There are more than 100 different types of human papilloma virus. The most common types are found on the skin and appear as warts seen on the hand. HPV can also infect the genital areas of males and females. According to the Centers for Disease Control & Prevention (CDC), genital HPV is the most common sexually transmitted infection. There are at least 40 HPV types that can affect the genital areas. Some of these are low-risk and cause genital warts while high-risk types can cause cervical or other types of genital cancer. The high-risk HPV types may also cause head and neck cancer, also called oropharyngeal cancer, which is becoming more prevalent.
How prevalent is HPV-derived head and neck cancer?
Over the past decade there has been at least a four to five-fold increase in the number of tonsillar and base of tongue cancers as a result of HPV. Research indicates that approximately 60 percent of cases of a type of squamous cell carcinoma in the head and neck area are HPV-related, and this number is rising quickly. Several studies evaluating the prevalence of active oral HPV infection have found that three to five percent of adolescents and five to 10 percent of adults have active HPV infection. In contrast to active infection, estimates are that 70 percent of adults have been exposed to HPV virus as demonstrated by the presence of HPV antibodies in their blood.
Why is HPV-derived head and neck cancer becoming more prevalent?
The epidemiology of oral HPV infection is not well understood. However, HPV has long been known to be present in the genital area and to be a significant cause of cervical, vulvar, penile, and anogenital carcinoma. It is believed that an increased number of people are engaging in oral sex practices and as a result are contracting HPV in the head and neck region, resulting in a higher rate of head and neck cancers.
Who is at risk for HPV infection and head and neck cancer?
HPV is a sexually transmitted infection and the number of lifetime sexual partners is an important risk factor for the development of HPV-associated head and neck squamous cell carcinoma. Research has shown that:
The odds of HPV-positive head and neck cancer doubled in individuals who reported between one and five lifetime oral sexual partners.
The risk increased five-fold in those patients with six or more oral sexual partners compared with those who have not had oral sex.
It is important to know that HPV-positive head and neck squamous cell carcinoma has also been reported in individuals who report few or no sexual partners. Other traditional risk factors include history of tobacco or alcohol use, history of oral lesions, family history of thyroid cancer, and history of radiation therapy.
What are the symptoms of HPV-related head and neck cancer?
Symptoms include hoarseness, pain or difficulty swallowing, pain while chewing, a lump in the neck, or non-healing sores on the neck. If you have any of these symptoms, speak with your doctor or visit http://www.entandallergy.com/ to schedule an appointment with an ENT & Allergy Associates specialist.
If HPV is a sexually transmitted infection, are there other ways to contract the virus? Researchers are still evaluating the various ways HPV can be transmitted. There have been reports of HPV transmission through what is referred to as “deep french kissing.” It may also be possible for the virus to be transmitted to an infant through the infected mother’s cervical canal.
Should I get vaccinated?
All cases of cervical cancer are derived from HPV. Two vaccines, Gardasil and Cervarix, have been developed to protect against HPV infection. The vaccine is administered in three doses over a six-month period. Currently, the vaccine is approved for females ages 9-26. It has not however been approved for young males. The rationale for this is that if young girls are vaccinated against HPV, there will be a decrease in the active HPV transmission to males, and potentially a decrease in the incidence of HPV- related oropharyngeal carcinoma in men.
How are HPV- related carcinomas treated?
HPV-induced head and neck cancer has been well demonstrated to respond to almost all forms of therapy, including surgery, external beam radiotherapy, and chemotherapy. New technologies have been developed that greatly improve treatment response. The use of robotic surgery followed by a course of radiation treatment has had positive outcomes. At Mount Sinai, the use of robotic surgery and radiation, with no chemotherapy required, resulted in three-year survival rates of 90 percent, and significantly improve patient quality of life.
How does the robotic procedure work? What are the benefits?
Mount Sinai is one of very few centers in the country that use a robot to safely remove tumors, especially those growing in challenging locations. Robotic surgery is far less invasive than non-robotic tumor surgeries, greatly minimizing complications and recovery time—and maximizing quality of life after surgery. Quality of life data and the data produced by others demonstrates that patients treated with transoral robotic surgery and deescalated adjuvant therapy have a significantly improved quality of life, oral function, diet, and less long-term toxicity. As a result, Mount Sinai is dedicated to treating patients with HPV-induced carcinoma using this protocol in an effort to improve survival outcomes and decrease short-term and long-term toxicity.
What is the long-term prognosis for people with HPV-derived head and neck cancer?
While the prevalence of head and neck cancer derived from HPV is steadily increasing, data suggest that it is easily treated. Patients with HPV-induced oropharyngeal cancer have a disease-free survival rate of 85-90 percent over five years. This is in contrast to the traditional patient population of excessive smokers and drinkers with advanced disease who have a five- year survival rate of approximately 25- 40 percent.
My significant other is genital HPV positive yet has no history of cervical cancer, can I get oropharyngeal cancer by kissing her or having oral sex with her?
Yes. Transmission occurs through sexual contact and partners have routinely exchanged virus early in their relationship.
Do men or women get this more frequently?
Cases of this cancer are much more frequent in men. At Mount Sinai the ratio between men with this and women is roughly six or seven to one. The average age of a patient with this is 40-55, a decade younger than the traditional “smoker/drinker” patient with head and neck cancer.
Why are men at higher risk for this cancer?
The prevalence and manifestation of this virus is much higher in the genitalia of women because of their anatomical make-up.
Is there a way to determine if I am oral HPV positive?
Not yet. Scientists are working on a diagnostic test, but there is nothing commercially available.
Who should get screened?
People with a history of tobacco or alcohol use, a history of oral lesions or exposure to radiation therapy, and those with 5 or more sexual partners should be screened. Symptoms to be aware of include hoarseness, pain on swallowing, difficulty swallowing, pain on chewing, a lump in the neck, or non-healing sores.
How do I get screened for HPV- related throat cancer?
People who have a persistent sore throat or enlarged lymphnodes should be examined. Getting screened is quick and painless. Doctors place a very thin, flexible telescope, the size of a piece of spaghetti, with a miniature camera on its tip, into the nose to examine the throat structures, including the vocal cords.
Where did I get HPV from?
It is difficult without specific DNA viral typing to determine who transmitted the virus or where the virus was acquired.
Can the vaccine be used as treatment if I already have HPV-induced oropharyngeal cancer?
No. Patients with known HPV-induced oropharyngeal cancer do not appear to benefit from vaccination as the vaccination is used for prevention, not treatment.
What new research is ongoing to better understand and prevent HPV-derived head and neck cancer?
The Mount Sinai Medical Center will initiate one of the first HPV vaccines for patients who have been diagnosed with HPV-induced head and neck cancer. Also, specialists are currently evaluating the relationship between women with HPV and their sexual partners who develop oral cancer to determine ways to screen patients, treat patients, and educate the public.
Where should I go if I want to learn more about HPV-derived head and neck cancer?