Information for the patient on Human Papilloma     Virus (HPV) and Head and Neck Cancers       The Education Committee- 20...
Human Papilloma Virus (HPV):        Definition   Human Papillomavirus (HPV) has the    ability to be transmitted from per...
HPV and Cancer   “Low risk” HPV subtypes can cause genital    warts but rarely cause cancer.   “High-risk” HPV can cause...
HPV- Transmission   HPV is the most common sexually    transmitted infection in the United States   >50% of people who a...
HPV-Transmission   HPV can be passed through genital contact    and oral sex   7% of the general population (age 14-69) ...
HPV – Signs/Symptoms   In >90% of cases the body’s immune system    will clear the HPV (usually within 9 months    to 2 y...
Who is at risk for HPV infection          of the Oropharynx   Increasing age       HPV infection is found in 2% of 14-17...
Who is at risk for HPV infection          of the Oropharynx   Sexual activity     HPV infection is extremely uncommon (<...
Who is at risk for HPV infection   Smoking       People who smoke may be at greater risk for        getting an HPV infec...
Treating HPV infection   There is no known treatment for HPV infection   In >90% of cases the body’s immune system will ...
How do you prevent HPV infection?   Prevention of HPV infection:     Abstinence     Condoms provide only partial protec...
Vaccination   Centers for Disease Control and Prevention    (CDC) now recommends       HPV vaccination for both boys and...
FDA-approved HPV vaccines   Gardasil (Merck)     Approved for boys and girls, age 9-26     Covers HPV types 6, 11, 16 a...
Timing of Vaccination   Vaccination is recommended prior to the    start of sexual activity   “Catch up” vaccinations ma...
HPV - Vaccination   Length of protection against HPV infection    following vaccination     Is unknown     Protection l...
Screening for HPV-related cancers   There is no blood test to screen for HPV    infection   Screening for cervical/anal ...
Screening for HPV-related cancers   Screening for oropharyngeal cancer       There are currently no screening tests appr...
What is the Oropharynx?   The oropharynx consists of: tonsils and tonsillar    fossa, base of tongue, soft palate includi...
Oropharynx cancer caused by               HPV   The incidence of oropharynx cancer caused by    HPV in the United States ...
Oropharynx Cancer:              Signs/Symptoms   Common       Persistent mass in the neck   Less common     Difficulty...
Oropharynx cancer caused by              HPV   Can occur in young people   Who are otherwise healthy   With an otherwis...
Diagnosis   Referral to an Ear, Nose and Throat    specialist, or Head and Neck Surgeon is    needed   A physical examin...
HPV Testing   Testing for HPV status for biopsies obtained    from the oropharynx area or from neck mass    if present ca...
Oropharynx cancer caused by         HPV - Treatment   Oropharynx cancer caused by HPV    frequently responds well to trea...
Oropharynx cancer caused by         HPV - Treatment   Prognosis for Oropharynx cancers that are    HPV positive is very g...
Frequently asked Questions   Can I get cancer from my spouse who has HPV    positive tonsil cancer?     Most adults in t...
   If you have been in a long-term monogamous    relationship there is very little concern as you    have probably alread...
   There is some evidence that the HPV virus can    even be passed along with mouth to mouth    kissing but this needs to...
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Information for the Patient on Human Papilloma Virus (HPV) and Head and Neck Cancers

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

  1. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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

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