Cancer | Mount Sinai Today

Alcohol Increases the Risk for Cancer. Here’s What You Should Know.

Updated on Jan 10, 2025 | Cancer, Your Health

The U.S. Surgeon General recently released a report advising the public on the link between alcohol and cancer. According to the report, alcohol consumption increases your risk for at least seven types of cancer, including liver, colon, and breast cancer, and drinking is a leading preventable cause of cancer in the United States, contributing to almost 100,000 cancer cases a year.

Frances Lee, MD

“The advisory confirms what doctors have known for many years—alcohol causes cancer,” says Frances Lee, MD, Assistant Professor of Medicine (Liver Diseases), Icahn School of Medicine at Mount Sinai. “This advisory is not meant to cause shame or fear, but to empower the public. We all have the right to know the risks of our daily choices, and this advisory is a way for people to know the risks of alcohol use from a reliable source.”

In this Q&A, Dr. Lee discusses what you need to know about the relationship between alcohol and cancer, how to reduce your risk, and how to get help if you need it.

How does alcohol cause cancer?
Alcohol and its metabolites causes inflammation and damage to DNA, which is the pathway for cancer development. Additionally, when you drink alcohol, you increase the absorption of other carcinogens in your environment—for example, chemicals from cigarette smoke. Alcohol can also increase various hormones levels, such as estrogen, increasing breast cancer risk.

What types of cancer does alcohol increase my risk for?
In addition to breast cancer, alcohol increases your risk for various digestive cancers, including in the mouth, throat, esophagus, liver, and colon. Alcohol also causes chronic liver disease, and alcohol-related liver disease is also now the leading indication for liver transplant.

Is there any safe amount of alcohol that I can drink?
There is technically no safe amount of alcohol to drink; as the surgeon general advisory notes, increases in alcohol intake leads to stepwise increases in risk for developing cancer. However, we live in a society where social events are often centered on alcohol intake. For those without risks for developing chronic diseases or certain cancers, it may be reasonable to consume no more than one standard beverage a day for women and no more than two standard beverages a day for men. In the end, you have to weigh the risks and benefits of alcohol in the context of each person’s unique risk factors.

How can I reduce my risk for alcohol-related cancers?
The only way to completely reduce your risk is to not drink alcohol. That can be difficult, even for people who are not heavy drinkers, since alcohol is part of our culture. But reducing your intake by any amount will decrease your risk for developing alcohol-related cancers.

When should I see a doctor?
Alcohol can cause various chronic disease that go unnoticed. As a liver doctor, I’m most concerned about alcohol-related liver disease that goes undiagnosed until it’s too late. Whether you are a heavy or moderate drinker, I recommend getting a regular checkup with standard blood work. If there is a problem with your liver enzymes, it is important to see a liver doctor and work together to reduce alcohol intake to allow the liver to heal and regenerate.

Are there any medications that can help me stop drinking?
There are medications that are very safe, even for people with liver disease. These medications are evidence-based and well tolerated. These medications reduce cravings by targeting the central nervous system, which has altered reward signals after years of alcohol intake. To be sure, the treatment of alcohol use disorder includes therapy/behavioral interventions, along with medications.

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Acclaimed Vocalist to Perform After Mount Sinai Saves His Life—and Voice—From Cancer

Updated on Jun 13, 2024 | Cancer, Featured, Head and Neck, Patient Stories

Johannes Schwaiger, Mount Sinai patient and Broadway musician, with fellow Broadway musician and wife Tessa Lang

About a decade ago, Broadway musician Johannes Schwaiger noticed a hoarseness in his voice, which he initially dismissed as allergies. A visit to a doctor that spring identified the real culprit—a tumor in the back of his throat. The subsequent care Mr. Schwaiger received at Mount Sinai, which included minimally invasive surgery and voice therapy, saved both his life and his voice.

“Now, thinking back, 11 years ago, I am completely cancer free and have followed my passion of music, in my case, singing, with a newfound purpose—to bring people together, and find those things that unite us,” he says.

On Thursday, June 6, the singer, who has performed on Broadway, including in Cats, will tell his story—one about “all kinds of love”—in a performance titled “All the Love in the World,” at the Kaufman Music Center in New York City. Mr. Schwaiger will perform alongside his wife, fellow Broadway musician Tessa Lang, who encouraged him to see a doctor when he began experiencing symptoms and stayed by his side through cancer treatment and his journey back to health.

