With Head & Neck Surgeon and Cancer Specialist Peter Vosler, MD
HPV, or human papillomavirus, is a common sexually transmitted disease that has long been connected with increased chance of cervical cancer in women. But it’s only more recently that connections between HPV and certain oral and throat cancers have been discovered and studied. With incidences of these HPV-related oral and throat cancers on the rise, we spoke with Peter Vosler, MD, a board-certified head and neck surgeon with extensive research on complex head and neck cancers.
How common are these HPV-related mouth and throat cancers?
Fortunately, these are very uncommon cancers. About 1.7% of men have it, or 1 in 60 men, and about 0.7% of women have it, or 1 in 140 women.
But we have seen a rise over the past two decades. From 1988 to 2004, it increased 225%. And right now, we're seeing an annual increase of 5%.
How common is HPV?
HPV is very common in our society. Approximately, 65-99% of people are infected with HPV. And if you've had more than four sexual partners, the chance at that point is over 99%.
Do all throat HPV infections lead to cancer?
No. The vast majority of throat HPV infections do not lead to cancer. There is one subtype of HPV, HPV 16, which accounts for about 90% of the cancers, and only 1% of infected people have this type of virus. Unfortunately, there are no good screening tools for this.
How is it spread?
The HPV itself is spread through sexual contact, usually oral sex from a man on a woman. And most of the HPV that's acquired through sexual contact is cleared by the immune system, so it doesn't cause cancer in most people.
Who is at greatest risk?
Men in their 40s to 60s, usually non-smoker and high socioeconomic status. And people who've had more than four sexual partners.
How long after an HPV infection would it take for someone to develop one of these cancers?
It usually takes a long time. The virus has to first stick into the tonsil tissue in the back of the throat, and then it takes some time to transform. It's usually at least 10 years, but it's probably in the order of 20-30 years before people who get the virus develop cancer from it.
So it's not necessarily because of a recent sexual partner.
It's definitely not because of a recent sexual partner. And patients will often ask, “Did someone go outside of the marriage or the relationship to get this?” And no, it's probably something that happened when they were in their 20s.
Can the HPV vaccine help prevent these cancers?
“We're optimistic that the HPV vaccine will help prevent these cancers,” says Dr. Vosler. “However, it will take decades before we see that manifest. Right now, children and people up to age 45 are getting vaccinated, so it's probably going to take another 20-30 years before we see a decline in the overall incidence of this cancer.”
Learn more about the HPV vaccine here, and why it’s important for children to be vaccinated.
If someone has an HPV-related cancer, is their spouse or partner also going to get it?
It is very unlikely. People who have this cancer do not transmit the cancer. And it's likely that they acquired the HPV virus decades ago, so they're no longer infectious.
How would someone know if they have HPV-related oropharyngeal cancer?
The initial symptom that patients with HPV-related oropharynx cancer have is a painless neck mass. Some patients also have symptoms of difficulty swallowing, voice changes, or ear pain on the side of the neck mass
Is this a treatable cancer?
It is a very treatable cancer. About 90 to 95% of patients that have this are successfully treated, and have a five year survival rate of 90, 95%. So very highly treatable.
What does treatment look like?
Treatment involves either surgery or a combination of radiation therapy and chemotherapy. If it's a small tumor that has only one node involved, then surgery is a good option. However, if it's a larger tumor and multiple lymph nodes are involved, then radiation and chemotherapy are probably preferable.
If someone finds a mass on their neck, what should happen next?
If the mass doesn't go away within 1-2 weeks, with or without antibiotics, then you should be seen by a head and neck cancer surgeon. If you see me, I would obtain a focused history and perform a physical exam focusing on the looking at an palpating the tonsils and base of tongue, and using a flexible scope to visualize the back of the tongue. I would biopsy any obvious masses in the tonsil that can be easily reached in clinic, and I would also do an ultrasound-guided biopsy of the neck mass.
Can you know for certain if a cancer that presents in the throat or the neck is in fact HPV-related?
A biopsy is the only way to determine if the mass is caused by HPV. A biopsy gives us two pieces of information. First, it tells us the type of cancer, and in this case, it is typically squamous cell carcinoma. Second, it tells us if the cancer is caused by HPV or if it is related to smoking.
How important is it to see a specialist who is familiar with these areas?
It's incredibly important to see someone who specializes in head and neck cancer care to ensure you get a proper and timely workup. It is important that you are seen by a head and neck cancer surgeon, radiation oncologist, medical oncologist, and speech pathologist.
And at The Brian D. Jellison Cancer Institute we have all those specialties. We meet on a weekly basis at a multidisciplinary tumor conference to go over all our patients and make sure that we have the appropriate treatment plan for everybody and make sure that we have a consensus among our specialists.
Hear more from Dr. Vosler on this recent episode of SMH Healthcasts.