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#165929 06-04-2013 07:33 AM
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PaulB Offline OP
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With all the recent talk about HPV, Sex, has me all hot and bothered lol. I do have some questions, some which I have theory, knowledge about, but I still can't answer properly. These questions may have been discussed previously, but haven't seen much discussion about.

1. If someone already has HPV-16 related cancer, like many here, are they still at risk for developing another cancer from a different high risk HPV type strain, like HPV-18, they were not previously exposed to, if exposed later in life, under the right environment, immune system, or are they immune therefter from all high risk HPV strains?

2. Similary, is a person with HPV-16 oral cancer, still at risk for another HPV-16 cancer in other areas, being it's a systemic disease, like the anogeninital area, and vice versa, from chronic exposure to HPV, compromised immune system brought out from being dormant under the right environment in that area.

3. Also, the same with current HPV-16 cancer, once resolved, even if not resolved is there risk of developing cancer again (not talking mets) same oropharyngeal area that is not associated with the first cancer from chronic exposre to HPV-16, a little like "field of cancerization" from smoking, again, under the right environment. I guess could be classified as second primary, even to diffirent area than the first, lets say you have right tonsil, next can you develop the left tonsil under the perfect storm or are you again immune to HPV-16 cancer again.

4. Related to question #3, even Metachrounous or synchronous HPV-16 related cancer, which is usually related to smoking, exposure of carcinogens to the aerodigestive tract, but guess some HPV lung involvement may fit under this since some go there, not talking Mets.

Brian Hill has explained it. Thanks. Maybe I can repost.

Last edited by PaulB; 06-04-2013 08:50 AM. Reason: Brian Hill

10/09 T1N2bM0 Tonsil
11/09 Taxo Cisp 5-FU, 6 Months Hosp
01/11 35 IMRT 70Gy 7 Wks
06/11 30 HBO
08/11 RND PNI
06/12 SND PNI LVI
08/12 RND Pec Flap IORT 12 Gy
10/12 25 IMRT 50Gy 6 Wks Taxo Erbitux
10/13 SND
10/13 TBO/Angiograph
10/13 RND Carotid Remove IORT 10Gy PNI
12/13 25 Protons 50Gy 6 Wks Carbo
11/14 All Teeth Extract 30 HBO
03/15 Sequestromy Buccal Flap ORN
09/16 Mandibulectomy Fib Flap Sternotomy
04/17 Regraft hypergranulation Donor Site
06/17 Heart Attack Stent
02/19 Finally Cancer Free Took 10 yrs






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"OCF Canuck"
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HI there... not likely going to answer your questions well but here is my take.

HPV is a virus. Some viruses lay dormant. In my theory - someone may be exposed to HPV very early in life ( first sexual encounter - etc...) It likely takes a few things for it to manifest itself as a cancer. Firstly the right strain... then environment, and overall health. Maybe you are health compromised, maybe you smoke and drink, are stressed, or don't have the healthiest diet. Maybe all of the above. Regardless, this virus that is dormant, at some point finds a way in becomes active again and develops into a cancer - it may also have a lot to do with your overall immune system being able to kill the virus to start.

Regardless once it manifests itself you have a problem.

My one concern and I posted this on facebook today is Michael Douglas' claim that it was oral sex that caused his BOT tumor. Say what? If this virus is systemic, chances are it doesn't require oral sex, just sex, for it to be transmitted. It gives a false sense of security - "Oh he/she is HPV positive, but we've never had oral sex, so I can't get it." Hello. If you have had sex with someone who is HPV positive and are now positive yourself - you can quite possibly end up with an HPV cancer.

I do think because it is a virus, this is why it is easier to treat the cancer with rads and chemo but then the question remains, does it just kill the cancer, but not the virus (just forcing it into dormancy again)which could lead to another battle later, or does it kill both .

It does stand to reason that two different HPV's both of them cancer causing, could manifest at different times, so I would say yes, exposure, to say - a different strain could cause another dance with cancer, since you immune system seems to work against what you have - not having been exposed to it would mean that your system it would need to fight this virus as something new.


Cheryl : Irritation - 2004 BX: 6/2008 : Inflam. BX: 12/10, DX: 12/10 : SCC - LS tongue well dif. T2N1M0. 2/11 hemigloss + recon. : PND - 40 nodes - 39 clear. 3/11 - 5/11 IMRT 33 + cis x2, PEG 3/28/11 - 5/19/11 3 head, 2 chest scans - clear(fingers crossed) HPV-, No smoke, drink, or drugs, Vegan
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PaulB Offline OP
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Thanks. Some as I thought. Brian answered on the FB page. Is high risk HPV-16 really systemic or just effects the squamous epithelium where it entered the body from contact or exposure, make DNA changes, where it can lay dormant there, manifest later on under right circumstances in the area exposed. I have to do more reading, I forget more than I retain lol.