“She is my angel,” says Mr. Schwaiger, explaining that his ordeal with cancer was also hers. On stage, the couple will tell their story of love, hope, and survival through a selection of American, French, and Italian love songs.

“We’ve woven a tapestry of all the ways people love, and the journey that love takes, the highs and the lows, and the pursuit of love, no matter what the journey is,” says Ms. Lang of their upcoming performance.

For the couple, the journey began when Mr. Schwaiger received a diagnosis of stage IV head and neck cancer in 2013, and his worst fear—losing his voice—became a real possibility. “I underwent a CT scan, and the results were devastating,” he remembers.

Many patients who undergo surgery for head and neck tumors need a tracheotomy, a surgical opening in the neck that allows them to breathe through a tube.

“I walked around in a daze between disbelief and realty,” recalls Mr. Schwaiger.

The musician began singing at the age of nine in Munich, Germany, his hometown, and his international career went on to span operas, oratorios, concerts, and musical theater. The possibility of losing his voice “felt like losing my life,” he says.

The diagnosis also came as a shock to Ms. Lang. “Johannes was just so healthy, he grew up on a farm. There was never anything wrong with him, so that’s why this was just so unusual,” she says.

Mr. Schwaiger’s doctor referred him to Mount Sinai, where doctors performed laser surgery, a minimally invasive procedure, removing about 85 percent of the tumor without harming the surrounding tissue, eliminating any need for a tracheotomy. After the surgery, he underwent chemotherapy and radiation to remove the remaining cancer, which was provided under the expertise of his oncology team at The Tisch Cancer Institute at Mount Sinai.

“What I so much loved about Mount Sinai is they didn’t proclaim doomsday,” he recalls. “They said, ‘You have a good chance of healing, and that’s what we are going to do.’”

While the treatment cured him, the radiation to his throat made speaking and swallowing difficult, and Mr. Schwaiger’s voice was again in jeopardy. However, with guidance from Cathy Lazarus, PhD, Associate Professor, Otolaryngology, Icahn School of Medicine at Mount Sinai, he was able to keep his voice—and his career. In her research and clinical practice, Dr. Lazarus specializes in restoring function in head and neck cancer patients.

“It was tremendously helpful,” he says, adding that the therapy also helped him regain his ability to swallow and eat normally.

Mr. Schwaiger, who teaches at the American Musical and Dramatic Academy in New York City, describes the care he received from Mount Sinai as “divine intervention.” In 2015, he shared his story with fellow cancer survivors at a luncheon at Mount Sinai-Union Square. To show his appreciation for all who helped him during his ordeal, he decided to tell his story through a series of songs, which were “all about healing,” he says.

“I started to look at my voice from a different lens and found a new purpose within,” he says.

It is a new purpose Mr. Schwaiger will convey when he takes the stage with Ms. Lang for the All the Love in the World concert this June.

“This concert is a testament to the journey I walked through and the love that endured and helped me to overcome and heal,” he says.

Get Your Ticket to the “All the Love in the World” Concert

The “All the Love in the World” concert is a benefit in support of Dreamgates, a nonprofit organization that uses performing arts events to bridge cultural divides and embrace artistic co-creation in a global community. It will take place Thursday, June 6, at 7:30 pm at the Kaufman Music Center in New York City. Tickets are available here.

Are you a cancer patient?

Free tickets will be set aside for the first 10 cancer survivors who contact Mount Sinai. Those interested should email David Schwab at david.schwab@mountsinai.org with the subject line: “All the Love in the World.”

What Are “Forever Chemicals,” and Can I Avoid Them?

Updated on Dec 15, 2023 | Cancer, Your Health

You may have been hearing a lot lately about “forever chemicals,” or PFAS (per- and polyfluoroalkyl substances), so called for their ability to stay in the body and environment for years and resist breakdown.

In this Q&A, Shelley H. Liu, PhD, Associate Professor of Population Health Science and Policy at Mount Sinai, explains what these chemicals are, why they are linked to cancer, and how to reduce your exposure. An expert on PFAS, Dr. Liu researches the wide-ranging health impacts of these chemicals, including identifying disparities in exposure burden across populations.

