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Medical Intel

Oct 19, 2018

Human papillomavirus (HPV) is the most common sexually transmitted infection in the U.S., and this virus is behind a surge in head and neck cancers among young people. Dr. Matthew Pierce discusses who is at risk, warning signs and how we treat these cancers.



Intro: MedStar Washington Hospital Center presents Medical Intel where our healthcare team shares health and wellness insights and gives you the inside story on advances in medicine.

Host: Thank you for joining us today. We’re talking with Dr. Matthew Pierce, an otolaryngologist and head and neck surgeon at MedStar Washington Hospital Center. Welcome, Dr. Pierce.

Dr. Pierce: Thank you. Thanks for having me.

Host: The human papillomavirus, or HPV, is one of the most common sexually transmitted infections. In most people, the virus courses through the body and leaves without causing any health problems, though HPV is known to cause cervical cancer in women.  However, men and women in their 30s and 40s are developing head and neck cancers at an alarming rate as a result of HPV infection. In the U.S., HPV is thought to cause 70% of cancers in the oropharynx, which is the back of the throat, the base of the tongue, and the tonsils. Dr. Pierce, why is this virus that was once associated solely with cervical cancer now so strongly associated with head and neck cancer?

Dr. Pierce: We don’t really know the answer to that at this point. Uh, it’s only recently, and I say recently in the past 20-25 years, been associated with cancers of the oropharynx, or the back of the throat. These cancers may have always been associated with HPV, and we’re just now realizing it and newly diagnosing these types of cancers. The majority of people have been exposed to HPV at some point in their life. And the vast majority, 90% of the people, clear this without any effects whatsoever. There’s a small population that, for whatever reason, harbors the HPV virus, either in their tonsils, cervix or elsewhere. And there are over 100 types of HPV, but there’s only a very small few percentage of those different strains that actually cause or are related to cancer. And that small percentage, and even smaller percentage who are infected with what we call those high-risk types of HPV, actually develop cancer. And again, we don’t really know why some people develop cancer and why some people don’t, but there’s a lot of good research going into that now. But, uh, there are those high-risk type of HPV infections.

Host: Nearly everyone who has had at least one sexual partner has been exposed to HPV. How do you discuss that with patients?

Dr. Pierce: HPV is a sexually transmitted disease. I don’t really have that conversation with them once they’re diagnosed. You know, it’s a big deal being diagnosed with head and neck cancer, and they really want to know kind of what to do about it. And so, I think it’s good to discuss treatment options and where we go from here. With, uh, head and neck cancer, it’s a very morbid type of cancer to get, and it can really affect patients’ appearance as well as their swallowing and speech, and so it really affects a lot of different parts of their day to day lives. Uh, and so, getting the correct diagnosis and getting a good treatment plan is essential. The interesting thing about HPV head and neck cancers is that they actually respond better to treatment and they have a better prognosis than most other cancers of the head and neck. It’s kind of the silver lining of this wave of cancers.

Host: Why do HPV-related head and neck cancers respond a little bit better to treatment than other head and neck cancers?

Dr. Pierce: Uh, we actually don’t know why these patients respond better to treatment as of yet. There’s a lot of studies going into that, and there’s actually a lot of studies that are looking at what we call a de-escalation or actually trying to reduce the amount of treatment that we actually have to give these patients while maintaining the same results and the same outcomes.

Host: So, on the one hand you have a cancer that’s quote/unquote “relatively easy to treat”, but it can also can be quite destructive. Can you talk about the effects or the symptoms of HPV-related head and neck cancer?

Dr. Pierce: So, HPV head and neck-related cancer is--I wouldn’t say it’s necessarily easy to treat but I would say that it responds better to treatment. Whether that is radiation or chemotherapy, or even surgery, these patients tend to do better after treatment, and they have a better prognosis. Cancers of the head and neck can very frequently affect the patient’s swallowing function and speech, as well as the outward appearance, and so, depending on what type of treatment and where the cancer is located. You can have some scarring from... if the patient has surgery or radiation. Uh, the side effects of treatment can often cause issues with swallowing, or speech, or other aspects of day to day life. I think with head and neck cancer, the best outcomes are when we catch these cancers early on. And the reason that they are very morbid is because of one, their aggressiveness, and two, because of the location. And, you know, anytime you have a tumor that requires treatment in the mouth, in the neck or the throat, it can affect multiple organ systems, including swallowing, speech, uh, and as you can imagine, appearance as well. And so, it is something that we recommend, if you are suspicious, just come in and be seen, and see a specialist if you’re concerned about anything in the head and neck area.

