HPV-Linked Throat Cancer May Have Telltale Signs

Hi friends, This article from WebMd is very important - I hope you all get a chance to read it.

-- Dr. Dale

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http://www.webmd.com/sexual-conditions/hpv-genital-warts/news/20140320/hpv-linked-throat-cancer-may-have-telltale-first-symptoms?page=2

Signs of potential trouble could be different in people without the virus, study suggests

The first symptoms of throat and mouth cancer -- also known as oropharyngeal cancer -- may differ depending on whether the condition is caused by the human papillomavirus (HPV), a small study suggests.

Oropharyngeal cancer arises in the throat, soft palate, tonsils or base of the tongue. Smoking is a major risk factor, as is chronic infection with certain strains of HPV -- which causes warts in the genitals, mouth and anus, and is the most common sexually transmitted disease in the United States.

Although oropharyngeal cancer is relatively uncommon, the rate of HPV-linked cases has been rising -- particularly among white adults younger than 55. The reasons aren't clear, but experts suspect that changes in oral sex practices have a lot to do with it.

The U.S. Centers for Disease Control and Prevention estimates that each year about 8,400 Americans are diagnosed with HPV-related oropharyngeal cancer.

"We're seeing this in younger, healthy people who don't smoke," said Dr. Terry Day, senior researcher on the new study and a specialist in head and neck cancers at the Medical University of South Carolina, in Charleston.

Despite the concerning rise in oropharyngeal cancers, Day said, there has been a lack of research into the initial symptoms -- including whether the signs of HPV-linked tumors are distinct.

So his team looked at records for 88 patients diagnosed with oropharyngeal cancer at their center between 2008 and 2013. Most -- 71 -- had HPV-positive cancer, and for them the most common first symptom was a lump in the neck.

Half of those patients had a "mass" in the neck, versus only 18 percent of patients with HPV-negative cancer, Day's team reported in the March 20 online issue of JAMA Otolaryngology--Head & Neck Surgery.

For the patients without HPV infection, a persistent sore throat and difficulty swallowing were the most common first signs. More than half complained of a sore throat, while 41 percent had problems with swallowing.

Some patients with HPV-linked cancer had those symptoms, too, but less commonly: 28 percent had a stubborn sore throat, and only 10 percent had trouble swallowing, the findings showed.

An expert who reviewed the study called the findings "interesting," but said they should be interpreted with caution.

Larger studies are needed to confirm the results, said Maria Worsham, research director in the department of otolaryngology/head and neck surgery at Henry Ford Hospital, in Detroit.

Plus, Worsham said, the symptoms these study patients reported are not unique to cancer. So people should not assume that a lump in the neck means they have cancer -- or oral HPV, she said.

Another expert not involved with the study said that a lump could indeed be an infection that just needs a round of antibiotics.

But if the mass persists, see your doctor again, added Dr. Dennis Kraus, director of the Center for Head and Neck Oncology at Lenox Hill Hospital, in New York City.

According to Kraus, the findings help "codify" what many doctors have noted: that people with HPV-positive oropharyngeal cancer tend to have no symptoms, but instead notice a lump.

The "good news," Kraus said, is that HPV-positive cancers generally have a better prognosis. Patients with HPV-negative cancers tend to have a more-aggressive disease -- and, therefore, obvious symptoms like an irritated throat and difficulty swallowing.

Kraus agreed with Day that the face of oropharyngeal cancer has changed from years ago. HPV-positive tumors are now more common than HPV-negative ones, he said.

According to the CDC, about 7 percent of Americans have oral HPV, though only 1 percent have the particular strain (HPV-16) that's linked to oropharyngeal cancer.

Usually, the immune system is able to clear HPV from the body, and most people never know they were infected.

But for reasons that aren't clear, some people harbor chronic HPV infections. Persistent infection with a cancer-linked strain is the big worry: Nearly all cases of cervical cancer, for instance, are caused by HPV.