Shelley H. Liu, PhD

What are forever chemicals?

PFAS are a big class of man-made chemicals that have been around for decades. They are very useful to industry due to their stain- and water-resistant properties. They are used in all kinds of products from consumer products (like nonstick pans, carpeting, and textiles), to food packaging and firefighting foam. Because these chemicals are so widely used, they can be detected in the blood of more than 98 percent of Americans, including people who have not been exposed through their jobs. Because we may be continually exposed at low amounts to PFAS through everyday living, our accumulated exposure over time (such as over decades) to PFAS and other synthetic chemicals is a growing concern for our health and wellbeing.

What is the link between forever chemicals and cancer?

There is a lot of great ongoing research around PFAS and cancer. While emerging findings show concern, there is still a lot we don’t know. For example, there has been some early work showing potential links between PFAS and different types of cancer in what scientists call a “dose-response relationship,” meaning that higher concentrations of PFAS chemicals in the blood are associated with a higher risk of liver cancer or kidney cancer. This means that even if you can’t absolutely remove your exposure to PFAS, doing your best to reduce exposure over time could still be quite helpful. There is also very new research that suggests PFAS might be linked to hormonally-driven cancers, such as breast cancer, depending on whether you’re female or male and also your race and ethnicity. These are early studies right now, and we don’t quite know yet what those links are.

Seven ways to reduce your exposure to forever chemicals:

Drink filtered water
Reduce consumption of freshwater fish, and consider diversifying the fish you eat
Discard nonstick cookware that is worn, and replace nonstick cookware with stainless steel
Reduce use of paper and paperboard takeout containers
Reduce use of fabrics, textiles and other products labelled as water- or stain-resistant
Replace old carpets with new ones to keep babies safe
Test private well water for PFAS, and install a purification system if necessary

What products are forever chemicals commonly found in?

We don’t know every product that PFAS are in, but we do know some of the major ones. These include products with nonstick and water-resistant properties, such as nonstick pans and nonstick coatings in food packaging, as they are used as grease-proofing agents in fast food wrappers and take-out paperboard containers, as well as stain-resistant fabrics on your couches and carpets. Diet can also be another exposure source. For example, fish, such as freshwater fish, can sometimes be contaminated with PFAS, and there are many communities in the United States, including in New York, that have contaminated public drinking water. This spring, the U.S. Environmental Protection Agency proposed the first-ever enforceable federal-level regulation of PFAS in public drinking water, although this has not finalized yet. Private wells can also be contaminated with PFAS, and are not part of federal-level regulations. Unfortunately, PFAS are a pervasive problem because they are very stable molecules and resist degradation. Some PFAS can be eliminated fairly quickly from the human body, but others can remain for years (for example, three to five years), and they can accumulate in your organs, such as the liver. In the environment, PFAS can also be transported great distances by weather patterns and groundwater, and eventually make their way into public drinking water and food sources.

Who is most at risk?

Scientists are still researching which groups are at higher risk of exposure to PFAS and/or more vulnerable in terms of health impacts. We know that some people are highly exposed to PFAS through their occupation—for example, firefighters have high exposure to PFAS chemicals because PFAS are a major component of firefighting foam. When we think about non-occupational types of exposures, our research has shown that Asian Americans have a higher exposure burden to PFAS than other race/ethnicities, and we are researching why. It may be a combination of diet, consumer product use and immigration history, as PFAS are used and regulated and disposed of differently in other countries. The other way to think about who is at higher risk is to look at groups who already have poorer health or chronic conditions, and understand whether higher PFAS exposure may worsen their disease progression compared to people with a similar disease stage but with lower PFAS exposure. Perhaps their threshold of tolerance to cumulative PFAS exposure could be diminished. These are all ongoing and important research questions.

What are a few specific ways to reduce my exposure to PFAS?

