News | Published September 1, 2012 | Written by James Freije, MD, MPH, FACS

HPV-related head and neck cancer on the rise

Head and neck cancer in the U.S. is rising at a steady rate, and most of the cases we see in younger (age 40-60) patients are not caused by using tobacco products or excessive alcohol consumption; they are caused by human papillomavirus, or HPV. The virus can be transmitted by kissing or by oral sex. This is the same virus that causes cervical cancer through vaginal sex. (Note that a cold sore in the mouth is a herpes virus and is not the same as HPV.)

In the past, most of the head and neck cancer cases occurred in the 60-70 age group in people who were smokers or chewed tobacco, and heavy consumers of alcohol. Occasionally we see a patients in the 40 to 50 year-old-age group who are users of tobacco products. In the past 10 years however, we have seen a steady increase in patients in their 40s and 50s with cancer of the oral pharynx ? cancer in the tonsils or base of the tongue ? caused by HPV. These patients do not smoke or drink excessively. Symptoms include chronic throat pain or unexplained ear pain.

The medical community has known for many years that HPV causes cervical cancer. Most women over the age of 21 receive an annual pap smear to test for cervical cancer. Unfortunately, there is no test for HPV-related throat or mouth cancer, especially since there are more than 100 strains of HPV. Researchers have discovered that most people who contract the HPV virus are able to get rid of it naturally with no side effects; the incidence of HPV-related cancer is actually very rare.

A study published in October 2011 issue of Journal of Clinical Oncology traced more than 70% of new cases of oral cancers to HPV infection, putting it ahead of tobacco use as the leading cause of such cancers. And while HPV is transmitted primarily by oral sex, it can also be transmitted by kissing. This means that just about anyone can get the HPV virus. An article published in January 2012 by the Journal of the American Medical Association noted that 7% of teens and adults have the HPV infection in their mouths. And, since HPV can lay dormant in the body for many years, anyone could be infected and not know it.

The good news is that this HPV-related cancer reacts very well to radiation therapy and we rarely operate on a patient who has this type of cancer.

If someone presents with HPV-related throat or mouth cancer, they undergo a metastatic work-up that includes a PET scan to see if the cancer is contained. We then look for regional metastasis (spread of the disease) to the lymph nodes of the neck, as well as any distant metastasis to the lung and/or liver. Patients with metastasis tend to have a lower rate of survival but HPV-induced cancers tend to be very sensitive to radiation and chemotherapy for a better long-term result. Guardasil?, available for boys and girls, is the only vaccine that protects against four types of HPV and may offer some protection for HPV-induced cancer in the throat or mouth.

Remember, most people who get the virus will fight it off normally and will experience no side effects. The best prevention is to practice a healthy lifestyle so your body can fight off infection. However, if you do have a severe sore throat or long-lasting earache, please see your doctor. While many issues can cause those symptoms, is it also important to rule out head and neck cancer.

James E. Freije, MD,MPH, FACS, is an otolaryngology (ear/nose/throat) physician with Mount Nittany Physician Group, State College. More information is available at mountnittany.org.

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