Q&A

On Cancer: HPV and Cancers of the Head and Neck: Common Questions and Answers

By Christina Pernambuco-Holsten, MA  |  Friday, April 25, 2014
Pictured: Bhuvanesh Singh Neck surgeon Bhuvanesh Singh

The HPV vaccine has brought the link between HPV and cervical cancer to the attention of many Americans; and while women have been the focus of much of the talk around HPV and cancer, the sexual transmitted infection also puts men at risk for certain cancers.

HPV can lead to anal and penile cancers, as well as cancers of the oropharynx (the middle part of the throat, at the rear of the mouth, including the back of the tongue and the tonsils). In fact, says Memorial Sloan Kettering head and neck surgeon and scientist Bhuvanesh Singh, HPV-related oral cancers are the fastest-growing type of head and neck cancer in the nation, particularly among men.

In recognition of Head and Neck Cancer Awareness Month, we spoke to Dr. Singh about common questions related to oral cancers caused by HPV.

How does HPV infection affect my risk for getting head and neck cancer?

Typically, it can take years, even decades, for HPV to promote the development of head and neck cancer. These cancers most often occur in the base of the tongue or the tonsils. Your risk for developing head and neck cancer depends in part on the type of HPV to which you were exposed. For instance, some strains cause warts on the skin, mouth, or genitals, and rarely, if ever, cause cancer. Other strains are higher risk and have a greater association with cancer formation; those most commonly associated with head and neck cancer are HPV-16 and, less commonly, HPV-18.

Thankfully, for most people, including those with high-risk HPV, the body will get rid of the infection on its own. Unfortunately there is no way to predict which individuals infected with high-risk strains such as HPV-16 will go on to develop cancer.

Will alcohol or tobacco use increase my risk for developing HPV-related head and neck cancer?

Alcohol and tobacco use are major risk factors for head and neck cancer; however, they do not appear to affect the development of HPV-related head and neck cancer. In fact, people who smoke or drink heavily and have been infected with HPV tend to have a tumor that behaves more like one caused by alcohol and tobacco use. That said, heavy alcohol or tobacco use can certainly have an impact on your prognosis and your overall health.

How do I know if HPV caused my cancer, and if it did, what are my chances for a cure?

When head and neck cancer is diagnosed, the tumor can be tested for HPV using one of several methods. At Memorial Sloan Kettering, this type of testing is standard for all cancers of the oropharynx.

Generally speaking, patients with HPV-positive head and neck cancer have a very high cure rate — around 90 percent. In part this is because people who develop the disease are typically younger than the average head and neck cancer patient and therefore are better able to tolerate treatment.

Another reason these patients do well is that HPV-associated cancers respond better to currently used treatments than head and neck cancers associated with alcohol and tobacco use.

Current research at Memorial Sloan Kettering is looking at ways to minimize the side effects of treatment for patients with HPV-related oral cancers. For example, we are currently studying ways to use robotic technology to remove HPV-associated cancer with the hope of avoiding chemotherapy and/or radiation therapy. The challenge of current research is to decrease the treatment intensity without affecting a patient’s chances for a cure.  

 Should I get the HPV vaccine to prevent head and neck cancer?

The HPV vaccine is only useful before a person is exposed to the virus; it is currently recommended prior to any onset of sexual activity for boys and girls between ages 11 to 14.

The main proven benefit of the HPV vaccine is that it prevents cervical cancer and genital warts. The data on head and neck cancer prevention doesn’t exist yet, but certainly the hope is that once the benefits of the HPV vaccine begin to take effect, we’ll see a significant reduction in the incidence of HPV-positive oral cancers. 

 

Comments

Why HPV positive head and neck cancer has improved prognosis than HPV negative?

Sujita, thanks for your question. We sent it to Dr. Singh, who said, "The reason for this is not clear. We know that HPV (+) and HPV (-) cancers have different genetic changes. It is hypothesized that differences in behavior may be attributable to the differences in these genetic changes, but this has not yet been definitively established."