10/09 T1N2bM0 Tonsil
11/09 Taxo Cisp 5-FU, 6 Months Hosp
01/11 35 IMRT 70Gy 7 Wks
06/11 30 HBO
08/11 RND PNI
06/12 SND PNI LVI
08/12 RND Pec Flap IORT 12 Gy
10/12 25 IMRT 50Gy 6 Wks Taxo Erbitux
10/13 SND
10/13 TBO/Angiograph
10/13 RND Carotid Remove IORT 10Gy PNI
12/13 25 Protons 50Gy 6 Wks Carbo
11/14 All Teeth Extract 30 HBO
03/15 Sequestromy Buccal Flap ORN
09/16 Mandibulectomy Fib Flap Sternotomy
04/17 Regraft hypergranulation Donor Site
06/17 Heart Attack Stent
02/19 Finally Cancer Free Took 10 yrs






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Paul,

My take...

Most of your questions in my opinion can not be answered because of what we don't know about HPV. We don't know really how it's spread; we don't know if it goes dormant and if it does, we don't know what triggers it back out and we don't know why some of us clear the virus and sometimes it invades the cells successfully. We also don't know if once you acquire and clear it and you reacquire it are you immune or does your body have to attack it again and again.

Moffitt BTW is currently doing a study to try and determine how we acquire it.


David

Age 58 at Dx, HPV16+ SCC, Stage IV BOT+2 nodes, non smoker, casual drinker, exercise nut, Cisplatin x 3 & concurrent IMRT x 35,(70 Gy), no surgery, no Peg, Tx at Moffitt over Aug 06. Jun 07, back to riding my bike 100 miles a wk. Now doing 12 Spin classes and 60 outdoor miles per wk. Nov 13 completed Hilly Century ride for Cancer, 104 miles, 1st Place in my age group. Apr 2014 & 15, Spun for 9 straight hrs to raise $$ for YMCA's Livestrong Program. Certified Spin Instructor Jun 2014.
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PaulB Offline OP
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Thanks for the input, David. I think the immune system plays a part, so that may be the best we have right now to strengthen that. I guess time will tell. I was asking myself the questions, and realized I could not answer fully to some extent, and certain scenarios are possible, everything is, but not likely, as Brian Hill explained, and dare not to try to explain his input. Maybe after reading it 10x lol. I hope the study comes out, fairly quick, but probably takes time.


10/09 T1N2bM0 Tonsil
11/09 Taxo Cisp 5-FU, 6 Months Hosp
01/11 35 IMRT 70Gy 7 Wks
06/11 30 HBO
08/11 RND PNI
06/12 SND PNI LVI
08/12 RND Pec Flap IORT 12 Gy
10/12 25 IMRT 50Gy 6 Wks Taxo Erbitux
10/13 SND
10/13 TBO/Angiograph
10/13 RND Carotid Remove IORT 10Gy PNI
12/13 25 Protons 50Gy 6 Wks Carbo
11/14 All Teeth Extract 30 HBO
03/15 Sequestromy Buccal Flap ORN
09/16 Mandibulectomy Fib Flap Sternotomy
04/17 Regraft hypergranulation Donor Site
06/17 Heart Attack Stent
02/19 Finally Cancer Free Took 10 yrs






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I would love to know the answers to these questions. Being 25, I have a long time to potentially get reinfected with HPV and develop another cancer or develop a second primary (if that is possible). The fact that I developed cancer so quickly and at a young age worries me. Its possible my immune system is unable to clear HPV or I have some other genetic predisposition. My mom never was HPV+, so my docs don't think I was born with an infection.

I did a lot of reading on some threads about taking the HPV vaccine post treatment. It seemed some said it could help while others said that it will not help once you have been infected. I do wonder if it would make sense to get vaccinated, if only to prevent an infection of HPV18 (vs HPV16 which my cancer was positive for). Does anyone know if an infection of HPV16 imparts antibodies and immunity from an HPV18 infection? I would assume since they are distinct it would not, but I could be wrong.

Has anyone heard of someone in their 20s getting HPV+ cancer? My RO said she hasn't seen or heard of anyone as young as me, which is unsettling.

Last edited by AndrewL; 06-05-2013 03:09 PM.

Andrew
age 25

early 10/12 - enlarged lymph node area
01/13 SCC of L tonsil, L BOT, 2 L lymph nodes
stage IVa, T2N2bM0, HPV+

2/13 2 doses cisplatin big bag, 2 doses weekly cisplatin + 35x IMRT
4/13 TX finished
7/13 PET/CT - NED!
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Andrew, yes unfortunately it is becoming more common for 20 somethings to have HPV+ cancer. Of course its not an everyday occurrence but it does happen.

GET VACCINATED!!!!! The Guardisil series of shots are available to young men and women ages 12-26. If you can prevent getting HPV why not get the shots. Of course you may have already been exposed to this virus but you never know, the vaccine could protect you from this STD ever becoming anything more serious.


