Glomerular Filtration rate and its determinants.pptx
HPV and Head & Neck Cancer Guide
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