Episode Transcript
Announcer: 来自犹他大学医生和专家的医学新闻和研究，你可以用它来过更快乐、更健康的生活. You're listening to The Scope.
Interviewer: If you're listening to this podcast, 这是因为你想了解更多关于HPV病毒和引起它的癌症的信息，更具体地说，可能是因为你听说它会导致更多的头颈癌病例. We're with Dr. Marcus Monroe. He is a head and neck cancer expert and let's talk about HPV. 有一种类型的人乳头瘤病毒可能更多人熟悉，不是那么多的头颈部方面. So first of all, what is HPV? Just give us the basics.
Dr. Monroe: Yeah, sure. So HPV stands for Human Papilloma Virus. It's actually a group of well over a hundred different viruses of which, about 40 are known to be transmitted in humans and of these, a few of these subtypes are known to cause cancer in humans. The most well-known association, which has been known for decades, is the link between HPV and cervical cancer. That's the reason why women are recommended to get yearly screening pap smears.
Interviewer: Before we go any further, I think now more than ever, it's important that parents get their children vaccinated for HPV. There seems to be some hesitance and reluctance to do so. But now, 它开始在身体的其他部位移动，这是一种可以通过疫苗预防的癌症.
Dr. Monroe: Yeah, that's a really great point. So the HPV vaccine, there are a number of different vaccines, 所有可用的疫苗实际上都覆盖了与头颈癌有关的最常见的HPV亚型，包括亚型16和18.
The importance of vaccines is becoming increasingly relevant for HPV. For head and neck cancer, 估计在未来数年内，新病例的数目将超过子宫颈癌的数目. So this is actually a really rapidly rising cancer. However, unlike cervical cancer, we have no effect of screening mechanism. Meaning, for cervical cancer, we pick up many early premalignant lesions through pap smears, that are then we are able to prevent turning into cervical cancer. There is no equivalent early screening for HPV cancers of the head and neck.
Interviewer: And that makes it particularly dangerous.
Dr. Monroe: And that makes it particularly dangerous. So also the population that is at risk is different. So we're seeing the rapid rise in cancers in men of middle aged years, who don't have other traditional risk factors for head and neck cancers. So non-smokers, non-drinkers. 这是很多人通常不认为能从HPV疫苗中受益的人群. So it's important, not only for young girls but also for boys to be vaccinated.
Interviewer: Up into this point, 在医疗实践中，只有女孩才能接种疫苗?
Dr. Monroe: It has until relatively recently. It wasn't FDA approved for boys. However, that has changed and now the vaccine is approved for both boys and girls and so, I think this is in recognition of the other cancers, other than cervical cancer, which are associated with the virus.
Interviewer: So what's the link between HPV and cancers of the head and the neck? It seems like the two are kind of... it's a venereal disease in one case and now, we're up around the head and neck. That's a long way away.
Dr. Monroe: Yeah. 所以我认为在头颈癌的历史和最常见的风险因素中建立这个框架是很重要的, traditionally, 吸烟和饮酒对许多人来说是头颈部癌症最常见的原因, many years. We've seen a decrease in the instance of tobacco use in the U.S. and paralleling this, 头颈部癌症的发病率有所下降除了这一个亚组, cancers of the tonsil and back part of the tongue.
人们之所以发现它是因为在这个特定的地区新癌症的发病率在不断上升, we kind of took a step back and said, "Well, what's going on here?" and it turned out that these viruses were associated with the cancers. They were present in the cancers and integrated into the genomes of the cancers. And through, kind of, many years of work, 大发娱乐发现预测子宫颈癌的风险因素也可以预测头颈癌. Meaning, increasing number of sexual partners and specific sexual practices, particularly oral sex, increase the risk of developing cancers of the tonsil and back part of the tongue that are HPV related<.
So your question of it, the link between HPV, when we typically think of it as a venereal disease, 这可能是由于性行为的改变，但仍然是一个类似的联系，因为它是通过性传播的.
Interviewer: When physicians and researchers made this connection, was it a little shocking? I mean, I would think that was like, what? What's that cancer doing there?
Dr. Monroe: 这有点令人震惊，但有趣的是它确实改变了许多治疗头颈部癌症的医生在诊所里的谈话. 我认为对于许多头颈癌患者的配偶来说，重要的是要意识到这是一种无处不在的病毒. Meaning that, if you look at exposure rates in studies that have been done in women, 据估计，超过80%的人口在其一生中的某个时刻接触过这种病毒.
所以我认为大发娱乐应该小心地把它放在性传播疾病的背景下, but also realizing that it's an incredibly common infection. 它只是发生在很小的比例，出于一些大发娱乐不太了解的原因, this infection persists and eventually can lead to the development of cancer.
Interviewer: So who is at risk for HPV related head and neck cancer?