Host: What symptoms might a person experience if they have head and neck cancer that might cause them to go see their doctor?

Dr. Pierce: The symptoms can…can be very subtle, but it’s very important that patients go, if they have any concern at all, to go and see a specialist and get checked out. And some of the major symptoms that most people present with are a mass in the neck or a lesion in the oral cavity that does not heal or an ulcer that persists and doesn’t go away. Other more subtle symptoms can be difficulty swallowing or pain with swallowing. It can be changes in your voice, hoarseness, ear pain, or coughing up blood or blood from the nose. Usually if a symptom lasts for more than 2 or 3 weeks, and it’s not getting better, it’s good to go see a specialist and…and get it checked out.

Host: Do you recommend that any of your young adult patients receive the HPV vaccine, or is that reserved for younger folks?

Dr. Pierce: Absolutely. I think that the HPV vaccine is very important for young teenagers, and the current recommendation is for, uh, children who are 11 to 12 years old, both male and female, to get the HPV vaccine. Children as young as 9 years old, as well as adults up to the age of 26 for women and…and 21 for men, uh, are currently recommended to get the HPV vaccine. Currently, there’s no recommendation above that age, uh, and the reason for that is the majority of people have already been exposed to HPV at that time, and so it’s not gonna have any benefit to the patient once they’ve already been exposed, but for younger patients, it is something that is invaluable. And even though we don’t know the benefit at this time, we do know that it can prevent from an infection, and the prediction is that it will decrease the amount of cancers that we see in the future.

Host: Because HPV is so common, is there anything aside from the vaccine that parents can teach kids to do, or that young adults can do, to reduce their risk?

Dr. Pierce: The only sure way to completely avoid any risk is for complete abstinence, which is not a realistic expectation. Even for people who are in a monogamous relationship still have the risk of being exposed, um, either from their partner’s past partners or even from open-mouth kissing can even potentially spread HPV. And so, there is currently no recommendation specifically for reducing the risk of HPV transmission, uh, other than the standard safe sexual practices that are already recommended for decreasing the chance of STD transmission. The interesting thing about HPV-related cancers are that they typically involve a younger and healthier population. We typically see these in males more than females, about 3 to 1, and there’s usually males in their 50s to 60s, whereas tobacco-related cancers of the head and neck usually present about 10 to 15 years after that, so that is one of the differences that we have seen in the epidemiology of head and neck cancers and HPV cancers is they’re typically in a younger, uh, population.

Host: Could you talk about your team approach to head and neck cancer care at MedStar Washington Hospital Center?

Dr. Pierce: Absolutely. So here at MedStar Washington Hospital Center we have a multidisciplinary approach to cancer care, including HPV-related cancers. We talk about and present all of our new patients as well as our follow-up patients in a team approach, discussing with multiple ENT and head and neck cancer surgeons as well as chemotherapy doctors and radiation doctors. And we approach every patient in this multidisciplinary style of cancer care, uh, which has been shown and proven to be the best form of developing plans for cancer patients. We have a state of the art approach, both surgically and using other modes of treatment for head and neck cancer patients.

Host: Typically, are you having to do surgery on all of these patients, or is it rare that you’d have to do surgery?

Dr. Pierce: These patients respond well to all types of treatment. And depending on each individual patient, if it’s an early stage and a small cancer, these patients can undergo surgery. And one of the benefits that we have here at Washington Hospital Center is we offer a minimally invasive type of surgery to resect these cancers. And that’s in the form of either robotic surgery or transoral laser surgery. And these surgeries offer a minimally invasive way to cure and treat these patients. Fortunately, not everybody needs to have surgery and a lot of these patients respond very well to chemotherapy and radiation. And this… it’s usually, a discussion that has to be made with the patient as well as the tumor board.

Host: Thanks for joining us today.

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