The Big “C”-Chapter 2

October 16-October 28, 2019

Once I knew the type of cancer I have, I immediately googled “squamous cell carcinoma” (SCCs). The way I approach online research of serious, academic subjects is to review the initial search results to look for possible keywords. Wikipedia is a good place to find further keywords and search terms. From there I turn to the academic research databases EBSCO and Proquest (normally available to anyone with online access to their local public library card).

Many of the webpages I initially reviewed referred to SCC as a type of skin cancer. On a hunch, when I added “oral” to my search terms, I noticed “HPV” was frequently mentioned as well. This struck me as possibly significant; in 1987 I was treated for genital warts, so I may have bits of HPVⁱ DNA in my blood and/or plasma, just as having chickenpox as a kid means I have the virus causing shingles quietly sequestered somewhere in my body—at least for now.

What I found in the online Merck Manual (professional version) made me sit up and take notice, especially the following: “HPV type 16 causes 60% of oropharyngeal cancers [i.e. the main oral cavity, including the tonsils-MN] and patients have become younger (median age 57 yr, and bimodal peaks at 30 yr and 55 yr) as HPV infection has emerged as an etiology. The number of sexual partners and frequency of oral sex are important risk factors. The risk of developing oropharyngeal cancer is 16 times higher in HPV-positive patients. In Europe and North America, HPV infection accounts for about 70 to 80% of oropharyngeal cancers.” (emphasis mine) Later, the same Merck Manual entry says, “Patients who are HPV-positive have a 5-yr survival of > 75% (and a 3-yr survival of almost 90%), whereas HPV-negative patients have a 5-yr survival of < 50%.” (again, my emphasis) This difference in the prognosis between the two types is not at all a trivial one.¹

As an “interdisciplinary sciences” major from 2006 through 2008, I had a student membership in the American Association for the Advancement of Science (AAAS) because access to the broad spectrum of the sciences covered by the Science family of journals was crucial to my undergraduate thesis. Since 2011, I’ve paid for the “professional” membership, but never thought I’d use it to research a serious condition I had.ⁱⁱ

According to the American Cancer Society, as of February 2019, there is no FDA approved test for HPV in men², however, Wang et al., in Science Translational Medicine, reported on research into detecting HPV DNA in the blood plasma and saliva of individuals with head and neck squamous cell carcinomas (HNSCCs), noting that not all HNSCCs are created equal.³ The prognosis for patients with HNSCCs can vary greatly depending on exactly where in the head and neck it appears, corroborating the information I found on the Merck Manual site.

I live in Rapid City, South Dakota, and though one of the biggest employers in the Metropolitan Statistical Area (MSA) used by the the US Census, it is still South Dakota. I prepared myself to fight to have my cancer tested for the HPV 16 genetic markers. On my first visit with my radiation oncologist on 22 October, I came armed with arguments as to why I ought to be tested for the HPV markers. Much to my surprise, the oncologist readily agreed and said he would order the tests of my biopsy sample.

Later that same day, I was scheduled to have every molar and pre-molar in my mouth extracted—a long story I’ve relegated to the endnotes.ⁱⁱⁱ While I was home recuperating a day or two later, I got a call from my “nurse navigator” to let me know that the surgical oncologist that took the initial biopsy had ordered the tests for HPV DNA as matter of course and that my cancer was indeed HPV-positive. Given the much more favorable prognosis for HPV-positive HNSCCs, I was understandably relieved. I was also very impressed, in the absence of an FDA-approved test, that the sophisticated lab-bench technique, polymerase chain reaction (PCR), was deployed in analyzing my biopsy as standard operating procedure.
 

Like I said before, we’re going to science the shit out of this. Stay tuned.

Works Cited

1. Merck Manual. ‘Oropharyngeal Squamous Cell Carcinoma - Ear, Nose, and Throat Disorders’ Merck Man. Prof. Ed. at <https://www.merckmanuals.com/professional/ear,-nose,-and-throat-disorders/tumors-of-the-head-and-neck/oropharyngeal-squamous-cell-carcinoma>15 Oct. 2019

2. American Cancer Society. ‘HPV and HPV Testing’ Am. Cancer Soc.-Cancer Z. (18 Feb. 2019). at <https://www.cancer.org/cancer/cancer-causes/infectious-agents/hpv/hpv-and-hpv-testing.html>21 Oct. 2019

3. Wang, Y. et al. ‘Detection of Somatic Mutations and HPV in the Saliva and Plasma of Patients with Head and Neck Squamous Cell Carcinomas’ Sci. Transl. Med. 7, p.293ra104-293ra104; (24 Jun. 2015). doi:10.1126/scitranslmed.aaa8507

Endnotes

i   Based on the peer-reviewed literature I looked at thus far, there seems to be several sub-types of the human papilloma virus, and the one that causes genital warts is not as scary from the standpoint of cancer as some others.

ii  I must confess that getting mail from the AAAS addressed to “Dr. Northrup” is a hoot. Once when updating my credit card billing information over the phone with the AAAS, I told them I only have a lowly undergraduate degree in the sciences. The person I was talking to said that because I am paying for the “professional” membership, the database they use to address USPS mail will prefix my name with “Dr.”

iii  I have IBS-D, and the medication I take for it works by dialing down on the lubrication supplied to the lower GI tract. A downside of this medication, Amitriptyline, is that the moisture spigots are dialed down all over the body—leading to dry mouth, which can wreak havoc with ones’ oral health. I also grind my teeth, perhaps as an unconscious coping mechanism related to my ADHD. I had already quit using smokeless tobacco, and after the New Year, I planned on getting a huge amount of dental work done. The estimated cost after my dental insurance paid what they will cover was going to be in excess of $10,000—I planned to go Hollywood with implants, teeth whitening, the whole shebang.

Of course, being diagnosed with cancer made a hopeless wreck of my grand dental stratagem. Radiation therapy (radiotherapy) doesn’t usually affect the immune system, but if the target of the therapy is near bones, those bones ability to heal themselves. This means that any teeth that might possibly need to come out later on, had to come out now to allow time for my traumatized jaws to heal, before they go all Bruce Banner on me. This is why they pulled all my molars and premolars (bicuspids), leaving me with only my canines and incisors.

This means that at best, my grand dental stratagem will probably be restricted to dentures. It also means that for the next few years, I’ll be eating lots of soup and drinking lots of fruit/vegetable smoothies. It also occurred to me that I’ll need to watch my sodium intake as soups in restaurants and grocery stores can have obscene levels of sodium.