Christine
SCC 6/15/07 L chk & by L molar both Stag I, age44
2x cispltn-35 IMRT end 9/27/07
-65 lbs in 2 mo, no caregvr
Clear PET 1/08
4/4/08 recur L chk Stag I
surg 4/16/08 clr marg
215 HBO dives
3/09 teeth out, trismus
7/2/09 recur, Stg IV
8/24/09 trach, ND, mandiblctmy
3wks medicly inducd coma
2 mo xtended hospital stay, ICU & burn unit
PICC line IV antibx 8 mo
10/4/10, 2/14/11 reconst surg
OC 3x in 3 years
very happy to be alive smile
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I was 58 when I was Dx'ed and post recovery I traveled the "HPV speaking circuit" with Dr Anna Giuliano, the lead HPV researcher at Moffitt. Even in my advanced age and being married for 20 some years I asked her that question and after talking a while she said "if you were single you should get the vaccine." Well I wasn't and I didn't but I would have if I had been single and I would if I were you. Remember I'm NOT a Dr; I'm not a HPV research scientist and I'm not a Gardasil vaccine expert.


David

Age 58 at Dx, HPV16+ SCC, Stage IV BOT+2 nodes, non smoker, casual drinker, exercise nut, Cisplatin x 3 & concurrent IMRT x 35,(70 Gy), no surgery, no Peg, Tx at Moffitt over Aug 06. Jun 07, back to riding my bike 100 miles a wk. Now doing 12 Spin classes and 60 outdoor miles per wk. Nov 13 completed Hilly Century ride for Cancer, 104 miles, 1st Place in my age group. Apr 2014 & 15, Spun for 9 straight hrs to raise $$ for YMCA's Livestrong Program. Certified Spin Instructor Jun 2014.
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PaulB Offline OP
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1. still not fully sure. Possible, but not probable. Most are HPV-16. see vaccine info below.

2. May be possible distantly, but HPV does not have field of cancererization, unlike tobacco caaused, which can effect the whole aero digestive track, and HPV usually is site specific, with one area of involvement, not involving several other structires. I heard you develop an antibody once exposed. I guess you can be exposed to HPV the same time in several anatomical areas?

3. Again, you may have an antibody after exposure to HPV-16

4. HPV does not have field of cancerizsation like smoking related does. it is more site specific, not invloving other sites at once, but metastases or spread is different, and cancer can go anywhere.

I have read information from John Hopkins, Current preventive vaccine stragedy is not effective for treaating existing infections or established HPV-related disease, Treatment established disease requires activation of the cellular immune system, both CD4+and CD8+Tcells, which cane recogniize virus infected cells. There is a difference between precevntive vaccines and therapeutic vaccine straregies.

There is a safety study at John hopkins for HPV DNA Vaccine, to help your body's immune system recognize HPV-Infected and associated cancer cells to treat HNC patients.

http://clinicaltrials.gov/show/NCT01493154


10/09 T1N2bM0 Tonsil
11/09 Taxo Cisp 5-FU, 6 Months Hosp
01/11 35 IMRT 70Gy 7 Wks
06/11 30 HBO
08/11 RND PNI
06/12 SND PNI LVI
08/12 RND Pec Flap IORT 12 Gy
10/12 25 IMRT 50Gy 6 Wks Taxo Erbitux
10/13 SND
10/13 TBO/Angiograph
10/13 RND Carotid Remove IORT 10Gy PNI
12/13 25 Protons 50Gy 6 Wks Carbo
11/14 All Teeth Extract 30 HBO
03/15 Sequestromy Buccal Flap ORN
09/16 Mandibulectomy Fib Flap Sternotomy
04/17 Regraft hypergranulation Donor Site
06/17 Heart Attack Stent
02/19 Finally Cancer Free Took 10 yrs






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Hi David - Was your wife ever tested for HPV? I ask because when I was diagnosed and we learned the tumor was HPV+ my partner was told that they would just assume that she was also positive. I don't know what difference it would make, testing her, except that if she was negative maybe she should get vaccinated? I have felt that throughout my cancer diagnosis, treatment, and follow-up, the HPV issue was never fully discussed with me, and that might be because I was dealing with oncologists who know how to treat the cancers that are a result of the virus but are not themselves specialists in the virus. Or it might be because there are so many unknowns where this virus was concerned. -Michelle


SCC left tonsil, stage IV, HPV+, metastatic to one lymph node. Biopsy 12/23/10; tonsillectomy 1/13/11; DX 1/25/11; Peg in 1/28/11. Peg out 6/29. TX 1/31/11-3/21/11: 35 IMRT plus 3 Cisplatin. Pet-Scan 6/20/11 = CLEAR! Three years out, learning to live with the long-term side effects of radiation while reminding myself to feel blessed.
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