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HPV-related head and neck cancer

The information on this page was reviewed and approved by
Maurie Markman, MD, President, Medicine & Science at CTCA.

This page was updated on September 21, 2021.

Certain human papillomavirus (HPV) strains are known to increase the risk for cervical cancer in women, but evidence is accumulating that these infections increase the chances of developing other types as well—including head and neck cancers. HPV infection has also been linked to anal, penile, vaginal and vulvar cancers.

Each year, there are about 45,300 diagnosed cases of cancer in parts of the body where HPV may be found, and the Centers for Disease Control and Prevention (CDC) states that this virus may cause a majority (about 35,900) of them.

HPV infection is common in oropharyngeal cancers, which are found in the throat (pharynx). The oropharynx also includes the soft palate, tonsils and the back of the tongue. Cancers in the back of the throat are the most common HPV-related cancers seen in men.

It’s not always easy to spot oropharyngeal cancer, but patients may develop a lump in their throat or experience throat pain.

What is HPV?

HPV is the most common sexually transmitted disease in the United States, according to the CDC. There are more than 170 viruses in the HPV family, but not all result in health issues such as genital warts and cancer. The two main types of HPV associated with cancer are HPV 16 and 18, according to a 2019 review in the British Journal of Cancer.

If a patient is diagnosed with head and neck cancer, the doctor may order a laboratory test to check for certain types of high-risk HPV, as this information may help guide treatment.

Genetic material or DNA from HPV is seen in about two-thirds of oropharyngeal cancer cases, according to the American Cancer Society.

Screening for HPV precancers

Screening tests are available to detect precancerous changes caused by HPV infection in the cervix, but not for HPV-related head and neck cancers. Dentists may look for signs of oral cancers, including those related to HPV, during a yearly exam.

Three tests can help identify precancerous changes in the cervix:

If any of these tests reveal precancerous cells, these may be removed via a technique known as loop electrosurgical excision procedure (LEEP), which passes an electric current through a thin wire loop to remove abnormal tissue.

Other signs that may indicate HPV-related precancerous changes may include itching or bleeding in the affected area.

Most of the time, an HPV infection clears on its own without causing issues. When this doesn't occur, the person may develop genital warts. These take different forms. Some are large and raised, others may be small, flat or cauliflower-shaped. Some bumps occur on their own, and others pop up in groups. It may take years for an HPV infection to morph into cancer.

Risks for HPV-related head and neck cancers

Anyone who is sexually active can get HPV. It’s spread by vaginal, anal or oral sex with someone who has the virus. The more sexual partners, the higher the risk. The person doesn’t need symptoms to spread HPV.

By CDC estimates:

  • 10 percent of men have oral HPV
  • 3.6 percent of women have oral HPV

The risk increases with advancing age.

Researchers don't know whether having HPV alone is enough to cause oropharyngeal cancers, or whether other risk factors—such as smoking, chewing tobacco or drinking alcohol—also play a role.

Preventing HPV-related head and neck cancers

Prevention is the key to staving off HPV-related cancers.

Condom use and dental dams reduce the odds of HPV transmission or infection, but may not eliminate the risk entirely.

To further reduce risk, the HPV vaccine is considered to be highly effective. There’s a push to vaccinate children before they’re exposed to HPV. Gardasil 9® is the only HPV vaccine used in the United States. It helps stave off infection from nine types of HPV, including those linked to cancer.

These shots may prevent more than 90 percent of HPV-related cancers, according to the CDC.

  • Children should receive two shots at age 11 or 12. This series may also begin at age 9.
  • If started by or after age 15, three doses are needed.
  • The HPV vaccine may be given to some adults aged 27 to 45 who didn’t receive all of the required vaccine doses earlier.
  • The vaccine is equally important for males and females.

Treating HPV-related head and neck cancers

Patients who are diagnosed with oropharyngeal cancers linked to HPV infection tend to fare better than their counterparts whose head and neck cancers aren’t caused by HPV.

The treatment is often the same regardless of whether HPV is present, but HPV-related head and neck cancers seem to respond better to chemotherapy, radiation and other treatments, including newer cancer drugs such as targeted therapy and immunotherapy.

There’s a caveat, though. The patient who has HPV-related oropharyngeal cancer and also smokes may have more of an uphill battle.

A cancer care team will develop a treatment plan based on the tumor’s location, size and spread. In general, the treatment plan may involve surgery to remove a tumor, followed by other treatments to make sure there are no errant cancer cells. Reconstructive surgery may be needed after treatment to improve certain functions (such as chewing or swallowing) or to correct any defects that may have occurred as a result of cancer surgery.

Research is underway that seeks to determine whether HPV-related head and neck cancers may respond to lighter treatment, or whether specific treatments that target HPV-infected cancer cells may help eradicate these cancers.

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