A few ways to reduce your exposure include lowering your PFAS exposure through diet, using stainless steel cookware instead of nonstick when possible, replacing old nonstick cookware that contain coatings that may have worn off over time, and reducing use of paper and paperboard takeout containers. For babies and young children, carpeting may also be an exposure source. Some newer carpets are not treated with PFAS, so consider replacing old carpets with new ones. If your drinking water comes from private wells, it could be helpful to get your water tested for PFAS, and if you discover high PFAS contamination, consider using water filters, installing a reverse osmosis filtration system, which purifies water, or drinking bottled purified water (which is made with reverse osmosis filtration). In general, using water filters is helpful for PFAS and other contaminants, even if you have a public water supply. While it’s hard to eliminate PFAS exposure completely, it can be quite helpful in the long term if you can reduce your exposure. It would be helpful for our governments to regulate PFAS, and while there is some progress on this front, much more work needs to be done.

Is there a way to rid my body of PFAS?

Unfortunately, there are not many ways for your body to expel PFAS. They are extremely stable molecules, which is why they can remain in your body for years. As such, PFAS levels are often higher in older adults because they accumulate over one’s lifetime. However, menstruation, breastfeeding, and childbirth have been shown to be ways that PFAS are expelled from the body, though research shows that mothers can pass them to their babies. That said, there is no way to totally avoid exposure. You can even find PFAS in the Arctic because they get transported everywhere and persist in the environment. Further, PFAS are not the only concern. Over the last few decades, society has exponentially increased the production of all kinds of synthetic chemicals, some of which can eventually make their way into the human body, and we don’t yet know what that means for human health going forward.

Second Book Celebrates Cancer Patients’ Prose During Pandemic

Updated on Dec 13, 2023 | Cancer, Community, Featured

Alison Snow, PhD, LCSW-R (left), Emily Rubin, and Manjeet Chadha, MD

Cancer patients had much to express during the COVID-19 pandemic, and their heartfelt stories can now be read in a new book, The Write Treatment Anthology Volume 2: The Pandemic Years (Write Treatment Anthology Series). The book includes essays, short stories, and poems from 15 cancer patients, survivors, and caregivers—all members of the Write Treatment Workshops for Mount Sinai Hospitals.

“During the pandemic, in the spring of 2021, I found this loving and supportive group while they met on Zoom,” writes workshop member Liz York in an excerpt from the anthology. “It was difficult to meet people who understood the emotional challenges of cancer, so the group immediately became important to me.”

The sentiment is shared by novelist Emily Rubin, workshop founder and cancer survivor who spoke to a large audience of fellow patients, their families, and caregivers at a recent book launch for the anthology on Wednesday, November 15, held at Mount Sinai-Union Square. She was introduced by Manjeet Chadha, MD, Director, Department of Radiation Oncology, Mount Sinai Downtown, and Professor, Radiation Oncology, Icahn School of Medicine at Mount Sinai, who described her as a “guiding light and a huge resource in helping many of our patients find an outlet through their writing.”

As Ms. Rubin took the microphone, she told the packed auditorium that running the workshops has helped her to “connect through the creative act of writing with so many who, like me, have been participants in these workshops, come and stay with a yearning to tell stories and hear those of others. Together we have built a supportive, creative community of writers.”

The Write Treatment Workshops: Evolution and Founding

Emily Rubin, novelist and workshop co-founder

A co-editor of the anthology, Ms. Rubin founded one of the workshops in 2011 after she completed breast cancer treatment at Mount Sinai Beth Israel. The other workshop was started by Susan Ribner, an author who was treated for ovarian cancer at Mount Sinai West. While the two coincidentally formed the workshops around the same time, they had met years before at an Aikido dojo, a type of martial arts gym, in Chelsea. They collaborated on workshops and book readings, and after Ms. Ribner went into hospice care, Ms. Rubin took over both groups. Ms. Ribner died in 2014.

Before the pandemic, the workshops were held in-person at the Blavatnik Family Chelsea Medical Center and at Mount Sinai West but moved to Zoom during the pandemic. While the workshops continue to be held virtually, they stick to the same routine they have always followed since their origins: Ms. Rubin emails prompts, such as quotes, cards, or photographs, to participants to spur their imaginations. Each participant then writes for about a half-hour, aiming to create a short, finished product. About 600 people now take part in the workshops regularly—a number that has doubled since the workshops began.

