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Free Online Seminar: Latest Treatment Options for Head and Neck Cancer

Head and neck cancers are on the rise because of the connection with Human Papillomavirus (HPV). Join Johns Hopkins head and neck surgeon Dr. Christine Gourin as she discusses the latest surgical and non-surgical approaches for the treatment of head and neck cancers, such as oropharyngeal and laryngeal cancers. Dr. Gourin will also answer questions submitted by viewers of the presentation
WHEN: Tuesday, October 28
             7 p.m. to 8 p.m. EDT
More information and how to RSVP

No Increased Risk of Infection for Long-Term Sex Partners of People with
HPV-Related Oral Cancers

Release Date: 06/01/2013

Spouses and long-term partners of patients with mouth and throat cancers related to infection with the human papilloma virus (HPV) appear to have no increased prevalence of oral HPV infections, according to results of a multicenter, pilot study led by Johns Hopkins investigators. The study’s results suggest that long-term couples need not change their sexual practices, say the scientists.

“While we can’t guarantee that the partners of patients will not develop oral HPV infections or cancers, we can reassure them that our study found they had no increased prevalence of oral infections, which suggests their risk of HPV-related oral cancer remains low,” says Gypsyamber D’Souza, Ph.D., M.P.H., associate professor of epidemiology at the Johns Hopkins Bloomberg School of Public Health. She is expected to present the results of her study June 1 at the 2013 American Society of Clinical Oncology Annual Meeting.

HPV-related oral cancers are rising in prevalence among white men in the United States, and fear of transmitting the virus can lead to anxiety, divorce, and curtailing of sex and intimacy among couples, says D’Souza. Persistent oral HPV infections are a risk for developing oropharyngeal cancers, located at the base of the tongue, tonsils, pharynx and soft palate.

At the Johns Hopkins Hospital and three other hospitals, researchers conducted surveys and took oral rinse samples from 166 male and female patients with HPV-related oropharyngeal cancers and 94 spouses and partners. The scientists also studied patients’ tumor samples and performed visual oral examinations of spouses/partners. Of the 94 spouses/partners, six were male.

More than half of patients had at least one type of HPV DNA detectable in their oral rinses, including HPV16, the viral type most commonly associated with oral and other cancers. After a year, only seven patients (six percent) still had oral HPV16 DNA detectable.

Of the 94 spouses/partners, six had oral HPV infections (6.5 percent). Among the six, none of the men and two of four females (2.3 percent) had HPV16 infections at very low levels. These infections were not detectable one year later. No oral cancers were detected among 60 spouses/partners who underwent a visual oral exam.

One spouse and one patient reported a history of cervical cancer. Two spouses reported a history of cervical pre-cancer, and three patients said they had previous spouses with cervical cancers, but these were self-reported, unconfirmed cases.
“The oral HPV prevalence among partners who participated in this study are comparable to rates observed among the general population,” says D’Souza. “We suspect that long-term spouses and partners have been exposed to HPV, like most of us, and appear to have cleared the virus.”

D’Souza and her colleagues recommend that long-term couples need not change their sexual practices. “Certainly, with new sexual partners, caution is always advised.”
More research is needed to determine the timeline of progression for HPV-related oral cancers and how HPV is transmitted and suppressed by the immune system, adds D’Souza.

Funding for the study was provided by the Johns Hopkins Innovation Fund and the Richard Gelb Cancer Prevention Award.

Scientists contributing to the research include Neil Gross at the Oregon Health & Science University; Maura Gillison at the Ohio State University; Sara Pai at Johns Hopkins; Robert Haddad from the Dana Farber Cancer Center; and Marshall Posner from Mount Sinai Medical Center.

ASCO Abstract #6031: Oral HPV infection in HPV-positive oropharyngeal cancer cases and their spouses.

HPV and Head & Neck Cancer: What You Need to Know

Click to watch Sara Pai, MD, PhD, Associate Professor of Otolaryngology-Head and Neck Surgery and Oncology as she talks about human papillomavirus (HPV) and its connection to head and neck cancers in men and women. She discusses new research studies that detail the growing trend of these cancers, as well as the tailored treatments being developed for these cancers.

Collaborations Lead to Innovations             
The thyroid and parathyroid surgery team is performing transaxillary operations that leave no scar on patients’ necks.

After finishing his head and neck surgery fellowship at The Johns Hopkins Hospital in 2001, Ralph Tufano decided to stay and join the Head and Neck division, even though they were then performing only a handful of thyroid and parathyroid operations. “I felt like I could really be part of a growing area,” he says, “and make a difference.”

Last year, Tufano, now director of thyroid and parathyroid surgery, and his colleagues performed more than 250 thyroid- and parathyroid-related procedures, an expansive growth he attributes to Johns Hopkins’ interdisciplinary approach. Although endocrinology, general surgery, and otolaryngology–head and neck surgery are separate at many hospitals, physicians from these specialties collaborate here to make sure patients get the best care.

Such close teamwork allows them to develop the best plan to tackle especially difficult procedures, such as reoperations when cancer recurs. These surgeries can be incredibly complex, involving navigation around scar tissue from previous surgery. Tufano notes that the ability of the various specialist teams to pool their expertise is a draw for many cancer patients who need follow-up surgery. “We probably do more reoperative procedures than any other place in the country,” he says.

The close collaboration also allows Johns Hopkins’ thyroid and parathyroid surgeons to offer some unique options to patients here. Recently, head and neck surgeons including Jeremy Richmon and colleagues in the Department of Surgery began performing transaxillary thyroidectomies and parathyroidectomies, with incisions through a patient’s armpit instead of the traditional approach through the neck, which leaves a scar.

“We see the majority of thyroid problems in younger women,” Richmon says, “but sometimes those who are advised to have surgery are really reluctant to follow through because they know they’ll have a visible neck scar.”

The procedure involves inserting into a single armpit incision an endoscope with two cameras, along with three robotic arms for grasping, dissecting and cutting. Functional outcomes for this type of surgery have been shown to be the same as those of an open procedure for selected cases.

Richmon anticipates that it’s just a stepping stone to more innovative “scarless” thyroidectomies and parathyroidectomies. He and Tufano have successfully tested another procedure in cadavers in which they make an incision through the floor of the mouth to insert instruments just behind a patient’s teeth. They now hope to offer this option to patients in the next two years.

Meanwhile, Tufano and his colleagues are working on identifying a series of biomarkers that can predict a thyroid cancer patient’s prognosis. Those with a more favorable prognosis may qualify for less aggressive surgery or even avoid surgery altogether.

With thyroid cancers on the rise, Tufano notes that such innovations have never been more necessary.

“We’re excited to develop these ideas,” he says, “and get new treatments out to patients with thyroid and parathyroid disease.”

To refer a patient, call 410-955-3628


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