human papilloma virus

Cancer survivor advocating for men’s HPV awareness

Source: The Tampa Tribune (tbo.com)
By Mary Shedden | Tribune Staff
Published: July 28, 2013  
 

LUKE JOHNSON/STAFF

David Hastings, the co-owner of Gulport’s Habana Café, has testified in front of Florida legislators and officials at the Centers for Disease Control and Prevention, since becoming a volunteer patient advocate with the Oral Cancer Foundation.

 

Seven years ago, David Hastings got the worst news of his life. He had oral cancer, and a grueling series of radiation and chemotherapy treatments would be necessary if he wanted to survive.

Undergoing months of the “barbaric” treatment was awful, he said, but so was the knowledge that five different doctors couldn’t explain how a 56-year-old with no history of smoking or heavy drinking ended up with such an aggressive cancer.

“If something is trying to kill you, don’t you want to find out what it is?” the Gulfport accountant and business owner asked over and over.

It took months, but Hastings learned his cancer was linked to HPV, the sexually transmitted virus long known for its connection to deadly cervical cancers. The answer was elusive because few scientists at that time were looking at the virus and male cancers, he said.

Today, doctors know that about 5,600 cases of oral cancer diagnosed each year are tied to the human papillomavirus, a number increasing at a rate faster than that of tobacco- or alcohol-related oral cancers. That’s likely because more hospitals and cancer centers, including Moffitt Cancer Center, are able to test for the male HPV cancer connection on site.

Still, in June, when actor Michael Douglas announced that his stage 4 cancer was linked to oral sex with women, the news spurred nervous giggles, gossipy speculation and a lot of “who knew?” comments across the country.

The public reaction shows how much remains to be learned about the deadly disease, said Hastings, a volunteer patient advocate with the Oral Cancer Foundation.

Since 2006, the co-owner of Gulport’s Habana Café has testified in front of Florida legislators and officials at the Centers for Disease Control and Prevention.

He estimates he now spends about two hours a day educating people about HPV and oral cancer. The self-described “staunch Republican,” who keeps a framed photo of himself posing with President Ronald Reagan in his office, said his advocacy is not political.

“I became so vocal because there was a total lack of education to the public and front-line doctors,” said Hastings, now 65 and cancer-free.

Douglas’ announcement also shows how much significant science around these cancers has emerged in just the past few years, said Anna Giuliano, director of Moffitt’s Center for Infection Research in Cancer.

“The scientific literature keeps growing and growing,” said Giuliano, one of the doctors who was unable seven years ago to definitively tell Hastings how he contracted oral cancer, despite her own experience in HPV research.

Researchers, including Giuliano and others based at Moffitt, today are leading multiple international studies aimed at identifying who is most at risk for HPV cancers, why, and the treatment options for men with HPV-related cancers.

At Moffitt, research looking at the history of men with HPV-related cancers has been underway since 2005, Giuliano said. Her grants initially focused on male genital cancers, but now include oral cancers.

The most recent findings were published this month in the medical journal The Lancet.

HPV is the most common sexually transmitted virus in the United States, the CDC says. Almost every sexually active person – straight, gay or bisexual – will be exposed in his or her lifetime. But many will never develop cancer.

Hastings, a “product of the ’60s” who believes he was infected decades ago, long before he met his wife of 20 years, said men of his generation need to know this.

“My cancer was not caused by tobacco or alcohol. It was caused by a virus,” he said. “Men need to pay attention.”

These infection rates, and the extreme risks of HPV-related cervical cancers, prompted a lot of the initial research two decades ago. Giuliano said initial HPV research focused on women, but evidence is building concerning HPV-related cancers and men.

“In the background has been the question, ‘What about the guys?’ ” she said.

Also, a lot of attention has been paid to HPV vaccination, Giuliano said. The CDC and others see it as the most effective way to prevent future infections, and recommend it for anyone younger than 26 years.

Giuliano said the research now underway at Moffitt looks long-term at adults who missed the opportunity to get the vaccine. For example, researcher Andy Trotti is building on the growing understanding that HPV-related oncology patients have higher survival rates than men with other types of oral cancer.

Trotti, of the Radiation Treatment Oncology Group, wonders if HPV cancer patients can be given a less-aggressive treatment and face a similar chance of long-term survival.

Hastings, who has vivid memories of his treatment, said he welcomes research that could reduce the severity of the treatment. The radiation burns your throat and the ability to taste is gone within a week. Sores develop, as does constant nausea. Taking pain pills or attempting to swallow lukewarm liquids bordered on torture, he said.

“That research is so important for our generation,” he said.