The book, published on Amazon.com through grants and crowdfunding, includes an in-memoriam section with writings from those who have died. In one excerpt, Susan Masaad, MD (1938-2021), writes of a virtual visit with her gastrointestinal oncologist of whom she was very fond: “I have come to appreciate his wonkiness, encyclopedic knowledge of all the ways we can slash and burn the cancer, as well as his absolutely exquisite taste in clothing…”

In another excerpt, patient Norman Ford (1935-2021) offers words of encouragement: “To you my cancer-laden brothers and sisters I have a message. This is not a chore. In the thoughts and feelings on display you expressed courage, anger, uncertainty, and more…”

Copies of the The Write Treatment Anthology Volume 2: The Pandemic Years (Write Treatment Anthology Series)

The Write Treatment Anthology Volume 2: The Pandemic Years (Write Treatment Anthology Series) follows Volume 1, published in 2022, which includes essays, short stories, and poems from 23 workshop participants. During the recent book launch, Alison Snow, PhD, LCSW-R, Director, Cancer Center Supportive Services at Mount Sinai Downtown Cancer Centers, called the second anthology’s publication “an extraordinary accomplishment” for the hundreds of Mount Sinai patients who continue to live—and write—with cancer.

Learn more about Mount Sinai's Cancer Support and Wellness Programs and Events

Mount Sinai Researchers Share Thoughts on the Promise of mRNA Technology, a Nobel Prize-Winning Science

Updated on Oct 27, 2023 | Cancer, Featured, Research, Vaccines

Miriam Merad, MD, PhD, the Mount Sinai Professor in Cancer Immunology (left), and Nina Bhardwaj, MD, PhD, Ward-Coleman Chair in Cancer Research (right), lead some of the most cutting edge research in mRNA technology at the Icahn School of Medicine at Mount Sinai.

The 2023 Nobel Prize in Medicine was awarded jointly to two researchers, Katalin Karikó, PhD, and Drew Weissman, MD, PhD, for their decades-long work on messenger RNA (mRNA), which ultimately led to the successful development of COVID-19 vaccines that made a huge difference during the pandemic.

The concept of using mRNA to deliver genetic instructions was met with a lot of skepticism in the beginning, says Nina Bhardwaj, MD, PhD, Ward-Coleman Chair in Cancer Research at the Icahn School of Medicine at Mount Sinai. Because these molecules were rapidly degraded by the immune system, they were thought to be too transient to be used to express anything therapeutic, such as antigens or other molecules in immune cells, she added.

“It’s really through the two researchers’ sheer hard work and determination and validation, both in the lab and in the clinic, that this became a technology that can be harnessed for patient benefit,” says Dr. Bhardwaj, who is also Director of Immunotherapy and Medical Director of the Vaccine and Cell Therapy Laboratory.

The validation of mRNA as a delivery mechanism has opened the doors to vaccines in many other diseases, including cancer, says Miriam Merad, MD, PhD, the Mount Sinai Professor in Cancer Immunology, and Director of the Marc and Jennifer Lipschultz Precision Immunology Institute (PrIISM) at Icahn Mount Sinai.

“We’ve been quite interested in the mRNA for some time—not only this type but also another called the micro RNA,” says Dr. Merad. Even prior to COVID-19, Mount Sinai researchers have recognized the potential of various RNA for use in vaccines, such as for cancer, she adds.

Read more from Drs. Bhardwaj and Merad on their thoughts on mRNA technology, and learn how Mount Sinai is leading this field with its research.

Katalin Karikó, PhD (left), and Drew Weissman, MD, PhD, were the joint winners of the 2023 Nobel Prize in Medicine. Dr. Karikó, a Hungarian-American biochemist who worked at the University of Pennsylvania, continues her research as a professor at the University of Szeged in Hungary. Dr. Weissman, an immunologist, advances vaccine work at his laboratory at the Perelman School of Medicine at UPenn.

What’s the history of mRNA technology development been like?

Dr. Bhardwaj: There was a lot of skepticism in the beginning about how exogenously-delivered RNA—which we usually think of as these transient molecules that are rapidly degraded—can be utilized to express antigens and other molecules in immune cells. So the concept that could happen was not well accepted initially.

Dr. Merad: Also, much of the early focus was on cancer, and researchers were not obtaining fantastic results. Cancer vaccines are still yielding anecdotal responses, and it might not have anything to do with the technology.

What do you feel was a turning point for that skepticism?

