human papilloma virus

Global trends suggest HPV positive oral cancer greatly increased in young males

Source: www.zawya.com
Author: staff

While the incidence of smoking-related oral squamous cell carcinoma has decreased in many parts of the world, cases of human papilloma virus (HPV) positive oropharyngeal cancer (OPSCC) have greatly increased. Otolaryngologists are finding that the majority of their patients are male and a lot younger in age than their counterparts. This “new” head and neck cancer patient differs in several ways from the “traditional” head and neck cancer patients who were older, had significant tobacco and alcohol exposure, and potential tumours throughout the upper aerodigestive tract. The significance of this global trend suggests that more attention needs to be paid to the phenomena here in the Middle East.

Dr Marilene Wang, Professor, Chief of Otolaryngology, UCLA Department of Head and Neck Surgery, will be discussing the increasing incidence of young cancer patients who are non-smokers, but happen to be HPV positive and how these cases should be managed in the Middle East at the 11th Middle East Update in Otolaryngology Conference & Exhibition – Head and Neck Surgery (ME-OTO) from the 20-22 April 2014 at the Madinat Jumeirah Arena, Dubai, UAE.

According to Dr Wang, “Currently, the most common head and neck cancer patients are younger, primarily male, and have no or relatively minimal exposures to tobacco and alcohol. Yet, they often have histories of notable increased sexual encounters. Although HPV positive OPSCC demonstrates an alarming increasing incidence, this is balanced by a significant response to treatment regardless of advanced stage.

“Cases of OPSCC associated with HPV have increased 225% in the US from 1988-2004. HPV infection is ubiquitous, as up to 85% of adults may have an HPV infection at some point from any of the over 120 subtypes. Only a small percentage of these subtypes develop malignancy and these are primarily related to the HPV-16 subtype. There is also an increased risk of OPSSC in husbands of women with cervical cancer and in situ cancer.”

The majority of epidemiological studies on HPV positive OPSCC have been done in the Western hemisphere, where there is a documented rise in the incidence of both HPV infection and HPV positive OPSCC. The impact of HPV in other parts of the world is less clear.

“A recent study from Turkey did document an increase in the incidence of HPV positive OPSCC between 1996 and 2011, from 33% to 70% (Dural et al. Asian Pac J Cancer Prev. 2013; 14(10):6065-8). Further studies will need to be done to determine the incidence of HPV-positive OPCC in the Middle East,” says Dr Wang.
“Vaccination against HPV is recommended for adolescents and young adults, boys and girls, ages 9 -25, ideally prior to onset of sexual activity. This commonly utilized vaccine provides protection against the 4 strains of HPV most associated with cervical and OPSCC, including HPV-16. However, there is no evidence to support efficacy of the vaccine to treat HPV-related cancers,” concludes Dr Wang.

March, 2014|Oral Cancer News|

Support HPV Vaccination to protect children in the US

Source: www.usatoday.com

Author: Liz Sbazo

The USA is failing to protect children from preventable cancers that afflict 22,000 Americans a year by not vaccinating enough of them against HPV, a new report says.

Although a safe and effective HPV vaccine has been available for eight years, only one-third of girls have been fully immunized with all three recommended doses, according to a report from the President’s Cancer Panel, which has advised the White House on cancer since 1971. HPV, or human papillomavirus, is a family of viruses that causes cancer throughout the body, including cancers that predominantly affect men, such as a type of throat cancer. Only 7% of boys are fully vaccinated, although the Centers for Disease Control and Prevention has recommended the shots for them since 2011.

Raising vaccination rates to at least 80% of teen girls could prevent 53,000 future cases of cervical cancer in girls alive today, according to the CDC.

“Our children deserve this protection,” says panel chairperson Barbara Rimer, a professor at the University of North Carolina at Chapel Hill.

Administering the HPV shot poses practical difficulties not faced by other adolescent vaccines, because it currently requires three doses, at least two months apart, beginning when kids are 11 or 12, says pediatrician Mary Anne Jackson, director of infectious diseases at Children’s Mercy Hospital & Clinics in Kansas City, Mo., who wasn’t involved in the new report. Although emerging research suggest that two doses could be equally effective, experts have not yet changed their recommendations.

And at a total cost of $400 for three shots, the HPV vaccine is also more expensive than other vaccinations, although it’s often covered by insurance, Jackson says.

The real problem, research shows, is that doctors are treating HPV vaccinations differently than other shots recommended for kids at that age, such as meningitis and whooping cough boosters, Jackson says.

All too often, doctors offer HPV shots, giving parents the option to vaccinate, without strongly recommending them, says Debbie Saslow of the American Cancer Society, who served as an adviser on the report. That could be because doctors are leery of initiating a discussion about sexual activity, which is how HPV spreads, Saslow says. Doctors recommend giving HPV shots to kids at a young age, when they’re most effective.

Yet studies show that most parents are likely to follow their pediatrician’s recommendations, Jackson says. Most families would likely agree to HPV vaccinations if doctors simply included it in their general package of middle-school shots, Jackson says. Studies have found the vaccine to be extremely safe, with no increase in serious side effects, in spite of giving 56 million doses of the shots in the USA alone.