Advancements like this are critical, and results have been swift when compared to other cancer research, Giuliano said. But that’s still not enough.

“Between the two groups, we hopefully can in the next few years make a great difference,” she said.

 

*This news story was resourced by the Oral Cancer Foundation, and vetted for appropriateness and accuracy.

 

Fact check: Michael Douglas on HPV and throat cancer

Source: www.huffingtonpost.com
Author: Meredith Melnick

A Michael Douglas interview in The Guardian caused waves when the publication reported that the “Behind the Candelabra” star revealed HPV, the human papilloma virus, to be the cause of his stage-4 throat cancer diagnosis in 2010.

“Without wanting to get too specific, this particular cancer is caused by HPV, which actually comes about from cunnilingus,” Douglas allegedly told The Guardian.

Douglas, through his publicist, has said that the statement was misinterpreted: He wasn’t saying that his cancer was caused by the sexually transmitted disease — merely that many cancers like his are HPV-positive. As The Daily Beast points out, there is scant research evidence to directly link the act of cunnilingus with HPV infection. But regardless of the details of his own cancer, the actor is right about one thing: A growing majority of oral cancer cases are caused by HPV.

While most strains of HPV clear up on their own, the sexually transmitted disease is responsible for an array of cancers. As Douglas describes, it’s true that oral sex is an avenue through which a person can contract HPV and especially the strains, HPV-18 and HPV-16, the latter of which is responsible for half of oral cancer cases, according to the National Cancer Institute. HPV-16, HPV-18 and some less-common strains can also cause cancers of the cervix, vagina, vulva, anus and penis.

Douglas’ experience follows trends in cancer diagnosis, according to a January report from the American Cancer Society, which found a rise in oral cancer caused by HPV in both women and men. As the report said, as of 2004, 72 percent of oral cancer tumors were HPV-positive — up from 16 percent of tumors in data collected between 1984 and 1989.

Previously, excessive drinking and tobacco use were the most common causes of the throat cancer Douglas developed, but HPV has replaced tobacco as the leading cause of throat cancers. HPV’s rise as the leading cause of oral cancer is not just the result of growing rates of the virus — it is also explained by drops in smoking, thanks to public health campaigns that describe the dangers of cigarette use.

HPV-16 and 18 are targeted by the vaccine Cervarix and are two of the four strains targeted by Gardasil, the other of the two approved vaccines against HPV. Gardasil is currently recommended for boys between the ages of 13 and 21 and both Cervarix and Gardasil are recommended for girls, aged 13 to 26, according to the Centers for Disease Control and Prevention. HPV-6 and HPV-11, both of which the Gardasil vaccine immunizes against, cause about 90 percent of genital warts cases.

Despite the growing rates of oral cancer, cases like Douglas’ are still relatively rare, with about 7,100 new cases each year, reported USA Today. But that doesn’t mean oral HPV infection is rare: According to a 2012 study of Americans, aged 14 to 69, about 10 percent of men and 3.6 percent of women currently have an oral HPV infection.

According to the CDC, there is no screening test to determine overall HPV status. While women are screened for HPV-associated cervical cancer via a Pap-smear test, other HPV-associated cancers don’t have a specific screening test. Despite the fact that there are no uniform screening techniques for oral cancer, the prognosis for the disease is good, with an 80 to 90 percent survival rate, according to The Oral Cancer Foundation.

When a virus causes cancer, surgical robot can help

Source: www.bizjournals.com
Author: James Ritchie

Dr. Keith Wilson finds robotic surgery to be a good approach for removing tumors growing deep in the throat, as I recently reported. As it turns out, such tumors are often part of an alarming trend. They’re often caused by the sexually transmitted human papillomavirus, also known as HPV.

In decades gone by, oral cancer was almost always associated with tobacco and alcohol use. It was typically a disease of old men. No more. Many of Wilson’s patients are nonsmokers and very light drinkers.

“I can’t tell you how surprised people get,” said Wilson, who is chief of staff at University of Cincinnati Medical Center. “We’re seeing younger, more affluent and more highly educated patients.”

High-risk HPVs cause virtually all cervical cancers. They have in recent years been implicated in oropharyngeal cancers. The oropharynx is the middle part of the throat, including the soft palate, the base of the tongue and the tonsils.

About 63 percent of oropharyngeal cancers, or 11,000 cases per year, are associated with HPV infection, according to the American Dental Association. They’re frequently under age 50.

Fortunately for such patients, HPV-associated oropharyngeal cancers have a better prognosis than those with other causes. Wilson said that cure rates can approach 90 percent.