Dr. Bhardwaj: I think, in especially the last decade, this technology was being used a good deal at the National Institutes of Health’s Vaccine Research Center as a platform for developing vaccines against other infectious agents, not COVID-19 at the time. What had been generated from the platform showed promise, in preclinical models.

When the COVID-19 pandemic came along, there were highly immunogenic modified “cassettes” generated wherein one could just plug in antigens—such as the spike protein of the COVID-19 virus—which could be rapidly formulated into vaccines and tested.

But even prior to that, there were ongoing efforts to use this technology as platforms for cancer vaccines, which are now being tested in the clinic with encouraging preliminary results in randomized studies in melanoma.

Dr. Merad: I think the big two were the lipid nanoparticle (LNP) as a delivery mechanism, and of course, a disease that somehow was the perfect case to try this new therapeutic strategy.

Drs. Karikó and Weissman were able to change up the RNA prior to the injections so that the molecules persisted longer. They were making clear advances in the way the proteins were being made. But, still, the real fixes started when they learned to encapsulate the mRNA in nanoparticles.

In fact, Dr. Karikó went to BioNTech (which partnered with Pfizer to produce the COVID-19 vaccine) and Moderna also licensed mRNA technology, and what happened was that two companies developed a way of delivering mRNA. This extra component—the delivery mechanism—was what made therapeutics possible.

Also, the pandemic is kind of a boost for mRNA technology. Because, first, of the number of patients available, and second, we are in a bit of a risk-taking mode. These vaccines were already developed against pathogens, so they just had to be pivoted to COVID-19.

One solution that companies like Pfizer/BioNTech and Moderna used to protect the mRNA instructions in their vaccines from being degraded by the immune system was loading them into tiny fat particles known as lipid nanoparticles (LNPs). These delivery vehicles are also able to find the targeted cells, which mRNA molecules alone cannot achieve. Icahn School of Medicine at Mount Sinai honored the efforts of the BioNTech executives during its 54th Commencement in May 2023, conferring upon them honorary Doctor of Science degrees.

Learn more about LNPs and mRNA technology in a Q&A with BioNTech executives

What research is Mount Sinai doing with mRNA?

Dr. Bhardwaj: One exciting line of research includes work from Yizhou Dong, PhD, Professor of Oncological Sciences at Icahn Mount Sinai, who works with the Icahn Genomics Institute and PrIISM. He is one of our newly recruited faculty members, who has been working in this space for quite a while. He has demonstrated that RNA can be used as a platform to introduce various kinds of immune modulators into cells, including dendritic cells, a key cellular potentiator of the immune system.

Dr. Dong uses RNA-LNPs to introduce various types of immune modulators into immune cells and even cancer cells to enhance antitumor immunity. My team is using RNA-LNPs to encode newly identified antigens, such as neoantigens, which arise from mutations in cancer cells, and then use those within vaccine constructs.

In preclinical models, we have shown that such RNA-lipid constructs, developed in-house in The Tisch Cancer Institute, are immunogenic and can have therapeutic benefit in treating cancers. Our goal is to take that to the next level: develop our own vaccine constructs and deliver them into humans.

Dr. Merad: We’ve been interested in exploiting mRNA to translate into specific proteins. We have been very much interested in using mRNA to change the immunosuppressive environment of tumors, where we use mRNA to go into the tumor and start making it look like an infection to induce an antitumor immune response. There is a lot of effort in using mRNA to transform cancer lesions—which can suppress and evade the immune system—into something very inflamed that can be recognized by the immune system and lead to tumor clearance.

One of my colleagues, Brian Brown, PhD, Director of the Icahn Genomics Institute, and Professor of Genetics and Genomic Sciences at Icahn Mount Sinai, is quite interested in using mRNA in different types of disease settings. My lab is mostly looking at inflaming regions in cancer, or reducing inflammation in inflammatory diseases—in this case we use mRNA as cargo to deliver proteins that will dampen inflammation and enable inflammatory lesions to heal.

What do you see as the future of mRNA technology?

Dr. Bhardwaj: I think the breadth is enormous. We can add many different types of immune-enhancing modulators into these particles—not just antigens—including homing receptors and cytokines. RNA platforms have been given intramuscularly and intravenously, and it’s possible you may be able to deliver it intranasally and into the skin, as well as directly into tumors.

