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Interviewer: Your doctor told you that you have a type of head and neck cancer that was caused by the HPV virus. Now what? We're going to talk about that next on The Scope.

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Interviewer: You've been told by your doctor that you have a type of cancer that was caused by the HPV virus and it's in your head and your neck. We're going to talk about an HPV head and neck cancer right now with Dr. Marcus Monroe. He's a head and neck cancer expert in the University of Utah Health Care. Let's just start with the basic. First of all, head neck cancer caused by HPV, tell me about it? What's happened?

Dr. Monroe: So HPV is Human Papilloma Virus and it actually causes a very specific subset of head to neck cancers. Cancers in the region of the head and neck that we call the oropharynx, which includes the tonsils and the base of the tongue so the part of the tongue that's behind what you can actually see in your mouth.

The important things for a patient that has been newly diagnosed are, one, to seek out a medical team that has experience in treating head and neck cancers. Probably more than any other cancer, the treatment of head and neck cancer's really a team sport. Typically treatments can include surgery, radiation, chemotherapy and so having physicians with expertise in radiation oncology, medical oncology as well as surgical oncology are very important. It's important to seek out a team that works well together.

In addition because the head and neck, you can think of the tonsils and the back part of your throat if you've ever had a sore throat just the pain and the difficulty of getting through that infection. Treatments in the area can be particularly rough and so it's really important not only to have the physicians but to have the entire support team. And so that includes dentists, swallowing and language therapists, nutritionists, physical therapists, and really a complete support group.

Interviewer: How bad can it get? I would imagine most people are concerned, "Is this going to kill me?"

Dr. Monroe: So the good news for HPV or oropharynx cancer is that when we look at that in comparison to other types of head and neck cancers, typically cancers that are caused by tobacco and alcohol use, the overall survival is better. In fact, if we look at for cancer specifically of the tonsil and the base of the tongue, the increase in survival is 25% absolute percentage points across all stages, so very significant increase in survival.

So I think the first take-home message is that if you're starting to search the Internet and you're at some of what has been recorded for head and neck cancer, you realize that, in many times, HPV-related cancers have an improved prognosis. And that's because of that some of . . . because it's a relatively new phenomenon, some of the data that we do have on there on survival is outdated and doesn't really apply to oropharynx cancer. Now, that being said, treatment in this area does carry some toxicity.

Interviewer: What does that mean?

Dr. Monroe: So toxicity means side effects from the treatment.

Interviewer: Okay. Typically, what is the treatment? Is it surgery? Is it chemotherapy?

Dr. Monroe: The treatment that's curative includes surgery and radiation. Chemotherapy given by itself . . . while the responses are high, meaning the tumor strings down, the long-term control is very, very low. So chemotherapy is typically not given by itself. The two treatments that have been shown to be associated with the cure of the diseases, surgery and radiation, are both used and it depends upon the individual patient and the individual tumor characteristics.

Across the US, the most common treatment is probably radiation based, the combination of radiation and chemotherapy. Chemotherapy is often given along with radiation to make the radiation work better. For patients with lower volume disease, meaning smaller tumors in the back part of their throat, we're beginning to evaluate the role of surgery to remove the tumors mainly so that we can achieve, one, the elimination of chemotherapy or, two, the reduction in the dose of radiation with the goal being of minimizing some of the long-term side effects of treatment. So the side effects of treatment can include difficulty swallowing long term. The radiation therapy also affects the salivary glands and so most patients will experience dry mouth.

Interviewer: So this is for the rest of their life or just immediately after treatment?

Dr. Monroe: Yeah, for the rest of their life.

Interviewer: Okay.

Dr. Monroe: And so most patients who undergo radiation treatment for the oropharynx will have increases salivary production. Now, the good news is that some of it returns over time, but it never returns to the level that it was prior to treatment. And that has important implications only just from a quality of life perspective, but the saliva has important function particularly in preserving our teeth. And so patients who undergo radiation therapy also are at higher risk of developing dental decay and it's one of the reasons why having a dentist onboard who is trained in treating patients who have radiation therapy to their mouth is important. There are specific dental precautions that can be done to minimize the risk of dental decay in patients.

Interviewer: What are some of the other concerns or considerations you get from patients after being diagnosed with HPV head and mouth cancer?

Dr. Monroe: Yes, I think that one of the most frequent questions that we get is not from the patient itself but from their loved ones or spouses. Many have gone online and read that HPV is a sexually transmitted disease and there are fears of, one, that they may acquire the infection or, two, that there's infidelity on the part of their loved one. I think there are a couple of important points to consider.

The first is that HPV is a ubiquitous infection, while over 80% of the population is exposed and many times, these infections occur decades before the actual onset of cancer. Many people have already been exposed if their loved one has HPV. The increased risk of cancer for loved ones has been demonstrated, but it's incredibly small. So we do know from studies that have done in the Scandinavian countries that women who have cervical cancer, there's a slight increase in the risk of developing oropharynx cancer or head and neck in their spouses.

Interviewer: And then you said a slight.

Dr. Monroe: A slight. It's a very small percentage of patients.

Interviewer: Okay. So not likely.

Dr. Monroe: Not likely, generally speaking.

Dr. Monroe: In Utah, studies that we have done here have demonstrated that patients with oropharyngeal cancer, there is a higher risk of cervical cancer in their spouses above the population so the converse of the studies that have been done in Europe.

So I think what this points to is that what you might expect from a disease that's sexually transmitted is that if one partner has HPV exposure then the other partner is likely to be exposed to HPV. And if they're exposed, there's a very small risk of developing cancer. As of right now, there are no recommended guidelines other than many people will have recommended spouses, female spouses of patients with head and neck . . . to undergo their already recommended cervical cancer screening.

Interviewer: I think kind of the final point then would be also that this is a completely preventable if you have vaccination when you're young before you're exposed to it. And that's kind of a tough thing, especially here in Utah. We're not getting these vaccinations taken care of.

Dr. Monroe: I think that's an incredibly important point. So vaccination rates in Utah are lower than the national average. This is a really important preventable, not just from the head and neck cancer perspective, but there are many other cancers and non-cancer conditions caused by HPV. So, prevention is really key.

Interviewer: And there's a prevention out there. It's just that we're not using it to scale.

Dr. Monroe: We're not using it, yes.

Interviewer: So if you have been diagnosed with the head and neck cancer because of the HPV virus and you have young children, then really be sure you get that vaccination taken care of.

Dr. Monroe: That's true. So I encourage all of your loved ones and children of the appropriate age to become HPV vaccinated. It's something that's relatively easy to do and has been shown to be effective for many other cancers and is thought to be effective for oropharyngeal cancer as well.

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