What is the connection with the human papillomavirus?

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headandneckcancercheck_mcxd2u · Accepted Answer

As our understanding of cancer evolves, so does the way oncologists stage cancers. As of January 1, 2018, a new staging methodology was put into place by the American Joint Committee on Cancer (AJCC), and the way head and neck cancers are now staged has changed significantly. The most dramatic changes have been made to staging for mucosal melanoma, oropharyngeal cancer, cancer with an unknown primary, and oral cancer. For example, prior to the changes instituted in 2018, most oropharyngeal cancers were classified as stage IV. Today, many of those would be considered stage I or II. We also now know that oropharyngeal cancers that are HPV positive (also called p16 positive)--that is, they contain DNA from the human papillomavirus (HPV)—have a better prognosis than those that are HPV negative. Under the recent changes to the TNM system, there are different staging criteria for HPV-positive and HPV-negative oropharyngeal cancer.
More than half of all sexually active people contract one or more types of HPV at one time, making it the most common sexually transmitted disease in the US.
What is Human Papilloma Virus (HPV)?
- The human papillomaviruses or HPVs are a group of more than 150 related viruses. The most common types are found on the skin and appear as warts seen on the hand. More than 40 of these viruses can be easily spread through direct skin-to-skin contact during vaginal, anal, and oral sex. 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 is throat cancer linked to HPV?
- There are high-risk and low-risk types of HPV. The low-risk types can cause genital warts or no symptoms and do not typically cause cancer. High-risk types, especially types 16 and 18, are associated with oropharyngeal cancers (or cancers of the tonsils, base of tongue, and throat). Unfortunately, oropharyngeal cancer associated with HPV infection has increased dramatically over the past 20 years in young men and women without traditional risk factors, like smoking and drinking.
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.
What are signs and symptoms of HPV-related cancer?
- A lump in the neck
- Lump or sore in mouth or throat
- Hoarseness or change in voice
- Swallowing problems or pain
- An earache that doesn’t go away
- Bleeding: nose, mouth, or throat
- Numbness
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. Aside from high-risk HPV, other traditional risk factors for developing head and neck squamous cell carcinoma include history of tobacco or alcohol use, history of oral lesions, family history of thyroid cancer, and history of radiation therapy.
If HPV is a sexually transmitted infection, are there other ways to contract the virus?
- You can get HPV by having vaginal, anal, or oral sex with someone who has HPV. It also spreads through close skin-to-skin touching during sex. A person with HPV can pass the infection to someone even when they have no signs or symptoms. If you are sexually active, you can get HPV, even if you have had sex with only one person. You also can develop symptoms years after having sex with someone who has the infection.
How should I protect myself?
- Consistent and correct use of condoms can reduce the transmission of HPVs between sexual partners, but because there are areas not covered by a condom, infection may still occur.
- It is recommended that girls and women between 9 and 26, and boys and men between 9 and 21 years of age should be vaccinated against HPV. Currently, there are three vaccines approved for the prevention of HPV: Gardasil® VIS*, Gardasil®9, and Cervarix®(exclusively for girls).
- The vaccines are safe and highly effective in preventing infections with HPV types 16 and 18. Gardasil® VIS* and Gardasil®9 also prevent infection with HPV types 6 and 11, which may cause genital warts, benign tumors, or no symptoms at all. Gardasil®9 also prevents infection with HPV types 19, 31,33, 45, 52, and 58, which cause anal, cervical, vulvar, and vaginal cancers. These vaccines are one of the best ways parents can prevent cancer in their children.
- Regularly visit your dentist or physician. Ask that they perform an oral, head, and neck exam at each visit.
- 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 can help avoid the need for radiation or chemotherapy altogether. Many large trials have also shown promise in using lower doses of radiation after robotic surgery to effectively treat this cancer, with survival rates over 90%.
How does the robotic procedure work? What are the benefits?
- Robotic surgery is far less invasive than non-robotic tumor surgeries, greatly minimizing complications, minimizing recovery time, and maximizing quality of life after surgery. Many studies have shown that patients treated with transoral robotic surgery may have improved quality of life, improved swallowing function, and less long-term toxicity.
How prevalent is HPV-derived head and neck cancer?
- In the US, HPV-associated oropharyngeal squamous cell carcinoma is one of very few cancer types that has been increasing in prevalence of the last several decades. Studies have shown that this incidence may continue to increase until the benefits of widespread HPV vaccination (in both men and women) has been reached.
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% 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%.
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?
- Oropharyngeal cancer is only caused by certain strains of HPV. Certain low-risk strains lead to genital warts and only very specific strains (typically 16 and 18) can lead to oropharyngeal cancer. Intimacy and oral sex can cause transmission of the HPV strain that your partner has. If this is a high-risk strain, this can be a risk factor for future development of oropharyngeal cancer unless you are vaccinated.
Do men or women get this more frequently?
- Cases of this cancer are more frequent in men. In both the US and the UK, the incidence of oropharyngeal cancer in men has also surpassed the incidence of cervical cancer in women. However, this increased incidence can be decreased through the widespread adoption of HPV vaccination in men at a young age.
Why are men at higher risk for this cancer?
- Although we do not fully know why, this may be true due to differences in infection susceptibility and transmissibility. A gender disparity between the number of reported lifetime sexual partners may also be a contributing factor.
Is there a way to determine if I am oral HPV positive?
- Currently, there is no widespread or commonly recommended screening tool for oropharyngeal HPV.
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 lymph nodes 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?
- One promising area of research has been developing a “liquid biopsy” that can identify circulating tumor DNA. Clinical studies have shown that this may be able to predict treatment response for patients with oropharyngeal cancer or predict cancer recurrence. Its utility as a screening tool to identify patients at high risk for developing HPV-associated head and neck cancer is still being investigated.
Where should I go if I want to learn more about HPV-derived head and neck cancer?
- If you would like to learn more, please refer to the many resources below. If you think you or a loved one may be at risk, please consult your doctor.
- HPV-related Oral, Head, and Neck Cancer Resources