Dr. Monroe: Population that we've seen the greatest increase in risk is white men in their 50s. However, this increased risk is actually noted across genders and ethnic groups. Specifically, when you pare down a little bit more into that population, similar risks factors for other sexually transmitted diseases become apparent and behavior, 例如，性伴侣数量的增加，第一次性行为发生的年龄过早，以及口交的做法都与患口咽癌的高风险有关.
Interviewer: What are some of the symptoms, if you have this type of cancer? You said there is really not an effective screening for it. So what am I looking out for then?
Dr. Monroe: In general, 症状可能与局部肿瘤本身或肿瘤扩散的发展有关. These tumors, a little bit different than tobacco related tumors, tend to be actually relatively small. However, they can cause some symptoms such as pain when swallowing, pain in the ear and occasionally, bleeding from the mouth. More commonly, however, 当它们扩散到附近的淋巴结时首先会出现这些淋巴结通常位于颈部. And so, the vast majority of people actually present with a new lump in the neck.
Interviewer: Okay. So if you discover a new lump in the neck, run, don't walk, to your physician.
Dr. Monroe: I think the important thing to realize is lumps in the neck can be common, so not to be too scared about them. They can be associated just with reactions to virus illnesses. So I think appropriate course of antibiotics or simply observation is appropriate at first. However, for those that lumps that persist past two or three weeks or seem to be increasing in size, those are the ones that are more and more concerned and should be evaluated.
Interviewer: Is there a treatment for HPV head and neck cancer?
Dr. Monroe: Yeah. So as of right now, HPV癌症的治疗与非HPV癌症的治疗非常相似，包括手术联合治疗, chemotherapy and radiation. 好消息是人乳头瘤病毒癌症的预后比非人乳头瘤病毒癌症好，现在大发娱乐开始研究大发娱乐是否能同样有效地治疗这些癌症，但毒性更小.
所以这个领域的一个活跃的研究领域就是减少大发娱乐所做的治疗. Radiation, surgery or chemotherapy, because this is such an important area of the throat, we use it more commonly than you think, can be associated with quite a bit of toxicity, damage to dentition, difficulty swallowing, both, in the short and long term, requirements for feeding tubes. And so we're really, kind of, 着眼于维持大发娱乐同样的治愈率同时减少大发娱乐治疗的长期毒性.
Interviewer: Is there a what can be done to prevent this type of cancer? We know one answer is, hopefully, parents are getting their children both boys and girls the HPV vaccine.
Dr. Monroe: Yeah. I think the most important thing from an initial standpoint of prevention is the vaccine. 虽然大发娱乐没有专门针对口咽癌和疫苗预防的具体数据和试验, we do have trials that demonstrate in cervical cancer, the lowering of the risk of spreading the infection and we know it's the same viruses. While it hasn't been proven yet, there is general widespread thought in the field that vaccines will prevent these cancers. So I think that's the first step.
The second step is realizing that vaccines are only one part of this cancer. 所以传统的吸烟和饮酒的风险因素也与这些癌症有关，事实上, there seems to be a link between alcohol, tobacco, specifically tobacco, and the HPV virus where they may work synergistically to promote cancers. So we see a number of patients that have both risk factors for tobacco and HPV.
Interviewer: But once you've been diagnosed with head and neck cancer or any HPV caused cancer, it's too late for the vaccine and you need to move on to a treatment?
Dr. Monroe: Yeah. As of right now, 大发娱乐没有任何证据表明，在你患上另一种癌症后接种疫苗有任何好处. So really, prevention and prevention really before the onset of sexual activity, given that HPV is such a widespread infection, remember the over 80% of the population has been exposed. 但是一旦你得了癌症，个别病人的疫苗接种真的没有任何好处.
Now, one thing that is a benefit and from studies that we've done here in Utah, is demonstrating that there is a link between not only the patient, 但也增加了家庭成员和配偶患HPV相关恶性肿瘤的风险. So while the individual patient may not benefit from vaccination, 这是一个重要的信息，如果你有一个家庭成员，其他家庭成员可能会受益, one, 如果他们在合适的年龄或两岁从筛查其他HPV相关的恶性肿瘤.
Interviewer: Does it pass genetically? Probably not.
Dr. Monroe: It does not. So it seems to be an environmentally acquired infection and risk factor. However, since we do see some linkage within families and family members, there probably is some genetic susceptibility to prolonged infection, realizing that well over 80% of the population comes exposed, but well under that actually acquire a cancer related HPV. 清除病毒可能有一些大发娱乐还不了解的遗传易感性.
Interviewer: Is there anything I've forgot to ask or anything you feel compelled to say?
Dr. Monroe: I think the most important thing is to vaccinate your children. Remember, 疫苗不仅对女孩很重要，对男孩在性行为开始前的早期也很重要.
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