The da Vinci surgical robot is an effective tool for removing them, he said, because its long, joined arms can go where a surgeon’s hands can’t. But the machines, made by Sunnyvale, Calif.-based Intuitive Surgical Inc., are gaining some criticism. The robotic surgery system is facing safety questions from the U.S. Food and Drug Administration after a string of complaints across the country – as many as 500 since January 2012.

Oral cancer cases higher in developing countries

Source: pakobserver.net
Author: staff

Oral cancer is the sixth most common cancer reported globally with roughly two thirds of these reported in developing countries, according to a report. Regardless of nationality, roughly half of long-term smokers will die from the effects of tobacco smoking, be it oral cancer, lung cancer or cardiovascular disease. In India 20 deaths per 100,000 are caused by oral cancer as compared to 10 deaths per 100,000 in the US and two deaths per 100,000 in the Middle East.

Oral cancer, as well as updates in maxillofacial reconstruction, microneurosurgery, oral trauma, and facial cosmetic and orthognathic surgery, will be reviewed at the 2nd Oral and Maxillofacial Surgery Congress to be held in Dubai from May 1-5. Organised by Imedex in association with Arab Health, this year’s meeting will provide a number of new features that explore the rapidly reshaping field of oral and facial surgery.

“The main causes of oral cancer have classically been related to smoking tobacco products and the Middle East has a higher rate of tobacco consumption then many other countries and this includes the use of the Shisha or Hookah,” said Dr Eric J Dierks, Clinical Professor of Oral and Maxillofacial Surgery at Oregon Health and Science University, USA and director of the Fellowship in Head and Neck Oncologic Surgery based at Legacy Emanuel Hospital in Portland, Oregon, who will be speaking at the congress.

“There is a myth that smoking through a Shisha pipe is safer than smoking cigarettes but this is almost certainly not the case. Several recent studies have indicated that Shisha smokers actually inhale more of the cooled smoke than would a cigarette smoker thereby increasing their exposure to carcinogens within the smoke,” he said.

To an ever greater extent, human papilloma virus (HPV) is a causative factor in cancer of sites in the oropharynx such as the tonsil or the base of the tongue, although HPV related cancer is much less common within the mouth itself. Approximately two thirds of cancers of the base of tongue and tonsil are caused by HPV and 80 per cent of these cases occur in men.

“There is no relationship between either smoking or alcohol intake with the HPV associated oropharyngeal cancer. Fortunately, HPV associated oropharyngeal cancer actually carries a much better prognosis than does a cancer in this location that is not associated with HPV. Although research is ongoing, the reason for this is as yet unclear,” Dierks said.

The early diagnosis of oral cancer is extremely important because not only is the prognosis significantly better for early stage cancer, but the treatment involved is often less extensive, Dr Dierks said.

April, 2013|Oral Cancer News|

Robotic surgery vs. radiation, chemo for throat cancer, study to see which is best

By: Sheryl Ubelacker, The Canadian Press, April 17, 2013
Source: ottawacitizen.com
 

TORONTO – It was quite a shock for Rod Sinn when he learned the persistent sore throat he’d had for five months, initially diagnosed as tonsillitis, was actually an increasingly common form of throat cancer caused by the human papilloma virus.

Equally unpleasant was the news that the standard treatment for oropharyngeal cancer, which typically affects the back of the tongue, tonsils and nearby tissues, is radiation and chemotherapy.

Sinn, a physically fit non-smoker who only drinks alcohol occasionally, had seen what the double-barrelled treatment could do. A friend diagnosed with throat cancer a year earlier and given the standard treatment lost his salivary glands and sense of taste.

“I thought, wait a minute, there’s got to be another option. I really don’t like the side-effects of all that radiation,” the 52-year-old businessman, who lives in Oakville, Ont., near Toronto, said Tuesday.

After searching the Internet, he discovered doctors at Western University in London, Ont., were the only ones in Canada performing robotic-assisted surgery for throat cancer.

Sinn had the robotic surgery in spring 2011, plus a follow-up operation to remove some lymph nodes for testing to make sure his cancer hadn’t spread. While the surgery left him unable to swallow for several weeks and he lost some taste buds for a time, he is virtually back to normal except for some numbness in his neck where the lymph nodes were removed.

“It was fantastic,” said Sinn, who counts himself a believer in the surgery.

While it may be an end for Sinn — he said he “cried like a baby” after being told he was cancer-free two months after the treatment — it is just a beginning of sorts for his surgeon, Dr. Anthony Nichols.

