Dear Arnavaz, have you checked other risk factors like alcohol, or somehow, poor oral hygiene? by the way, we can check HPV in specimen. If anybody has a recommendation, please let me know

Although there is some association with oncogenic HPV and oral cavity SCC, the association between HPV and HNSCC is much stronger in oropharynx, especially tonsil. HPV tumours are typically not well differentiated. If you wanted to investigate this further, the easiest method would be to look for p16 overexpression in pathological specimen.

Hi Arnavaz,

Actually, in our department of Oral and Maxillofacial-Head and Neck Surgery from the University Hospital Infanta Cristina, Badajoz, SPAIN, we are observing an increasing rate of young patients (below 50 y-o) among the oral cancer population. When studying their habits, it is not rare to do not find tobacco or alcohol consumption. We are now systematically asking for HPV colonization among these patients to the pathologist. Although we have no results yet, our impression is similar to yours.

thank you raul, for your observation, which is exactly matching mine.

we are seeing more younger patients now, no habits, no sharp teeth, with oral SCCa,

and i am worried ...

dr omrani, i always take the full history and check the oral mucosa myself.

dr biron, i am interested in finding a factor that would reduce/prevent SCCa in the oral cavity and maybe, some treatment modalities.

KAMINAGAKURA, E. ; VILLA, L. L. ; ANDREOLI, M. A. ; SIMAO, J. ; VARTANIAN, J. G. ; SOARES, F. A. ; NISHIMOTO, I. N. ; ROCHA, A. C. ; KOWALSKI, L. P. . High-risk HPV in oral squamous cell carcinoma of young patients. International Journal of Cancer (Print), v. 130, p. 1726-1632, 2012.

Thanks tania for the reference to article..ill look it up.

Are you an oral surgeon or a dentist?have you seen any such cases?

Dear;

Actually white lesions is now increasing among populations, but specifically oral lesions of HPV origin in my opinion have correlation with anal lesions , it is dominant in female anus so anal suckling may be most of transmission in recent years.Also transformation to cancer is due to the neglect of immediate treatment or even biopsy resulted in conflict with other lesions.The typing 16 is dominant in both oral and female anal infections treatment based on either of sites may be beneficial to reduce cancer.

An youngster with White lesion/Carcinoma without any habits probably has 2 chances for occurrence.

History of familial occurrence of carcinoma has to be probed. Transmitted genetic defects tend to cause Ca in younger age groups.

HPV associated lesions often tend to occur in oropharynx rather than anterior part of the mouth. Such suspicious lesions need to be checked, Sexual history probed to elicit the probable etiology.

However till demonstration of viral particles by any method, all other alternatives need to be considered as they would be a "high risk" and vulnerable group.

SEAR studies details the increasing occurrence as early as 1990's.

Thanks rooban..i feel the same

Dear Arnavaz,

There really is no debate about the association between HPV 16/18 and head and neck cancer. Mainly affects lingual and palatine tonsils. Much higher in younger males and there is a definite association with oral sex. Very good research at John Hopkins, USA Dept ORL, Westera W, Pai S, Also see clinics of North America Aug 2012.

Please see links below. We are running a conference in Galway, may 17th.

Ivan.

http://www.conference.ie/Conferences/index.asp?Conference=200

https://www.youtube.com/watch?v=NVn0CJLkq7E

Dear Arnavaz,

HPV is definitely becoming an increasing problem in HNSCC. In our department we routinely determine status of p16 oncoprotein in all oral and oropharyngeal carcinomas. Furthermore we observed that HPV related carcinomas mostly present in early T category but usually have cervical lymph node metastases. Therefore you can look to this combination if you want further clinical signs of HPV related carcinomas. Our study will be published soon.

greetings George

Thanks georgios

the two cases ive seen recently were at base of the tongue and had cervical lymph nodes enlarged.

I would be interested in knowing more about your study.

Ivan, im sorry but i havent been following the posts for a few days..i want to visit ireland and attending the galway conference would have been a good opportunity to combie learning and a holiday.

Unfortunately, this year will be difficult as my daughter is appearing for the pre-medical test(its an entrance exam) due in next may.

But pl keep posting..its good to read all opinions and findings from everywhere.

HI GEORGIOS

how do you determine status of p16 oncoprotein in oral and oropharyngeal carcinomas.?

pl me give me details of this test.

i will find out if this is available/routinely done in bombay.

would this help in screening petients?

as in, would it give a good forecast of which patient is more likely to develop oral cancer?

Hi georgios

im awaiting your reply still.

hi ivan

i searched for clinics of North America Aug 2012. there was nothing on this subject there.

Apologies Arnavaz,

I missed your reply.

Details of issue are below - it was June! We have also uploaded our presentations from our HPV conference onto youtube. I will try to paste link below.

