by Kimberly Allen, RN
Human papillomaviruses are a group of over 150 different viruses of the papillomavirus family, approximately 40 of which are usually transmitted through sexual contact. The truth is most of the HPV’s pose no threat and there are no symptoms indicating it’s presence. However, as with so many other things there are those few that just have to make their presence known. While some cause minor issues like warts there are those that are known to cause a variety of cancers, the most common being cervical cancer. HPV can also cause cancer of the vagina, vulva, and penis as well as anal and oropharangeal cancers. HPV is currently the most common sexually transmitted disease diagnosed in people 15-44 years of age in the US, and out of those approximately 74% were diagnosed in people 15-24 years of age.
A report by The American Social Health Association states that approximately 75-80% of Americans that are sexually active will at some point become infected with HPV. Currently there are approximately 6 million new HPV infections diagnosed every year. Since the 1990’s the incidence of HPV related cancers has “jumped 225%”. Experts say that approximately 12,200 women are diagnosed with cervical cancer every year in the US and another 7,100 people will be diagnosed with HPV related oropharangeal caner. While oropharangeal cancers caused by other factors like smoking and alcohol consumption are declining those caused by HPV are increasing.
The best way to avoid HPV related cancers is through vaccination. There is currently available an HPV vaccine that is effective against HPV infection and HPV related cancers. The vaccine is available for both men and women. It is a series of 3 injections given at intervals over one year. Most experts recommend all girls 11-12 years of age receive this vaccine series. They also recommend tat girls 13-26 years of age that did not receive the vaccine get the vaccine. However, research indicates that only 32%, that’s less than one third of girls between 13-17 that are eligible to receive the vaccine have received all three doses and less than half haven’t even received one dose.
This vaccine has been tested and proven safe, however, there continue to be a significant amount of controversy surrounding its use. The thing is the controversy is about the vaccines safety it’s become a moral issue. The opponents of the vaccine claim it’s a license for sexual promiscuity. They argue that by giving a vaccine that protects against sexually transmitted infections and cancers you are saying it’s OK to have sex. However, most health experts are in favor of the vaccine saying it’s a vaccine to prevent against cancer. The thing is the vaccine works best if given before a person becomes sexually active. Just like the flu vaccine works better if you get it before you get the flu. The federal government is launching a campaign promoting the HPV vaccine with a goal of getting 80% of all eligible girls vaccinated by 2020. The HPV vaccine can save lives and significantly reduce HPV related cancers and with the current HPV related cancer rates on the rise it’s the best tool we have. Instead of looking at it like you’re telling your teenager to go out and have sex you should look at it the way it was meant to be when developed, you are protecting your teenager from a potentially serious, even fatal disease.
HPV and Anal Cancer
Though anal cancer is considered rare the incidence of HPV related anal cancer is on the rise. There were 6,230 newly diagnosed cases of anal cancer in the US last year, with 780 deaths, of those 90% were HPV related. Approximately 80% of anal cancers develop in people over 60 years of age, though it can be diagnosed at any age. When anal cancer is diagnosed before 35 years of age the incidence is higher in men than women. Single men are also six times more likely to develop anal cancer than married men. There are also a variety of other factors that can increase your chances of developing anal cancer in addition to HPV. Both men and women that have multiple sexual partners throughout their life as well as those that participate in consensual anal sex have a greater chance of developing anal cancer. Smoking can also increase your chance of developing the disease.
Anal cancer develops in the anus. The anus is not the same as the rectum, it is below the rectum. If you have cancer in your rectum it’s rectal cancer, which is more common than anal cancer. The anal canal is the very last one and half inches of your large intestine, between the anal opening and the rectum.
Anal cancer almost always develops in the squamous cells, which are the cells that comprise the lining of the anus and anal canal as well as numerous organs. A genetic mutation occurs in one cell, altering the DNA of that cell. As that cell reproduces the number of cells with altered DNA increases. Normal healthy cells have a specific cycle of growth, reproduction, and then dying. The cells with altered DNA also alter that cycle. The cells with the altered DNA not only reproduce faster but longer than normal cells because they don’t die as normal cells do. This produces a build up of abnormal cells that form a mass or tumor. These abnormal or cancer cells can also invade the surrounding areas.
Frequently the early symptoms are mistaken for hemorrhoids. Early symptoms include itching around the anus along with mild bleeding. The blood is usually a bright red which is one of the reasons many mistake it for hemorrhoids. Other symptoms include pain and/or a feeling of pressure in your anus, you may also notice a lump near your anus. Other symptoms you may experience are a change in your regular bowel habits and/or unusual discharge from your anus.