The scope of what we can do, what we can encode and add, and the potential combinations with other immunomodulatory agents is vast. I think the field is moving really fast, especially with new companies coming into the field and startups accelerating rapidly.

Dr. Merad: Right now, the big conundrum that we have is: how can we raise an immune response against cancer that is beneficial, without inducing a harmful response against other tissue? I think the answer is delivery.

With mRNA, it provides all the instruction needed for therapeutic effect, but what we are still working on is enhancing that cell-specific delivery system. If we were allowed to bring that instruction to the right compartment, then we can afford to do so much more.

Questions to Ask Your Doctor About HPV-Related Oral Cancer

Updated on Apr 11, 2023 | Cancer, Head and Neck, Sexual Health, Your Health

To make an appointment with Raymond Chai, MD, call 212-844-8775.

Did you know that the human papillomavirus (HPV) can cause cancers of the oropharynx (tongue, tonsils, and back of the throat), similar to how HPV causes cervical cancer?

Most oral HPV infections can clear naturally without treatment. But if the virus persists in the system, it could incite more serious health issues, such as these cancers. Additionally, the incidence is low, with about 12,000 new cases of these HPV-associated cancers diagnosed each year in the United States, but 80 percent affect men.

Raymond Chai, MD, a head and neck surgeon at the Mount Sinai Union Square location of the Head and Neck Institute/Center of Excellence for Head and Neck Cancers, answers some frequently asked questions about oral HPV infections.

What are my options for treatment?

The two main approaches are upfront radiation treatment with chemotherapy versus a primary surgical approach.

Do you offer transoral robotic surgery (TORS)?

This technology has largely replaced traditional surgery, which typically required splitting the lip and cutting the jaw to access the tumor.

Do you have a true multidisciplinary approach to this disease?

Both surgical and non-surgical treatments should be on the table and discussed. In select cases, the use of TORS can either completely eliminate postoperative radiation, lower the dose of postoperative radiation, or eliminate the need for chemotherapy. This may reduce the risk of long-term side effects from high-dose radiation and chemotherapy.

What is your experience level with TORS? How many cases have you performed?

Experience matters with this new technology and as with any new surgery, there is a learning curve. Even seasoned surgeons who are experts with open approaches need to have the appropriate training and experience to become proficient in performing this surgery. Robotic surgery does not have the same tactile feedback that surgeons typically rely on in performing procedures. In addition, in TORS, complex anatomy needs to be re-learned from the inside-out, since the surgeon is now operating from inside the mouth instead of outside from the neck.

What is your rate of complications, particularly bleeding?

TORS has been shown to be very safe in expert hands, with a low rate of postoperative bleeding of 2-4 percent.

What is your average length of stay for TORS patients?

Studies have demonstrated that for high-volume TORS practices, patients on average leave the hospital two days following surgery.

Do you work closely with a swallowing therapist?

Whether the treatment is radiation with chemotherapy or surgery, the best post-treatment swallowing outcomes are seen when patients are followed closely with a seasoned speech-language pathologist.

What are your research efforts with TORS?

Across the country, investigators are actively recruiting patients in clinical trials that are using TORS as a platform for de-intensifying their cancer treatment. Mount Sinai was one of the early adopters of TORS and continues research activities related to the reduction of complications. We are leading efforts in de-intensification with the SIRS 2.0 trial, which relies on a novel blood test evaluating circulating tumor DNA (ctDNA). If HPV ctDNA becomes undetectable after surgery, patients are either observed without additional treatment or receive a highly de-intensified regimen of chemotherapy and radiation.

What is your protocol for follow-up care?

Nearly 100 percent of distant metastases for classic head and neck cancers related to smoking occur within the first two years of treatment. However, for HPV-related throat cancers, recent studies have suggested that distant metastases can occur even five years following treatment. Patients with this disease require long-term close follow-up. Mount Sinai has been a pioneer in the use of ctDNA for follow-up care. This highly accurate test can allow for earlier detection and treatment if the cancer recurs.

Should I get a second opinion?

The answer should always be ‘yes.’ Patients need to be able to fully explore their options and to familiarize themselves with centers that have the most experience with all treatment options for this disease, whether that be TORS or non-surgical therapy.

Learn More about the Head and Neck Institute/Center of Excellence for Head and Neck Cancers

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