Otolaryngologic Clinics of North America

HPV and Head and Neck Cancer

Guest Editor: Sara Pai, MD

June 2012 (Vol 45, Issue 3)

http://www.youtube.com/user/1978diarmuid

Best wishes,

Ivan.

thanks ivan..ill look into this.

i recently attended a "Master Class in Oral Pathology and Oral Medicine"

Dr. Alexander Ross Kerr, Dr. Lakshman from Hong Kong, Dr. Saman from King's College, London and Dr.Zain and Dr. Cheong from Malaysia were there.

the sessions were extremely informative.

It was really nice interacting with them.

There was a very nice rewiev in Nature reviews on cancer in 2010 dealing with HNSCC including HPV-driven oral/oropharyngeal cancers:

http://www.nature.com/nrc/journal/v11/n1/full/nrc2982.html

Overexpression of p16 is easy to measure on FFPE tissue by simple immunohistochemistry (HIER protocol recommended).

thanks regina..ill have a look.

im preparing a presentation on HPV in Or4al Cancer for the association of medical women of india meeting.

any inputs would be welcome.

pl write to me with your ideas/opinions

thank you

not sure what exactly you're searching for, but you could check the GLOBOCAN website for graphics and figures - you can choose by cancer type or region or both:

http://globocan.iarc.fr/

Dear Arnavaz,

sorry I didnot see your querstion. p16 can be determined with immunohistochemistry:

* "An HPV infection in tumor tissue was retrospectively determined using p16 immunohistochemistry as a highly sensitive and specific surrogate marker for HPV-associated carcinogenesis [7]. P16 immunohistochemistry was performed using a primary antibody retrieved from Santa Cruz Biotechnology (clone JC8, dilution: 1:100). Tumors were considered positive for p16 when strong nuclear and cytoplasmic staining was present in >60% of cells."

* Prognostic factors in limited (T1-2, N0-1) oropharyngeal carcinoma treated with surgery ± adjuvant therapy. Psychogios G, Mantsopoulos K, Agaimy A, Koch M, Zenk J, Waldfahrer F, Iro H. Head Neck. 2013 Mar 6. doi: 10.1002/hed.23229. [Epub ahead of print]

Thank you georgios

here's one more referene on p16 Immunohistochemistray in OPSCC:

http://www.nature.com/onc/journal/v21/n10/full/1205214a.html

p16INK4a (DCS-50.2, Progen Biotechniques, Heidelberg,Germany)

Thank you regina..

Im so glad for all the positive in puts ive received...

Thank you to all of you.

I am not an expert in this area, but it seems to me that a lot of the answers are obfuscating and over-complicating what should be obvious, that unphysiological sexual activity bypasses the body's normal protective mechanisms and gives viruses a free rein in uncustomary places. Is it only someone like Michael Douglas who is prepared to say this in public?

Dear Gordon,

I think you just say the same thing in other words: oral sex gives HPV the possibility to infect the oropharyngeal region and leads to oropharyngeal carcinoma in some cases.

Unfortunately "physiologic sexual activity" does neither offer any protection for HPV as the number of genital condylomas and cervix cancer patients shows. So I don’t really think that there is a "normal protective mechanism" against HPV.

So only protective possibilities are to have no sex at all or to get the HPV vaccine.

Btw does anyone have an opinion about safety of HPV vaccine?

My comment was a general one applicable to any organism, viral or not, that causes sexual infections. There is clearly a baseline risk of catching infection from standard (physiological) sex, but is there any organism where the risk of spreading or developing infection is not raised with unphysiological sex activity?

Please have a look at this

http://www.nature.com/bdj/journal/v188/n7/full/4800481a.html

I had aresearch on this topic and I found that most of HR-HPV-positive OSCC cases corresponded to young patients(

Interesting disscusion.

Relatively few oral cancer are HPV positive, but many oropharyngeal ones are. And they are located in the tonsil and the base of the tongue (lymphatcic tissue). These patients are younger than the usual (drinking-smoking) oral cancer pateints, but never "youngsters".

All  "youngsters" we have see with oral cancer (tongue), aged 20-30 were HPV negative.

Hope it helps.

"These patients are younger than the usual (drinking-smoking) oral cancer pateints, but never "youngsters".   All "youngsters" we have see with oral cancer (tongue), aged 20-30 were HPV negative."

So what activity do such younsters particularly engage in that would expose them to unusual viruses outside their natural habitat?  The epidemiology is surely giving the vital clue.

There is no activity we might coin as a trigger or risk factor.

They do not smoke nor drink, but even if they did,  the habit would have been during a period of only few years since they are 20 and 22  years and this would probably be only a coincidence. I guess the same applies for HPV: oral sex will not induce a tumor within few years.