The treatment for anal cancer depends on what stage it’s in, meaning how far it has spread, as well as the state of your overall health and personal preference. Most of the time your Dr will recommend a combination of chemotherapy and radiation therapy. When detected and diagnosed early anal cancer is very treatable with an overall 5 year survival rate of 60% for men and 71% for women. Fortunately half of all anal cancers are found and diagnosed before they have spread, when diagnosed in the beginning stages the 5 year survival rate increases to 82%.
Though there is no sure way to prevent anal cancer there are steps you can take that can significantly reduce your chances of developing the disease. In addition to practicing safe sex getting vaccinated against HPV are the best ways to prevent anal cancer. There are two vaccines against HPV, one called Gardasil is approved for use in both males and females 9-26 years of age. Gardasil has also been shown to protect against anal cancer. Other steps that can help prevent anal cancer as well as other health problems includes quit smoking as well as eating a healthy diet an exercising regularly. Whenever you take steps to boost your immune system like eating healthy and regular exercise you reduce your risk of disease.
HPV and Orophalangeal Cancer
Though the rates of many types of cancer are declining the incidence of oropharangeal cancer is on the rise. In fact the American Cancer Society estimates that approximately 40,250 people will be diagnosed with oropharangeal cancer in the US this year with approximately 7,850 deaths. Oropharangeal cancer occurs twice as much in men as in women. It affects both Caucasians and African- Americans equally, however, recently there has been an increase the HPV related oropharangeal cancer in Caucasian males under 50 years of age.
Oropharangeal cancer, also called throat cancer, is one of the most common of the head and neck cancers and involves the oropharynx. The oropharynx is located at the back of the mouth and includes the area from your tonsils to the tip of your voice box and the middle of your throat as well as the back of your tongue and the soft palate in the back of your mouth. Over 90% of oropharyngeal cancers start in the squamous cells. The squamous cells are the flat cells that make up the membrane that lines your mouth and throat.
There are several factors that can increase your chances of getting oropharangeal cancer including smoking and chewing tobacco and heavy alcohol use. Though the incidence of oropharangeal cancer caused by those factors has been decreasing the incidence of oropharangeal cancer due to HPV and poor diet have been increasing.
As with any other disease the earlier oropharangeal cancer is detected and diagnosed the better your chances for receiving effective treatment. Symptoms that you should be aware of especially if you have any risk factors include a lump on one side of your neck that is painless. Frequently this lump is the first indication that you can see of oropharangeal cancer. Unfortunately the lump also indicates that the cancer has already spread to the lymph nodes in your neck. Most people also experience pain on one side of their throat that can be felt in your ear when you swallow. In many people the cancer is large enough to block the opening to your throat making swallowing difficult and very painful. In some people their jaw swells and becomes difficult to move, while others experience a change in the sound of their voice and almost all experience unexplained weight loss.
Treatment for oropharangeal cancer depends on what stage it’s in as well as your overall health and personal preference. When diagnosed in the early stages oropharangeal cancer can usually be cured. The primary goal of any treatment plan is preserve the function of the surrounding organs, tissues and nerves. The Dr and medical team must also take into consideration such things as how the treatment might affect your quality of life. How will you look and feel, will you be able to eat, talk an even breathe? In most cases your treatment plan will be developed by a multidisciplinary team that will evaluate all aspects of your disease and how it will affect your quality of life. There are numerous avenues of treatment available to your Dr including surgery, chemotherapy. and radiation therapy. Your care team will discuss the options that are best for your individual situation. There are also clinical trials available that your Dr can help you locate.
Though there is no sure way to prevent oropharangeal cancer there are measures that you can do to reduce your chances of developing the disease including stop using all tobacco products and limit alcohol consumption. Another significant measure you can take is getting the HPV vaccine. With HPV related oropharangeal cancer on the rise the vaccine can protect you against cancers related to HPV. Eating a nutritious diet high in fresh fruit and vegetables and low in saturated fats and regular exercise can boost your immune system reducing your risk on developing many diseases including oropharangeal cancer.
Kimberly Allen is a registered nurse with an AND in nursing. She has worked in ACF, LCF and psychiatric facilities, although she spent most of her career as a home health expert. She is now a regular contributor to HealthAndFitnessTalk.com, dispensing advice and knowledge about medical issues and questions. You can reach her with any comments or questions at firstname.lastname@example.org.