Information for the Patient on Human Papilloma Virus (HPV) and Head and Neck Cancers

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  • 1. Information for the patient on Human Papilloma Virus (HPV) and Head and Neck Cancers The Education Committee- 2012 David Goldenberg- Chair Kavita M Pattani, Miriam Lango Ellie Maghami Erich M. Sturgis Theodoros Teknos
  • 2. Human Papilloma Virus (HPV): Definition Human Papillomavirus (HPV) has the ability to be transmitted from person to person Over 120 subtypes have been identified and characterized into “low-risk” and “high- risk” and are referred to by number  ****One of the most significant infectious carcinogens in humans
  • 3. HPV and Cancer “Low risk” HPV subtypes can cause genital warts but rarely cause cancer. “High-risk” HPV can cause several types of cancer in men and women  Cancer of the cervix, vulva and vagina  Cancer of the penis and anus  Head and Neck cancers – specifically the oropharynx
  • 4. HPV- Transmission HPV is the most common sexually transmitted infection in the United States >50% of people who are sexually active will have acquired genital HPV over their lifetime >80% of women over the age of 50 will have contracted at least one strain of HPV The lag time between exposure and diagnosis of cancer can be 20-30 years
  • 5. HPV-Transmission HPV can be passed through genital contact and oral sex 7% of the general population (age 14-69) has a throat infection caused by HPV at any given time  However, only 1% is infected with the type that causes cancer 3% of 16 - 20 year-olds
  • 6. HPV – Signs/Symptoms In >90% of cases the body’s immune system will clear the HPV (usually within 9 months to 2 years) Majority of patients develop no signs or symptoms of infection and thus infected individuals can remain oblivious**** Cancer occurs when infection persists & body’s defenses fail
  • 7. Who is at risk for HPV infection of the Oropharynx Increasing age  HPV infection is found in 2% of 14-17 year olds but 11% of 55-64 year olds Men  HPV infection is more common in men than women (10% of men and 4% of women are infected)
  • 8. Who is at risk for HPV infection of the Oropharynx Sexual activity  HPV infection is extremely uncommon (<1%) in those who report no sexual activity, and those who received the HPV vaccine  Risk of HPV increases with number of sexual partners. People reporting greater than 20 previous sex partners have the highest rates of HPV throat infection  Sexual activity years ago can still result in HPV infection and resultant cancer
  • 9. Who is at risk for HPV infection Smoking  People who smoke may be at greater risk for getting an HPV infection in the throat. Those who smoke more are more likely to get infected:  20% of those who smoke at least a pack of cigarettes a day were found to have an active HPV infection
  • 10. Treating HPV infection There is no known treatment for HPV infection In >90% of cases the body’s immune system will clear the HPV on its own (usually within 9 months to 2 years) In some people, the immune system is unable to clear the HPV infection. Some of those people will develop cancer but it will take 20 or more years. The reason that some individuals are not able to clear the HPV infection, and go on to develop cancer is unknown
  • 11. How do you prevent HPV infection? Prevention of HPV infection:  Abstinence  Condoms provide only partial protection  Vaccination may provide protection against the most common “high-risk” HPV infections, but not against all HPV subtypes that cause cancer  For this reason, routine screening with PAP smears is still recommended to detect cervical and anal cancers  There is currently no approved test to screen for throat cancer  Data is not yet available regarding the effectiveness of the vaccination
  • 12. Vaccination Centers for Disease Control and Prevention (CDC) now recommends  HPV vaccination for both boys and girls as of 2011 However, since vaccination is not mandatory  <50% of teenage girls have received the vaccination last year
  • 13. FDA-approved HPV vaccines Gardasil (Merck)  Approved for boys and girls, age 9-26  Covers HPV types 6, 11, 16 and 18 Cervarix (GlaxoSmithKline)  Approved for girls, age 10-25  Covers HPV types 16 and 18
  • 14. Timing of Vaccination Vaccination is recommended prior to the start of sexual activity “Catch up” vaccinations may be administered to girls and boys aged 13-25, However, vaccination is ineffective in those already infected with HPV
  • 15. HPV - Vaccination Length of protection against HPV infection following vaccination  Is unknown  Protection lasts at least 5 years, but length of protection continues to be studied Safety  Not yet fully determined  Reported rare side effects have included fainting and blood clots
  • 16. Screening for HPV-related cancers There is no blood test to screen for HPV infection Screening for cervical/anal cancers:  PAP smear  Used to screen for cervical and anal cancers and pre- cancers  HPV DNA test  is more sensitive than PAP smear, as a screening test for cervical cancer and pre-cancer  has not been studied as a screening test for throat cancer
  • 17. Screening for HPV-related cancers Screening for oropharyngeal cancer  There are currently no screening tests approved for the early detection of throat cancer caused by HPV A comprehensive physical examination (and biopsy if needed) by an otolaryngologist/ head and neck surgeon is essential to establish the diagnosis
  • 18. What is the Oropharynx? The oropharynx consists of: tonsils and tonsillar fossa, base of tongue, soft palate including the uvula, pharyngeal wall, anterior and posterior tonsillar pillars The oral tongue (anterior portion) is not a part of the oropharynx
  • 19. Oropharynx cancer caused by HPV The incidence of oropharynx cancer caused by HPV in the United States is increasing, and is believed to be caused by changes in sexual practices
  • 20. Oropharynx Cancer: Signs/Symptoms Common  Persistent mass in the neck Less common  Difficulty swallowing  Persistent sore throat  Ear pain  Weight loss  Bleeding from throat
  • 21. Oropharynx cancer caused by HPV Can occur in young people Who are otherwise healthy With an otherwise healthy life-style Who never smoked cigarettes Many people develop a prominent neck mass, and the oropharynx cancer itself may be small, and barely visible
  • 22. Diagnosis Referral to an Ear, Nose and Throat specialist, or Head and Neck Surgeon is needed A physical examination, biopsy and imaging studies may be recommended
  • 23. HPV Testing Testing for HPV status for biopsies obtained from the oropharynx area or from neck mass if present can result in diagnosis. p16 will also routinely be tested which indicates HPV etiology as well
  • 24. Oropharynx cancer caused by HPV - Treatment Oropharynx cancer caused by HPV frequently responds well to treatment. The type of treatment is determined by the extent of the cancer, and whether it has spread. Often, a combination of treatments is recommended,  For example, surgery and radiation, or radiation and chemotherapy
  • 25. Oropharynx cancer caused by HPV - Treatment Prognosis for Oropharynx cancers that are HPV positive is very good given the available treatment options Consultation at an institution with expertise in the treatment of such cancers is recommended.
  • 26. Frequently asked Questions Can I get cancer from my spouse who has HPV positive tonsil cancer?  Most adults in the United states have already been exposed to HPV by the time they are in their 50’s  Greater than 90% of individuals mount an effective immune system and clear the infection within two years of exposure  Those with HPV associated cancers probably became infected 20-30 years prior to current cancer diagnosis as a young adult
  • 27.  If you have been in a long-term monogamous relationship there is very little concern as you have probably already been exposed to the virus and acquired natural immunity; the medical evidence so far does not call for lifestyle modifications in this setting If you are a young adult under age 26 consider getting vaccinated and being more selective and conservative in your sexual practices
  • 28.  There is some evidence that the HPV virus can even be passed along with mouth to mouth kissing but this needs to be examined scientifically with further studies