With the help of a $223,000 grant from the Canadian Cancer Society, Nichols and radiation oncologist Dr. David Palma are conducting a three-year trial to determine whether robotic surgery is superior to standard treatment in curing the cancer and giving patients a better quality of life with fewer side-effects.

Since late 2010, the surgical team has performed about 40 of the robot-assisted operations.

The clinical trial, which now includes doctors at the University of Ottawa, will compare treatments in almost 70 patients, with half randomly selected for standard treatment using radiation, with or without chemotherapy, and the other half getting robotic surgery.

Although robotic-assisted operations for throat cancer are widely done in the United States, the researchers say there has been no clinical trial proving the surgery is better for patients.

“Before we can adopt a new treatment, we have to prove that the rates of cure are as good as they are with the standard treatment, which is chemotherapy with radiation,” said Palma, a clinician-scientist with the Ontario Institute for Cancer Research.

“Sometimes new technologies are introduced with a lot of hype but don’t prove to be helpful in the end. Transoral robotic surgery has shown tremendous promise as a treatment option, and we are the only ones in the world doing this type of study right now.”

Nichols said that in an era of cost-containment in health care, it’s critical to show that using the $2.5-million robots for the surgery is the right thing to do, “that we’re helping patients, not harming them.”

“Patients with HPV-related throat cancers tend to be younger and healthier and have a good chance of being cured. As they will have to live with the side effects of treatment for decades, post-treatment quality of life is of paramount importance.”

From a surgical point of view, minimally invasive robot-assisted procedures seem to be head and shoulders above standard surgery for throat cancer, which often involves making large incisions in the face and neck, even splitting the jaw to allow the surgeon access to the back of the throat.

Patients who have had this kind of surgery in the past are often left not only facially disfigured, but unable to swallow and dependent on a permanent feeding tube.

With the newer technique, doctors use tiny robotically controlled surgical implements to remove tumours of the tongue, tonsils, palate or throat. The robot has a viewfinder and 3-D camera that can see around corners, and the tiny robotic arms can get into tight spaces where the surgeon’s hands won’t fit.

While the surgeon watches what’s happening on a screen, the robotic arms precisely mimic the movements of the surgeon’s hands and can even filter out a surgeon’s hand tremor.

“To work in the back of the throat, around the back of the tongue and the voicebox is just a line of sight issue,” Nichols said. “You can’t see really well around that corner, down towards the esophagus. But if you can use an angled camera to overcome that, combined with the 3D viewer and magnification, it lets you see a lot easier.

“So it can make surgeries that are very challenging — and in some cases not possible through the mouth — now possible to do through the mouth.”

Nichols said in the past, most throat cancers were caused by heavy smoking combined with alcohol consumption. A dramatic reduction in smoking rates over the last few decades has resulted in a big drop in related oral cancer rates.

But in the last 10 to 20 years, there’s been a huge upswing in the number of cases caused by the human papilloma virus, or HPV, a sexually transmitted disease that can lead to throat cancer in some people two or even three decades after the initial infection.

In fact, HPV is linked to about 25 to 35 per cent of oropharyngeal cancers, and is also the major cause of cervical cancer in women.

“We’re seeing a veritable explosion,” said Nichols. “So each year, we’re seeing more and more of these patients and they have tumours in this exact location, which was otherwise hard to reach.”

Sinn doesn’t need to wait for the study results. He’s already made up his mind about robotic surgery.

“To me, it’s important to let the medical community know this is available,” he said. “I’ll be the guy standing in the corner waving the flag, saying: ‘Hey, this is fantastic.”

 

* OCF Note – The caveat to this story is that while there is little question that compared to the older surgical technique that this is far less invasive and the treatment related morbidity/ damage from it is definitely less- the big unknown will be; do these surgical only solution patients have the same disease free (no recurrence) years afterwards as those who get radiation and chemo. With some recurrences being reported out in patients more than the five year mark, it will take far longer than the time period indicated in this trial to know if surgery alone has the same long term curative rates as the current standard of care.

**  This news story was resourced by the Oral Cancer Foundation, and vetted for appropriateness and accuracy.

 

 

 

April, 2013|Oral Cancer News|

Researchers design drug to block incidence of head, neck cancer caused by HPV virus

Source: www.news-medical.net

Researchers have discovered a new mechanism by which the human papilloma virus (HPV) causes head and neck cancer, and they have designed a drug to block that mechanism. Though further research is needed, the new agent might offer a safer treatment for these tumors when combined with a tapered dose of standard chemotherapy.

