

If you are a dental professional and want to learn more about the dental industry’s role in addressing the rising occurrence of oral cancer, visit the ADA’s Oral and Oropharyngeal Cancer page.

April, 2018|Oral Cancer News|

What’s the link between HPV and head and neck cancer?

Source: blogs.bcm.edu
Author: Dr. Michael Scheurer

As a molecular epidemiologist, I’ve been conducting research on human papillomavirus (HPV)-related cancers since my dissertation work in 2003. While working with the clinical faculty here at Baylor College of Medicine, I’ve heard many questions lately about the possibility of the HPV vaccine “helping treat” head and neck cancer (HNC).

It’s important to know the link between HPV and HNC because patients with HPV-positive tumors often have better survival rates than those with HPV-negative tumors. Check out these frequently asked questions to learn more about HPV and HNC.

What is HPV?

  • HPV is a sexually transmitted infection that can infect the oral cavity, tonsils, back of throat, anus, and genitals.
  • There are many types of HPV. Some types can cause cancer and other types can cause warts.
  • HPV infection is very common in the U.S. with more than 50 percent of adults being infected at some point in their lifetime.
  • There is no treatment for HPV infection.
  • For some people, their HPV infection naturally clears while others develop cancer after many years.

What is oropharyngeal cancer?

  • Oropharyngeal cancer occurs in the tonsils and back of throat.
  • In the U.S., HPV now causes most oropharyngeal cancers.
  • Most doctors would recommend that oropharyngeal cancers be tested for HPV.
  • Smoking and alcohol use can also increase risk of developing oropharyngeal cancer.

How did I get HPV infection in my mouth or throat?

  • The most likely route of exposure is by oral sex, although other routes may exist.
  • Performing oral sex and having many oral sex partners can increase your chances of oral HPV infection.
  • HPV is not transmitted casually by kissing on the cheek or sharing a drink with someone.
  • We do not know for sure if HPV is transmitted by open-mouth or “French” kissing.

What does it mean as a HNC patient if I have HPV in my tumor?

  • Many studies have shown that oropharyngeal cancer patients with HPV in their tumor have a better outcome than people without HPV.
  • These patients tend to respond better to both chemotherapy and radiation treatment for HNC. Appropriately selected patients also have excellent outcomes after surgery.

Is the HPV vaccine for me?

  • The HPV vaccines work by preventing people from getting new HPV infections.
  • These vaccines do not treat HPV infection or the cancers that HPV cause.
  • The vaccines are currently recommended for people ages nine to 26 years old.
April, 2018|Oral Cancer News|

Accurately identifying aggressive head and neck cancers

Source: www.eurekalert.org
Author: press release

The Case Western Reserve-led research team will analyze computerized images of tissue samples for patterns which could become “biomarkers,” or predictors, for determining relative risk for recurrence in one particularly common type of head and neck cancers.

Those tumors, known as oropharyngeal cancers, occur primarily at the base of the tongue and in the tonsils.

Currently, however, oncologists tend to treat all of these tumors with the same aggressive level of therapy. This is the case even though many of the oropharyngeal tumors which are caused by the human papilloma virus (HPV) tend to have favorable outcome-regardless of treatment-while another subset of the tumors progress and metastasize, or spread.

“Right now, it’s a one-size-fits-all therapy for all of these patients with HPV head and neck cancers,” said Anant Madabhushi, MD, the F. Alex Nason Professor II of Biomedical Engineering, founding director of the CCIPD at the Case School of Engineering and primary investigator in the new research.

“There are currently very few validated biomarkers and approaches that are accurate enough to be able to identify which of these cancers are more aggressive or which ones are less aggressive,” he said. “That has limited the ability of clinicians to even hold clinical trials to find out if they can de-escalate therapy for some of these patients-or who needs more aggressive therapy.”

The National Cancer Institute (NCI) recently awarded a $3.15 million, five-year academic-industry partnership grant to Madabhushi and his team to pursue the research and build toward establishing those clinical trials.

Co-primary investigator on the grant is Vanderbilt University’s James Lewis Jr., MD, whose specialty is head and neck pathology, while Cleveland Clinic’s Shlomo Koyfman, MD, and David Adelstein, MD, are co-investigators with expertise in radiation and medical oncology.

Additionally, Pingfu Fu, an associate professor of population and quantitative health statistics at Case Western Reserve, brings expertise in biostatistics. Cheng Lu, a senior research associate in CCIPD is also involved with the project.

Madabhushi’s team is again working with Mark Lloyd, MD, of industry partner Inspirata Inc., the Florida-based company also teaming up with the lab on studies of breast and lung cancer-work supported by more than $6.3 million in NCI funding.

The team presented its data at the 2018 United States and Canadian Association of Pathology (USCAP) meeting in Vancouver this month and has generated data to suggest that the approach could soon become a clinically actionable tool.

Initial results on almost 400 oropharyngeal cancer patients suggests that the technology is independently prognostic of disease progression-meaning that it could stand alone in helping clinicians figure out how aggressive the disease is and then make a more informed decision on how aggressively to treat the cancer.

“In those cancers, they’ve established whether you can modulate your therapy based on the risk profile for those tumors,” Madabhushi said. “But in head and neck, clinicians might have a sense that there are different risk profiles for different patients, but nobody knows for certain. We want to change that by giving them the risk stratification tools to better help the patient.”

March, 2018|Oral Cancer News|

Australia may become the first country to eliminate one form of cancer

Author: Brad Jones
Date: March 8, 2018
Source: flipboard.com

The International Papillomavirus Society has announced that Australia could become the first country to eliminate cervical cancer entirely.

According to a new study, Australia’s efforts to distribute a human papillomavirus (HPV) vaccine for free in schools have been a resounding success. The sexually transmitted infection causes 99.9 percent of cases of cervical cancer.

In 2007, the Australian federal government began offering the vaccine to girls aged 12-13, and in 2013 it was made available to boys, too. Girls and boys outside of that age bracket but under nineteen are also entitled to two free doses of the vaccine.

Between 2005 and 2015, the percentage of Australian women aged between 18 and 24 who had HPV dropped from 22.7 percent to just 1.1 percent. Immunization rates have increased further since 2015, contributing to what’s being described as a “herd protection” effect.

Coupled with a more advanced screening test that was introduced by the Australian government in December 2017, there are hopes that no new cases of cervical cancer will be reported within ten or twenty years.

THE WORLD ISN’T CATCHING UP

In the US, the HPV vaccine is not free. It can cost as much as $450 for the full regimen, according to the Association of Reproductive Health Professionals, although financial assistance is often available. In 2016, 78.6% of 15-year-old Australian girls, and 72.9% of 15-year-old Australian boys were vaccinated – but only 50% of American girls between 13 and 17, and 38% of American boys between 13 and 17 had received the vaccination, as per data published by the Henry J. Kaiser Family Foundation.

The situation is much worse in the developing world, where papillomavirus incidence rate remains high. “Two-thirds of the world’s population of women don’t get access to what Australian women do,” said Joe Tooma, the chief executive of the Australian Cervical Cancer Foundation. “Unless we do something, it will still be one of the major cancer killers in developing countries.”

Administering the HPV vaccine in schools has also proven to be effective in a trial that took place in Bhutan. Offering this kind of free access to the vaccine in other developing countries may seem like an expensive measure, but as the Australian example shows, it could ease the burden of cervical cancer down the line.

 

March, 2018|Oral Cancer News|