There are, however, two vaccines against the most common cancer-linked HPV strains -- including HPV-16. Experts recommend all children ages 11 and 12 be vaccinated. Older girls and women up to age 26 should get "catch-up" shots if they've never been vaccinated. The same advice goes for boys and men ages 13 to 21.

The vaccines -- Gardasil and Cervarix -- are known to ward off genital and anal HPV infections. Studies on whether the vaccines prevent oral infections are just starting. But, Kraus noted, they do target the major HPV strain linked to oropharyngeal cancer.

HPV & cervical cancer screening

HPV test approved for cervical cancer screening

http://www.cnn.com/2014/04/24/health/hpv-test-approval/

By Elizabeth Landau and Val Willingham, CNN

(CNN) -- The FDA announced approval Thursday of the human papillomavirus DNA test as a primary screening method for cervical cancer.

The U.S. Food and Drug Administration initially approved the HPV DNA test in 2011, for use alongside or as a follow-up to a Pap test, but this is the first time it has been green-lighted as a primary screening technique.

The FDA announced approval of the method on Thursday after an FDA advisory committee unanimously recommended in March that the HPV test become the first line of screening for the deadly disease.

The approval is limited to women over the age of 24.

Developed by Roche Molecular Systems Inc., the cobas HPV Testcan be used to see if a woman needs additional screening for cervical cancer and to gather information about her future risk.

The Pap test -- the standard for 60 years -- is designed to look for abnormal squamous cells that could indicate cervical cancer, while the HPV test looks for DNA from the virus. A vaginal swab is required for both the Pap test and the HPV DNA test, so you won't notice a difference at the doctor's office.

"The potential benefit of (the HPV test) is that everybody that has a precancerous change or cervical cancer will have a positive test," said Dr. Kevin Ault, professor at the University of Kansas Medical Center in Kansas City. "You're not going to miss anybody."

There are other HPV tests out there, but this one can detect the most problematic strains -- HPV 16 and 18. The test can also detect DNA from 12 other types of HPV that are associated with an increased cancer risk. HPV causes more than 99% of all cervical cancers.

The problem with any HPV test is that a lot of women -- between 2% and 10% -- will test positive for the virus, Ault said. And most women who get HPV don't develop cervical cancer.

HPV is so common that at least 70% of people who are sexually active will get a genital HPV infection at some point in their lives, according to the National Cancer Institute.

"Most people who get HPV only have it for a few months or a year and then it goes away," Ault said. "It's really the people it persists in that are going to the problem."

But how do we know who with HPV will likely develop cervical cancer? Positive results on the HPV test will necessitate further screening, he said. Patients who test positive may have to have a Pap smear as well, and potentially biopsies and other procedures.

"The disadvantage is a lot of people are going to be scared," he said.

If this new test is adopted as the primary screening method, Ault said, doctors can focus their Pap examinations on women who are already known to have HPV.

In most cases, patients who don't have HPV are less likely to need a Pap, which is why the advisory committee felt it best to recommend the Roche test be administered as the first form of detection, women's health experts say.

If both the Pap smear and the HPV test are negative, that would mean the patient essentially has almost no chance of developing cervical cancer in the next five years, Ault said.

"Every year, 12,000 women are diagnosed in the U.S. with cervical cancer. This is especially tragic because cervical cancer is a largely preventable disease, and it is well established that HPV is the cause of almost all cervical cancers worldwide. Women need better access to screening tools that include primary HPV screening in order to reduce their risk of developing cervical cancer," said Dr. Thomas Wright Jr., an expert in gynecology and pathology at Columbia University Medical Center.

Many gynecologists are used to doing routine Pap tests, so the HPV test may take a little while to replace the traditional pap smear, Ault said.

But Thursday's approval of the test does not change current practice guidelines.

Cervical cancer screening guidelines are usually proposed through organizations such as the American Cancer Society or the American College of Obstetricians and Gynecologists. The FDA's role is in approval of the test itself.

Where? Is? My? MOTIVATION??