HPV-positive head and neck cancer has become three times more common since the 1970s, and it could reach epidemic levels in the future, say researchers at the Ohio State University Comprehensive Cancer Center – Arthur G. James Cancer Hospital and Richard J. Solove Research Institute (OSUCCC-James) who led the study.

“We believe these findings will help meet the real need for more effective and safer therapy for a growing number of HPV-positive head and neck cancer patients,” says principal investigator Dr. Quintin Pan, associate professor of otolaryngology at the OSUCCC – James. The study was published in the journal Oncogene.

The research, which mainly used head and neck cancer cells, shows that a protein produced by the virus blocks a protein made by the host cell. The cell protein, called p300, regulates a gene called p53. This gene both controls cell division and protects the body against cancer by causing cells to die before they become malignant.By blocking the cell protein, HPV forces the host cell to live instead of die and to proliferate and form tumors.

The prospective new drug, called CH1iB, prevents the viral protein from binding with the cell protein. This restores the function of the p53 “tumor-suppressor” gene and triggers the death of the cancer cells.

“Our study revealed a new mechanism for p53 inactivation in HPV-positive head and neck cancer, and this allowed us to develop an agent that disrupts that interaction and reactivates p53 in HPV-positive head and neck cancer,” Pan says. “Our pre-clinical studies show CH1iB can reactivate p53 and eliminate HPV-positive head and neck cancer cells.”

Pan notes that the standard of care for HPV-positive head and neck cancer uses high-dose cis-platinum, a chemotherapy drug that causes serious side effects that are difficult for patients to tolerate. The drug’s toxicity raises the need for safer therapy, and, although further testing is necessary, combining CH1iB with a low dose of cis-platinum might one day provide an alternative.

For this study, Pan and his colleagues used high-risk HPV-positive head and neck squamous cell carcinoma cells. Key technical findings include:

  • The incidence of head and neck cancer caused by the human papilloma virus (HPV) has tripled since the 1970s and continues to grow; better therapy is needed;
  • This study discovered a new mechanism by which HPV causes head and neck cancer, and the researchers designed a drug that blocks the mechanism;
  • The findings could lead to a safer, more effective therapy for HPV-caused cancer
  • The small-molecule inhibitor CH1iB inhibits the binding of the HPV E6 protein with the p300 cell protein;
  • The binding of the CH1iB inhibitor with p300 reactivated p53 and dramatically potentiated the efficacy of cis-platinum in HPV-positive head and neck cancer cells.
  • The combination of CH1iB and cis-platinum eliminated 91 percent of HPV16-positive head and neck cancer cells; it also increased apoptosis by 984 percent and 443 percent compared with CH1iB and cis-platinum respectively alone.

“These results suggest that fewer cycles or a tapered dose of cis-platinum, along with a CH1 inhibitor, might be sufficient to effectively manage HPV-positive head and neck cancer patients and offer a better toxicity profile,” Pan says.

“Taken together, our data suggest that we’ve discovered a novel approach for reactivating the p53 gene in HPV-positive head and neck cancer that may translate to other HPV-positive carcinomas.”

Source: Ohio State University Medical Center

April, 2013|Oral Cancer News|

Emergence of HPV 16 and sexually transmiitted oral cancer

Source: communities.washingtontimes.com
Author: Dr. Ali by Ali Forghani

The human papilloma virus (HPV) is the second leading cause of oral cancer. HPV is certainly not a newcomer to the disease world. It is one of the most common sexually transmitted disease on the planet. As of this writing, over 120 variations of the virus have been discovered, with different strands of HPV affecting different areas of the body. Many people contract HPV daily without realizing they have a virus, as it is very possible to carry a strand while displaying no noticeable symptoms.

hpv_virus

HPV 16 Virus

HPV is a virus that is mainly focused on the outer surface of the body, the skin, as well as the mucus secreting areas. The most noticeable effect from certain strands of the virus is the appearance of warts on the skin, mainly concentrated on the arms, legs and hands.

Condylomata acuminatum, also called genital warts, are the strands of this virus found most commonly on individuals and are generally believed to be caused by the HPV strands 6 and 11. These particular strands of HPV are very common and easily treatable.

One of the prime reasons HPV is found so commonly in the world is the ease of transmission of the virus. HPV can be spread simply by contact of the skin, with certain strands branching out to be sexually transmitted.

These particular strands are the strands that should be of the most concern today due to the discoveries being made about the HPV STD strands. HPV 16, 18, 31, and 45 are the current strands associated with cancer and can be identified by the difference in physical markers they cause. These particular strands have growths that are flat and nearly invisible to the eye as opposed to the more conventional warts people are accustomed to recognizing.

