Ever Vigilant

A male patient in his 30’s. Left inferior internal jugular node metastases with extranodal invasion, two years after brachytherapy of tongue cancer. PET-CT scanning, 64 minutes after fludeoxyglucose ( 18 F) in the amount of 3.7 MBq/kg was administered. The blood glucose level at the time of the FDG dosage was 108 mg/dl. PET-CT scan shows some fluff around the tumor. The tumor of the left cervix was SUVmax 17.7, with 36 x 37 mm size. In delayed phase, SUVmax was 25.6. (Photo credit: Wikipedia)

I wanted to share something Ry and I read, probably something from the Oral Cancer Foundation website, when we were frantically looking for answers after he had been diagnosed with his reoccurrence. It was a statement, not an article, or maybe it was a “blurb” on some national cancer institute‘s website about a study that had been done using oral head and neck cancer tumor samples from the past 30 years that had been thought to be associated with traditional causes for these cancers (smoking and drinking alcohol) but many of the samples showed evidence of HPV. As a statistician, Ry assured me that the numbers they talked about, something like 70% with HPV, was more than statistically significant and that he was shocked at the numbers. However, after we thought about it, it made sense and merely confirmed what we already knew, that the medical community did not know much about these cancers, particularly those associated with HPV.

I wanted to find that blurb and share it here, but I could not find it. I did find a plethora of resources and articles siting the confirmation that HPV related oral head and neck cancers are on the rise by 70% between 1984 and 2004. Other articles suggest that it continues to be the rise, while those due to other risk factors (smoking and drinking) are declining, particularly for those under the age of 65.

Many of these articles are older, written before 2010 and the studies they site or are reporting about are even older.

From my perspective this simultaneously pisses me off and frightens me because this would suggest that for the past decade HPV related head and neck cancers have been on the medical radar for quite some time but not a whole lot has been done about it. Most people still have no idea that you can get HPV in a variety of areas within the body and that it can potentially cause cancer pretty much anywhere (i.e. the cervix, the mouth and throat, the anus, the penis, and apparently in the lungs now according to yet another article that I came across last week: http://oralcancernews.org/wp/hpv-linked-to-certain-lung-cancers-is-oral-sex-to-blame/Related articles).

Even most of Ry’s nurses were shocked to learn that HPV was the cause of Ry’s cancer. Actually, nearly everyone we encountered had no idea what HPV was, that it could cause cancer, and that it was sexually transmitted. Ry’s family and I found ourselves constantly educating people about it, and constantly feeling baffled by the confusion and ignorance most people expressed about the subject.

I mean, it kind of makes sense, the mouth is a very similar environment to the vagina. They are both soft, damp, warm, and dark. They are both perfect breeding grounds for nasty little viruses and bacteria.

Another article, actually an abstract explaining the efficacy for studying HPV and cannabis use, basically make the case for the possibility of infection with HPV from sharing joints called Bogarting that joint might decrease oral hpv among cannabis users:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2794675/

Ok, that’s scary. If it’s that easy to pass on, why not through kissing and why not through sharing a beverage or using the same spoon or fork? I don’t really want to think about that, it will certainly lead down a long and winding road to paranoia.

So what do I want to think about? I want to think about prevention and the facts as we knew them in the past, how we understand them now, and what we hope to understand in the future. These links gave me a bit of insight and hope, and they are written in a way that is way easier to comprehend compared to the study based articles from medical journals:

http://report.nih.gov/nihfactsheets/ViewFactSheet.aspx?csid=106

http://www.cancer.gov/cancertopics/factsheet/prevention/HPV-vaccine

What can we do? Are there new and exciting breakthroughs on the horizon? Will there be a cure? Thus far I think all we can do is get early detection: What the ‘rinse-and-spit’ oral cancer test could mean for dental professionals and their patients

and we can take preventative measures: HPV vaccination—reaping the rewards of the appliance of science | Oral Cancer Newsbit.lyThe optimism generated by scientific breakthroughs often turns to disappointment when applied to the real world of clinical care. It is therefore worth celebrating the extraordinary success of Australia’s national human papillomavirus (HPV) vaccination programme, which was implemented five years ago…

and we can hope that there will be funding for more studies like this:

Researchers Design Drug to Restore Cell Suicide in HPV-Related Head and Neck Cancer | Oral Cancer Neoralcancernews.orgResearchers 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 o…

and this:

http://ebm.rsmjournals.com/content/236/4/375.full

(this last one is academic, but if I can understand it, most people should. It talks about a number of possible treatments that might be more effective than the current standard of care)