Future HPV vaccines may soon be even more protective than the original shot. While the current vaccines can prevent about 70% of cervical cancers, HPV vaccines under development will protect against 90% of cervical tumors, the report says.

“If we could get physicians to give a strong message about HPV vaccination to every child, we could make a real difference,” says Rimer, whose report notes that 60% of girls in the United Kingdom and 71% in Australia are fully vaccinated against HPV. “The conversation needs to be framed around cancer prevention, not about sex.”

State lawmakers could help boost vaccination rates, Rimer says, by passing laws to allow pharmacists to administer HPV shots to teens just as they do flu shots. Only 6% of pharmacists are in states that allow them to give HPV shots without prior approval from a physician.

The panel also asks President Obama to lend his support to HPV vaccination.

“Your support of widespread HPV vaccination starting today can help save thousands, and perhaps hundreds of thousands, of lives, and could forever alter the landscape for cancers related to HPV,” the report says. “No man or woman should have to suffer or die from cancer or other diseases when the means by which to prevent them is within our grasp.”

 

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

February, 2014|Oral Cancer News|

Michael Douglas: ‘Throat cancer’ was really tongue cancer

Source: cnn.com
Author: Jen Christensen, CNN

Michael Douglas never had throat cancer, as he told the press in 2010.

The actor now says he had tongue cancer. Douglas said he hid the diagnosis at the urging of his doctor to protect his career.

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“The surgeon said, ‘Let’s just say it’s throat cancer,’ ” Douglas told fellow actor Samuel L. Jackson for a segment that ran on British television as a part of Male Cancer Awareness Week.

Douglas says that the doctor told him if they had to do surgery for tongue cancer, “it’s not going to be pretty. You could lose part of your tongue and jaw.”

When Douglas first talked about his cancer diagnosis in the summer of 2010, he was on a worldwide publicity tour for the movie “Wall Street: Money Never Sleeps.”

Douglas and Jackson joked that could have been the end of his acting career. Douglas said if he had surgery he could see the director saying, “What’s your good side? I’ve got no side over here.”

“There really is no such thing as throat cancer per se,” explained Brian Hill, an oral cancer survivor and the founder of the Oral Cancer Foundation. Douglas has taped a public service announcement to raise awareness about oral cancer for Hill’s foundation.

“Throat” cancer and tongue cancer are both colloquial terms that fall under the oral cancer umbrella. Throat cancer usually refers to cancerous tumors that develop in your pharynx, voice box or tonsils. Tongue cancer refers to cancerous cells that develop on your tongue.

“The treatment up until just recently can be very brutal,” Hill said of tongue cancer. “Your career as a leading man could be over. If you have signed a contract to promote a movie, you would have a strong motivation not to say … ‘Maybe in six months I won’t have a tongue or lower jaw.’ ”

Douglas apparently did not need the potentially disfiguring surgery. He told Jackson he was instead treated with an aggressive form of radiation and chemotherapy. The treatment, he said, lasted five months.

In June, Douglas kicked off an animated conversation about the cause of oral cancer when he told The Guardian that he got throat cancer after engaging in oral sex. Oral sex can expose individuals to the human papilloma virus, which can cause cancer.

Later, Douglas’ publicist told CNN that Douglas did not blame HPV solely for his cancer; Douglas said he was also a smoker and a drinker. Smoking and drinking, particularly when combined, are considered the most significant contributing factors to oral cancer, according to the Centers for Disease Control and Prevention. So is Douglas’ gender. Men are twice as likely to develop oral cancer as women.

Oral cancers account for 2% to 4% of all cancer diagnoses in the United States. An oral cancer diagnosis is particularly serious; only half of the people diagnosed with oral cancer are still alive after five years, according to the CDC. In large part, that’s because of the late diagnoses of this disease. Most signs of this cancer are difficult to detect and are often painless.

Douglas told Jackson that initially his doctors treated him with antibiotics. Douglas had been complaining of a soreness at the back of his teeth. Three months later when it still hurt, the doctor gave him another round of antibiotics. Nine months later, after talking to a friend who was a cancer survivor, he went to the oncology department where a doctor did an initial exam and then a biopsy. He was diagnosed with stage four oral cancer in 2010.

Douglas is not the first celebrity to misidentify the kind of cancer they have.

Actress Valerie Harper, who first came to fame on the TV show “Mary Tyler Moore,” announced her cancer on the cover of People magazine in March. The story said she had little time left to live and was suffering from terminal brain cancer. It turns out the “Dancing With the Stars” celebrity actually had lung cancer that had spread to the lining of her brain.

“I see a lot of people with ‘brain cancer’ who actually have… lung cancer or breast cancer or some other cancer (that spread) to the brain,” Dr. Otis Brawley, the American Cancer Society’s chief medical and science officer, told CNN. “We treat cancer according to its origin.”

Harper’s kind of cancer, leptomeningeal carcinomatosis, can be slowed but the cells are adaptable and can develop a resistance to treatment. A complete remission is unlikely.

Douglas, on the other hand, has had regular check-ups since the diagnosis. At his two-year mark, he told Jackson, his doctors said he was clear of the cancer.

“There is a 95% chance it’s not coming back,” he told Jackson.

October, 2013|Oral Cancer News|

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.

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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|