The two strands of importance here are HPV 16 and 18, as these two have been determined to be strong causes of many of the cervical cancers of the world. Recent studies have linked HPV 16 to causing oral cancer in ever rising numbers. The oral cancers linked to HPV16 develop tumors in a different set of locations than non-HPV cancers, providing an easy method of identification.

HPV16 is often seen to manifest in the back of the throat, inside the mouth, the tonsillar pillars, and the tonsils themselves. Non-HPV tumors tend to be on the anterior tongue, the floor of the mouth and the mucosa of the cheeks. HPV16 is currently being spoken of as the second primary cause of oral cancer, and likely, will soon overpass alcohol and tobacco as being the primary cause.

There are two alarming concerns with HPV 16: The age of the victims that contract the virus and the method in which it is often transmitted. Oral cancer contracted via the ingestion of alcohol and tobacco is most often associated with individuals who are well into life, often over the age of forty. These people have often been smoking or drinking for the better part of their adult lives, and the cancer has built up over many years.

HPV 16 varies from this immensely as it most often found in people in their 20s with no traces of alcohol or tobacco consumption, although there is an additive link between consumption of these and HPV 16. The ease of which HPV 16 is unknowingly transmitted lies in the fact that it is mainly transmitted by sexual contact. Remember that the virus resides on the skin, and this includes the skin of the anus, vagina and penis.

Often oral contact of these areas allows the HPV to transfer directly to the oral cavity. It is usually the case that the carrier of HPV 16 is not even aware and spreads the virus unknowingly to their partner.

April, 2013|Oral Cancer News|

Spike in oral cancers puzzles experts

Source: www.turnto23.com
Author: Victoria Colliver/San Francisco Chronicle

Christine Schulz has never visited England, but she speaks with the clipped inflection of a vaguely British accent. It’s not an affectation but, rather, the mystifying after-effect of an 18-hour surgery she endured in 2009 to remove about half her tongue due to a cancerous growth that had spread to her lymph nodes.

Surgeons used skin from her wrist and upper leg to re-create the missing portions of her tongue. Through long term speech therapy, Schulz, 47, of Hollister, Calif., re-learned how to eat and talk with her reconstructed tongue. If she sounds as if she’s from a different country, Schulz isn’t complaining.

“At the moment I woke up from surgery, I realized exactly what a huge deal it was,” she said, describing how she had an incision in her throat to allow her to breathe and was prohibited to speak in her earliest days of healing.

Oral cancers, which include those of the mouth and tongue, are most common in men over 60 with a long history of smoking or chewing tobacco, often combined with heavy drinking. But in recent years, a spike in the incidence of oral cancers is being attributed to human papilloma virus or HPV.

But Schulz’s cancer was neither HPV– nor tobacco-related. That puts her in a camp of fewer than 7 percent of all oral cancers that have no identifiable cause, according to the Oral Cancer Foundation, an advocacy group based in Newport Beach, Calif.

“Surprisingly, a high percentage of tongue cancers — 45 percent — is not related to the virus. The cause, we don’t know,” said Dr. Steven Wang, a head and neck surgeon at the University of California San Francisco with expertise in microvascular reconstructive surgery.

Tongue cancer is relatively rare, diagnosed last year in about 13,000 U.S. patients — more than 9,000 men and 3,700 women. It leads to some 2,000 annual deaths, according to the National Cancer Institute. Overall, there were 42,000 diagnoses of the broader category of oral cancers, which include the mouth cavity, lips and the oropharynx, or the part of the throat at the back of the mouth. Oral cancers combined kill about 8,000 each year.

While statistics show many cancer types leveling off or even decreasing in recent years, the incidence of oral cancer has increased, due in large part to HPV. Between 1988 and 2004, the percentage of HPV-related oropharynx cancers skyrocketed by 225 percent, according to a 2011 study published in the Journal of Clinical Oncology. But that doesn’t explain the rise in oral cancers among patients with no known cause.

“It could be a genetic predisposition or it could be an outside source, a causal agent that hasn’t been discovered yet,” said Brian Hill, the Oral Cancer Foundation’s executive director.

Wang, who reconstructed Schulz’s tongue, said nonsmoking-related oral cancers tend to be less responsive to chemotherapy and radiation than HPV- and smoking-related tongue cancers. And often the symptoms are overlooked. His latest research, to be published in the journal Otolaryngology — Head and Neck Surgery, found that former or current smokers with a form or tongue cancer called squamous cell carcinoma had a better chance of surviving than patients with the same cancer who never smoked.