Thank you Joyce Marter!! Depression is a huge case for my patients.   Tips for motivation is just one of the ways to punch depression in the face.

Make an appointment if you think you have depression.  You don't deserve it.  Let's throw it away.

I got you.

-- Dr. Dale

Zero Motivation to Go to Work? 10 Tips

http://www.huffingtonpost.com/joyce-marter-/zero-motivation-to-go-to-_b_4805174.html?utm_hp_ref=healthy-living

Joyce Marter

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Psychotherapist

We all need the occasional "mental health day" off from work to reboot our minds and bodies, but what if you have already called in sick one too many times? Assuming you're experiencing a normal ebb in the energy you have for work and not a more serious issue (like depression, addiction or abhorring your job, in which case you should consult a therapist immediately), here are some things you can do:

1) Incentivize yourself. Treat yourself to your favorite coffee or tea on your way to work. Make lunch plans. Schedule something nice after work, like a workout, a get-together with friends, or a pj's night at home with a good movie. Remind yourself these things are better than the guilt of calling in sick, the awkward excuses that need to be made (or the fake cough) and the overwhelm of twice as much work the next day.

2) Use a mantra. Select a positive statement to get you moving (i.e., "When I do the best that I can, I am my best self"). Personally, I like Dory's "Just Keep Swimming" from Finding Nemo.

3) Take it one step at a time. Baby steps. Get out of bed, shower, get dressed, have something to eat, make your way out the door, etc. I often find that once I get moving, I pull out of my funk and gain momentum. As a licensed mental health professional, I strongly recommend singing, "Put One Foot in Front of the Other."

4) Make things easier for yourself. Take a cab instead of the bus. Skip the trip to the dry cleaner. Wear something comfy. Cross off a couple of things on your "To Do" list to lighten the load. Ask for the support you need from your partner, friends and family (even if it's just a pep talk or a little prodding).

5) Shift into cruise control. We can't run full speed ahead every day, and there are some days that require autopilot. As a therapist, these are days that I might make fewer enthusiastic interpretations or coaching suggestions for my clients, and might hang back and just listen attentively and reflectively. Often, these ebbs in my energy are opportunities for my clients to step forward and to make their own insights and direction. So, running at a slower pace isn't always a bad thing as it can provide perspective.

6) Fly under the radar. If you are a little low in motivation, perhaps this isn't the day to have extensive interactions with your boss or team. Use whatever flexibility you can to limit interactions (i.e., put on your headset, keep your nose in your computer, shut your office door, etc.). Keep interactions brief and cordial to make the day more manageable.

7) Do the work that is easiest for you. Perhaps today isn't the day you are going to complete the big project, but keep in mind that anything you do at work (no matter how small) is more than what you would have accomplished if you called in sick. When my energy is low, I tend to focus on organization that preps me for days when my energy is higher. I might get some filing done, complete some mindless paperwork or make a supply run, rather than tackling something that requires more brain power or passion.

8) Be of service to somebody else. I love being a therapist because my work gets me out of my own head. I'm often surprised at how recalibrated my energy feels after a good session. Even opening a door for somebody, giving a compliment or offering support or mentoring to a less senior colleague can ignite your internal energy source.

9) Practice gratitude. Instead of focusing on all the reasons you really don't want to go to work (the icky weather, the lame meeting, or whatever it is), focus on the good parts. You are alive. You have a job. You aren't really sick, etc. Gratitude promotes positive thinking that attracts good energy.

10) Practice self-care. Practice a few minutes of deep breathing or guided meditation to revitalize yourself. Take breaks when you can at work. Get out of the office and walk around the block to clear the cobwebs from your mind. Get proper rest, nutrition and exercise. Consider a massage, mani-pedi or similar if within your budget. If not, choose self-care that is free, such as reading a book, taking a bubble bath, or practicing yoga. Refuel yourself so that tomorrow is a better day!

"Nothing will work unless you do." -- Maya Angelou