BackTable / ENT / Podcast / Episode #23
Human Papillomavirus and Head and Neck Cancers
with Dr. Andrew Day
We talk with Dr. Andrew Day about the Human Papillomavirus (HPV) and Oropharyngeal Cancers.
BackTable, LLC (Producer). (2021, May 25). Ep. 23 – Human Papillomavirus and Head and Neck Cancers [Audio podcast]. Retrieved from https://www.backtable.com
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Dr. Andrew Day
Dr. Andrew Day is an an Assistant Professor of Otolaryngology Head and Neck Surgery at UT Southwestern Medical Center.
Dr. Gopi Shah
Dr. Gopi Shah is a practicing ENT at UT Southwestern Medical Center in Dallas, TX.
Dr. Ashley Agan
Dr. Ashley Agan is a practicing ENT and assistant professor at UT Southwestern Medical Center in Dallas, TX.
In this episode, head & neck surgical oncologist Dr. Andrew Day joins Dr. Gopi Shah and Dr. Ashley Agan in discussing the screening, treatments, prevention, and current research over HPV-positive oropharyngeal cancers.
We begin by discussing the ubiquitous Human Papillomavirus (HPV) and identifying high-risk strains. While there is still a lot of research to be done over this virus, Dr. Day describes the estimated prevalence of HPV in the adult population and available screening methods. He brings up the possibility of latent infections and differences in individuals’ immunogenic responses.
Moving into HPV-mediated cancers, Dr. Day distinguishes HPV-positive from HPV-negative head & neck cancers and discusses the differences in presentation and treatment for each type. HPV-positive oropharyngeal cancers usually present as neck masses with no other clear risk factors, and they can be confirmed through ultrasound-guided fine needle aspiration biopsy. Treatment options include various combinations of transoral robotic surgery, transoral laser microsurgery, chemotherapy, and radiation.
Finally, we discuss patient education over HPV and its associated cancers. We address patient inquiries about tonsillectomy as a preventative measure, advice for partners/spouses of HPV-positive cancer patients, and otolaryngologists’ role in raising awareness of the HPV vaccine (Gardasil 9).
CDC HPV Vaccine Recommendations: https://www.cdc.gov/vaccines/vpd/hpv/hcp/recommendations.html
[Dr. Gopi Shah]
When we say “HPV-positive,” I always also think of cervical cancer, anal cancer, penile cancer. Is it the same HPV strains? Are these all sort of similar in terms of the relation with HPV?
[Dr. Andrew Day]
Yeah. So these 13 high-risk types are responsible for all the cancers of these different anatomic sites: cervical, anal, penile, vaginal, vulva and oropharynx cancers. The thing that's different about them is that the distribution of which type causes cancer at which location varies. So for instance, HPV 16 is actually the dominant cause of cancer in the oropharynx and anus, whereas the other types are responsible for a greater proportion of cervical cancers.
[Dr. Ashley Agan]
For patients who present to our practices with new cancers, can you talk about how a patient with an HPV-positive squamous cell carcinoma might present differently? Is it different? Is it the same? Do they look just like your patients who come in, or is the clue that maybe they don't have that history of smoking and drinking?
[Dr. Andrew Day]
Yeah, they have a very unique presentation, which immediately clues you in to the fact that they likely have HPV-mediated disease. I would say at least 50%, if not more, patients will present with neck mass and oftentimes they'll be totally asymptomatic otherwise. They might not even have pain. Some other patients will present with issues with swallowing, maybe voice changes, maybe a sensation of their lump in their throat or minor discomfort. That's in pretty stark contrast to our HPV-negative patients whose dominant symptom is fairly severe pain associated with weight loss and everything else.
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