“People always notice the sore or the ulcer in the mouth, but they’re not thinking it’s cancer,” he said. “They’re thinking, ‘I’ve never smoked, I’m too young.’ And, unfortunately, their doctors are thinking the same thing.”

Because treatment is frequently delayed, Wang said nonsmokers with tongue cancer are more likely to have the disease treated aggressively. Surgeons are able to reconstruct the tongue, but they have yet to find a way to re-create its function.

For Schulz, what started as a bump in the back of her tongue that wouldn’t go away turned into a life-altering experience. Her marathon surgery and reconstruction was followed by chemotherapy, radiation and a year and a half of speech therapy.

Most extremely sweet foods do not register on what’s left of her taste buds, although she loves chocolate more than ever. She avoids bread and crackers because those kinds of foods turn to cement in her mouth, and she finds salads just too much work.

“Putting food in my mouth still feels foreign,” she said, adding that it takes her a long time to eat. “I have to chew it. I have to have a thought about where it is inside my mouth and make sure it stays there, chew enough so I know I have to swallow and then I have to have water.”

Here are some signs and symptoms of the disease:

– Patches inside your mouth or on your lips
– A sore on your lip or in your mouth that doesn’t heal
– Bleeding in your mouth
– Loose teeth
– Difficulty or pain when swallowing
– Difficulty wearing dentures
– A lump in your neck
– An earache that doesn’t go away
– Numbness of lower lip and chin

Sources: National Cancer Institute; Oral Cancer Foundation

March, 2013|Oral Cancer News|

Detecting cancer’s biochemical ‘fingerprint’ for early diagnosis

Source: www.siliconrepublic.com
Author: Claire O’Connell

Detecting cancer in its early stages could help to make treatment more effective. Claire O’Connell found out from Dr Fiona Lyng about Cervassist, an emerging technology that uses spectroscopy to analyse tissue samples and spot when cells are showing signs of abnormality.

So far the technology has been focusing on assessing cervical smear samples, which are routinely collected as part of screening programmes for cervical cancer in many countries.

Cervical cancer is the one of the most common female cancers in Europe, and women are encouraged to be screened every few years. Cells are removed from the neck of the womb, and they are examined by eye under a microscope. If there are abnormal or potentially cancerous cells in the sample, the person can be monitored or treated as appropriate.

Cervassist, which is being developed at Dublin Institute of Technology (DIT), could offer another view of those cells on the microscope slide. By shining laser light on the samples and collecting some of the scattered radiation, the technology can automatically analyse the biochemical content of the cells, explains Lyng, who is manager of the DIT Centre for Radiation and Environmental Science.

“We use Raman spectroscopy to analyse the cervical samples – it’s a vibrational spectroscopic technique that gives a biochemical fingerprint of a sample,” she says. “If you shine laser light on a sample, light is scattered back and we collect the inelastic scatter, which contains information about the biochemical components in the sample, the proteins, nucleic acids, lipids and carbohydrates.”

Validating the technology
The team at DIT, funded by Enterprise Ireland, has been working with Prof John O’Leary and Dr Cara Martin at the Coombe Women and Infants University Hospital in Dublin, building up a database of Raman fingerprints from normal, abnormal and cancerous cells in order to develop and validate the technology.

Preliminary results suggest the Raman approach offers around 98pc accuracy, according to Lyng, and the hope is that the technology could eventually support screening programmes.

“It could be used as an initial screening step, to screen out all the normal samples – which are the bulk of the samples – and highlight the ones that are abnormal and have cytologists assess them,” she explains.

Lyng, who won the Enterprise Ireland ‘One to Watch’ award in 2011, has been working closely with DIT Hothouse, and Cervassist technology has been licensed to business partner Raman Diagnostics. At the moment, the drive is on to validate the technology with larger numbers of samples before moving to a clinical setting.

“We are now building up the numbers of the different classes of cervical cytology samples, and ultimately we want to move the Raman microscope into the current cytology setting and compare it directly, side by side with the normal screening programme,” says Lyng.

The research team has also been investigating whether Raman spectroscopy could help to identify the presence of specific human papilloma viruses (HPV) in cervical samples, which are linked with increased cancer risk.

SFI grant
Meanwhile, Lyng has just been awarded a grant from Science Foundation Ireland to develop the Raman technology to analyse oral cancer.

“For Raman spectroscopy, the ultimate goal would be to have an in vivo probe, so we wanted to concentrate on sites that are accessible to a fibre optic probe, and that’s one of the reasons we decided to have a look at analysing samples from the mouth,” she explains.

