Head & Neck, Cervical Cancers

Head & Neck, Cervical Cancers: The HPV Factor

Human papillomavirus — more commonly known as HPV — is stubborn.

It has been around for a long time, and it’s learned to evolve as humans have evolved.

And there’s not just one HPV. There are more than 200 related viruses and those are just the ones that infect humans. Of those, approximately a dozen can infect the mucosa (the moist parts of our body) and cause diseases including cancer.

Cervical cancer and head and neck cancer are two of the most common types of HPV-related cancers. While there is an FDA-approved screening for cervical cancer (get that Pap smear, ladies!), there isn’t one yet for head-and-neck cancer. So, prevention before infection is key.  And that can be easily accomplished with HPV vaccines. When administered prior to any contact with HPV, they can prevent more than 90 percent of HPV-related cancers — including those affecting the head and neck, cervix, anus, vulva, penis and vagina.

HPV vaccines and screenings put you in the driver’s seat when it comes to protecting your health. HPV might be stubborn. But it’s also preventable.

A Pit Stop with Rachel Katzenellenbogen, MD

Through the work she and her team are doing in her lab, Dr. Rachel Katzenellenbogen is driving research about HPV-related cancers forward. Dr. Katzenellenbogen, the Chuck and Tina Pagano Scholar, is a researcher who is committed to developing treatments for cancers caused by HPV.

Cervical Cancer

Abnormal bleeding and abdominal pain are two of the most common symptoms of cervical cancer. Unfortunately, some patients don’t have any symptoms until the cancer has become relatively advanced.

The best screening is the Pap smear. It’s been around for decades. However, when it was first developed, the fact that an HPV infection can cause abnormal cells in the cervix wasn’t known. Now it is — so we also have HPV DNA screening, which adds to the tools we have for detection.

There are cervical cancer screening tests on the horizon that wouldn’t require the use of a speculum. Eventually, there might be tests patients can self-administer at home.

In the United States, women should get their first Pap smear at 21. How often an individual needs to get one depends on whether HPV DNA is found. If it isn’t, the next Pap smear typically doesn’t need to be done for another three to five years. However, if a person has had multiple sexual partners, they should consider talking about that with their doctor.

Before the [GARDASIL®] vaccine, around three-quarters of adults in the United States had evidence of HPV in their mucosa. However, because the virus is typically short-term and quickly cleared by the body, many people weren’t aware they ever had it. It’s not common for someone to have a long-term HPV infection. But when it does stay around, that’s when it can start causing abnormal cells that can eventually turn into cancer.

Individuals who are living with immunosuppression challenges are at a greater risk for cervical cancer because their bodies may not be able to clear an HPV infection. These would include people such as transplant patients, those taking immunosuppressive medications for chronic disease, patients with HIV, and people who are experiencing bone marrow failure.

Other risk factors include being a smoker, having multiple sexual partners over a lifetime, and age. As you get older, there’s a greater risk for HPV.

Once someone becomes sexually active, using condoms can decrease the risk of exposure to and infection by HPV.

If a precancerous growth is found in the cervix, it can be removed. After that, your risk of cervical cancer goes almost back to baseline.

When cancer is found, treatment typically involves removing the cervix. Some people also need radiation and chemotherapy. Unfortunately, this might make it impossible for some patients to bear children.

Cervical cancer and head and neck cancer are two of the most common types of HPV-related cancers.

Head and Neck Cancer

Some of the most common symptoms of head and neck cancer are a lump on the neck or excessive throat clearing. This type of cancer occurs in different parts of the mouth and throat. It’s not going to be on your cheek or gums. So, that makes it harder to see.

There’s currently no formalized way to screen for head and neck cancer. There’s a lot of research going on to try to find a way to screen for it. But nothing at this point is leading to clinical guidelines of care.

The way head and neck cancer is typically detected is by a patient feeling a lump on their neck or by a doctor or dentist detecting it during a visit.

Head and neck cancer occurs predominately in males — three to five men for every one woman. And cases of HPV-positive head and neck cancer — which is cancer caused by HPV infection — are increasing.

Those who have HPV-positive head and neck cancer tend to be younger than those who have HPV-negative head and neck cancer. The HPV-negative cancers tend to be caused by smoking and drinking rather than an HPV infection. However, most head and neck cancers in the United States are HPV-positive.

Surgical excision of the cancer, radiation and chemotherapy are typically used to treat it. HPV-positive head and neck cancer isn’t as lethal as HPV-negative, but it can adversely impact oral health. For example, swallowing and talking can become more difficult.

Dr. Katzenellenbogen explains why she became an adolescent medicine doctor with a focus on HPV-related cancers

I’ve always found cancer biology to be very interesting — especially in reproductive care.

For me, being an advocate for making healthy choices from the start is so important. This is one of the main reasons why I’m an adolescent medicine doctor. I enjoy caring for teenagers and young adults as they begin to actively make choices about their own health and their own bodies.

HPV infection is something you can prevent with changes in sexual behavior. Also, we now have a vaccine that can help protect individuals from HPV infections.

My laboratory has done research that’s focused on developing a better understanding about how HPV highjacks cellular growth and how it progresses from precancerous to cancerous. Currently, we’re participating in international research in Kenya and Uganda, studying women living with and without HIV in those countries. We’re looking for biomarkers about disease progression and recession. The cellular factors that are important in cervical cancer are similarly important in head and neck cancers.

One of the most important goals I have is finding ways to help those who are dealing with HPV-related cancers live long, healthy and fulfilling lives.

Shaping the Future of HPV-related Cancers

The best way to describe Indiana University’s approach to HPV research is to say that it truly takes a village. At the Center for HPV Research, this village is composed of professionals from a variety of disciplines — including medicine, public health policy and community engagement, health communication, psychology and epidemiology. They’re working together to ensure everyone understands what HPV is, how it’s transmitted, how it can be prevented, how an HPV infection can lead to serious health consequences.

HPV research efforts currently underway are exploring:

  • The fundamentals regarding how HPV drives cancer development and progression.
  • Attitudes about and determinants of vaccination, with a particular focus on HPV vaccination.
  • How to quantify function biomarkers and identify HPV through typing and sequencing, leading to a roadmap that will assist in identifying women with greater risk of HPV-associated precancerous lesions.
  • Interested in clinical trials? Learn more.

With more than 40 researchers at IU going full speed ahead to unravel its mysteries, HPV is on its way to the loser’s bracket.

Racing Highlights

  • Almost five percent of cancers worldwide are caused by HPV.
  • HPV is the most common sexually transmitted infection.
  • There’s an HPV vaccine available to individuals from the ages of nine to 26. Vaccines can be given after 26 but are less effective at preventing an HPV infection.
  • In addition to cervical and head and neck cancers, HPV can also cause genital warts and cancer of the vulva, vagina, penis and anus.

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