18 May, 2023
While it is widely recognized that smoking is a significant cause of head and neck cancers, it is less commonly known that prolonged exposure to the human papillomavirus (HPV) can also lead to such cancers. Research suggests that approximately 30% of oropharyngeal cancers, which occur in the tonsils and base of the tongue, are attributable to HPV infections.[i]
This may be an alarming number; however, there are ways to diagnose these cancers accurately and manage them successfully. Also, there are a few measures that can help you reduce their risk.
Before learning how to prevent them, it is important to understand what HPV infection is and how it is linked to head and neck cancers.
Human papillomavirus (HPV) is a common sexually transmitted infection that affects both men and women. In most cases, HPV infections clear up on their own. However, in some cases, they can become chronic and become responsible for the development of various types of cancer, such as cervical cancer, vulvar cancer, vaginal cancer, penile cancer, anal cancer, and head and neck cancer.
Head and neck cancer associated with HPV infection is more likely to occur in the oropharynx, which comprises the back of the throat, the base of the tongue, and the tonsils.
When HPV infects the cells in the head and neck region, it alters the DNA structure of the infected cells and makes them divide uncontrollably. This abnormal division of cells leads to the formation of cancer. This virus is also capable of evading the immune system, which allows it to remain in the cells and continue to damage the cells in that region.
Of the many strains of HPV, HPV 16 is strongly associated with cancer risk; about 90% of HPV-induced head and neck cancers are caused by this strain. HPV-positive oropharyngeal cancers caused by HPV-16 have different characteristics compared to oropharyngeal cancers that are not caused by HPV.
These differences include how common they are (epidemiology), how they appear and affect the body (clinical presentation and anatomy), how they show up on medical scans (radiology), how they behave (behaviour), how they grow and spread (biology), and their expected outcome (prognosis).
Oropharyngeal cancer is the most common HPV-related cancer among males in India, accounting for a staggering 63.2% of cases. [ii]
HPV is transmitted through sexual contact, including vaginal, anal, and oral sex. The risk of developing HPV-related head and neck cancer is higher in people who have had multiple sexual partners and have engaged in oral sexual practices.
Since HPV-related oropharyngeal cancer does not occur immediately after infection with the virus, it takes years or even decades for cancer to develop. This is why early detection is critical for successful treatment. Symptoms of HPV-related head and neck cancer can include a persistent sore throat, difficulty swallowing, ear pain, and a lump in the neck. However, these symptoms are not specific to head and neck cancer and can be caused by other conditions as well.
Chronic HPV infection can cause different types of head and neck cancers:
Oropharyngeal Cancer: Oropharyngeal cancer is the most common type of head and neck cancer associated with HPV infection.
Oral Cancer: HPV infection can also cause oral cancer, where the cancer formation occurs in the lips, tongue, gums, and lining of the cheeks.
Nasopharyngeal Cancer: In some cases, HPV infection causes cells in the nasopharynx (the area behind the nose and top portion of the throat) to divide abnormally and form cancer.
Hypopharyngeal Cancer: HPV infections can lead to hypopharyngeal (the area where the throat meets the esophagus) cancers, as well.
Although there are no known ways to completely prevent the risk of HPV-induced head and neck cancers, there are some measures that can help reduce their risk significantly. They include:
Getting HPV Vaccination: As responsible surgical oncologists, it is our goal to not only treat HPV-related cancers but also to promote measures that prevent their occurrence. HPV vaccination has proven to be highly effective in preventing most cases of such cancers, and therefore, we should actively advocate for its adoption.
HPV vaccines can help in preventing chronic HPV infections and thereby reduce the risk of different types of cancer, including head and neck cancers, among men and women. The Centres for Disease Control and Prevention recommends that all children receive the HPV vaccine at age 11 or 12. In addition, the vaccine is recommended for all males through age 21 and all females through age 26 who have not been vaccinated previously.
Practising Safe Sex: HPV spreads through sexual contact; therefore, one way to reduce chronic HPV infection is by practising safe sex habits, which include using appropriate protective measures and avoiding multiple sexual partners.
Getting Screened Regularly: Regular cancer screenings can help detect head and neck cancers early when they are most treatable. The screening test involves a complete examination of the oral cavity and the head and neck region for signs of cancer.
Avoiding Tobacco and Excessive Alcohol Consumption: Tobacco use and excessive alcohol consumption can affect how the immune system functions and indirectly contribute to the increased risk of HPV-induced head and neck cancers. Therefore, avoiding tobacco and excessive alcohol can be helpful.
Maintaining Good Oral Hygiene: Good oral hygiene can help prevent HPV infection and reduce your risk of head and neck cancers.
To sum it up, chronic HPV infection can indeed cause head and neck cancers, particularly those occurring in the oropharynx. Not all cases of HPV infection will lead to cancer; however, regular screening tests or check-ups are recommended to support early detection and timely treatment. Prevention measures such as practising safe sex, getting vaccinated against HPV, and avoiding tobacco can be helpful in reducing the risk of developing HPV-related head and neck cancers.