Lyng will work with Prof Stephen Flint from the Dublin Dental University Hospital on the four-year grant: “We are looking to understand what the Raman spectra look like for normal, pre-cancer and cancer cells in the mouth and then take what we know from our work with cervical cancer and apply it to oral cancer.”

February, 2013|Oral Cancer News|

Throat Cancer and HPV – the researcher

6 February, 2013 12:26PM AEDT
By Carol Duncan (ABC Local)
Source: abc.net.au

 

Assoc Prof Karen Canfell is a researcher with the Lowy Cancer Research Centre at the University of NSW. HPV is her area of expertise. What does she want us to know about HPV and the vaccination program?

CAROL DUNCAN: Karen, your area of expertise is human papilloma virus and I understand there’s not just one but 100 or more?

ASSOC PROF KAREN CANFELL: That’s right, there’s a large number of types HPV that have been implicated in cancer but it’s really two of those types that are responsible for the vast majority of cancers, HPV 16 & 18 and those types are the ones that are included in the vaccine that is now available to us.

CAROL DUNCAN: I guess this is the point of this series this week is that we now have another cancer which is, in essence, preventable.

ASSOC PROF KAREN CANFELL: Yes, I think what we’re seeing with HPV is an incredible success story in cancer prevention. This started with the vaccination of girls and women in Australia. Because HPV has a very important role in cervical cancer and, in fact HPV is responsible for virtually all cervical cancers, the types we just mentioned (types 16 & 18) are responsible for about 70% of those cancers.

Five years ago, in 2007, we had the implementation of the National HPV Vaccination Program in girls and women in Australia and that’s really had incredible effects already. For example we’ve already seen a drop in the number of young girls infected with HPV, we’ve also seen a reduction in the numbers of high-grade abnormalities of the cervix which are the precursor to cervical cancer, and we’ve seen a reduction in anogenital warts which are also caused by different types of HPV which are also included in the vaccine.

So in terms of what’s happened in females, it’s just a remarkable story and we’ve really seen it play out in Australia before anywhere else in the world because Australia was one of the first countries to adopt the vaccine.

CAROL DUNCAN: And now it takes another step as of this year (2013) with the extension of the cervical cancer vaccine to boys.

ASSOC PROF KAREN CANFELL: That’s right. Again, Australia is one of the first countries to make this decision.

Last year, the Pharmaceutical Benefits Advisory Committee recommended that young boys are included in the National HPV Vaccination Program and that will roll out from this year. What that means is that it is going to provide incremental benefits to both girls and boys and I think what we have to remember here is that HPV is transmitted between males and females so vaccination of females was already going to have some beneficial effects for males ultimately because it would cut off the circulation of the virus in the population, but by including young boys in the program we have even greater coverage and we also have protection of the gay community, so I think this really does provide and important incremental step to protecting males even further against HPV infection and the cancers that can be caused by it.

CAROL DUNCAN: The cancers that HPV can cause in men are equally as horrific as cervical cancer.

ASSOC PROF KAREN CANFELL: That’s right, there is a whole range of cancers that HPV can cause in men and also in women in sites other than the cervix.

These include anogenital cancers but also cancers of the head and neck. These are an important set of cancers. I think the complication is that not all of these cancers are caused by HPV but still a significant fraction are and probably that fraction is increasing in the case of head and neck cancers.

CAROL DUNCAN: Dr Jonathan Clark mentioned that, and that so far researchers don’t know why the rate is increasing.

ASSOC PROF KAREN CANFELL: We can’t say definitively but it certainly seems that in Australia and the US that that is happening. A US study has recently shown that cancers of the head and neck maybe now about 70% of them could be attibutable to HPV, so that is a high proportion of those cases.

The other message we need to say here is that vaccination is a really wonderful thing and it’s going to have important long-term effects for men and women in Australia and in most countries which have implemented vaccination programs.

But for women in particular, it’s really important not to forget about cervical screening because that’s what is also protecting older, unvaccinated women against cervical cancer and really the two preventative mechanisms need to work together for the forseeable future.

The main message here is that the vaccination program in females has been incredibly effective. It’s about 73% coverage in young girls in Australia, so there still is one in four girls in Australia not being vaccinated so I think for parents of both young boys and young girls at school it’s really important to see this as a long-term wonderful gift that you can give to your children in terms of cancer prevention.

CAROL DUNCAN: I have watched six hours of throat cancer surgery, I can assure you you don’t want your children to go through that.

ASSOC PROF KAREN CANFELL: Yes I can imagine.

 

 * This news story was resourced by the Oral Cancer Foundation, and vetted for appropriateness and accuracy.

 

February, 2013|Oral Cancer News|