Can you please elaborate the differences in genetic changes between two groups? Thanks

Sujita, according to Dr. Singh, "The mechanism by which HPV promotes the development of head and neck cancers is to produce proteins that function as oncogenes. E6 and E7 are the main oncogenic proteins. E6 primarily imparts its effects by inactivating p53, which in non-HPV-related head and neck cancers is inactivated by direct mutation in the p53 gene instead. Similarly, E7 effects the retinoblastoma pathway, which in non-HPV-related cancers is inactivated by direct mutation. In addition, there are many other genetic differences between HPV and non-HPV-related head and neck cancers. As an example, the p16 protein is overexpressed in HPV-related cancers and lost in non-HPV-related cancers, with its expression often used as a surrogate marker for HPV infection. The significance of this and other genetic differences is not yet known." Thank you for your comment.

My husband was recently treated for head and neck cancer at Memorial Sloan Kettering. (Dr. Nancy Lee and Dr. Fury) His cancer was the cause of the HPV virus....I am interested in knowing more about the genetic changes between HPV (-) and HPV (+). Is one more receptive to Chemo and Radiation than the other?

Susan, according to Dr. Singh, HPV(+) tumors are more responsive to chemo-radiation treatment than those that are not associated with HPV. The basis of this increased sensitivity is not yet known. Thank you for your comment.

The genetic pathway for HPV cancers promotes programmed cell death, as occurs during treatment for the cancer. This and the lower average age of patients and reduced co-morbidity (presence of other life threatening diseases) leads to a better outcome, nearly twice a good for HPV positive as HPV negative patients

Guy, Dr. Singh says that this is correct, adding, "The differences are so significant that we and others are looking to see if we can get equivalent cure rates with less-aggressive treatment. We are also looking at whether the unique genetic composition of HPV-related cancers can be exploited by using more targeted agents. These approaches remain experimental and are only undertaken as part of clinical trials." Thank you for your comment.

Does having high risk HPV (16,18) that is actively causing cervical dysplasia mean that person is also at risk for HPV-related head and neck cancers? What type of screening is recommended if so? Thank you!

Odile, according to Dr. Singh, "Head and neck cancers are primarily associated with HPV type 16, the same one that causes cervix cancers. Sexual exposure, specifically oral sex, is thought to be the major route for exposure to HPV. Unfortunately, there are no screening procedures in place at present of head and neck cancers." Thank you for your comment.

Is there any way to tell if you carry the HPV virus?

Margie, there is no screening test to find out a person’s HPV status.

Some people find out they have HPV when they get genital warts. Women may find out they have HPV when they get an abnormal Pap test result (during cervical cancer screening). Others may only find out once they’ve developed more serious problems from HPV, such as cancers. There is no routine or standard HPV screening offered for men.

You can get more general information about HPV by going to the Centers for Disease Control website: http://www.cdc.gov/hpv/index.html

I have a question.... I was treated for stage 2A cervical cancer. Tretments ended 3 years ago. Since then I have had two (cervical tissue) HPV tests and am fine. Can I be HPV free in my cervix and still have HPV in my head and neck tissue? I did have polyps removed from my throat I believe twice as a very young child. I am now 65. Should I have my throat tissue tested as well or is the cervical tissue enough? Is HPV like the Herpes virus, hiding in your central nervous system only to emerge when your immune system gets weakened?

Dear Karen, you can be HPV free in the cervix but still have HPV in the head and neck region. If you are concerned that you may have head and neck cancer, it is best to be examined by an experienced head and neck specialist.

As for your question about HPV hiding in the central nervous system, Dr. Singh had this to say: "HPV usually stays in epithelial cells, not neural cells. It can remain undetected and exert its effects over decades. Factors leading to its persistence and activity are not well defined."

I have 3 questions and I would really appreciate your answer: (1) Can an MRI scan reveal throat and neck cancer?, (2) Does laryncospopy show white plaques in the throat if they exist or does a simple throat screening by a doctor is sufficient?, (3) What symptoms a patient may have so as to look into this more and how can a patient be diagnosed with this disease (i.e. what tests do you run so as to diagnose throat and neck cancer). A person in my family was diagnosed with HPV type 16 five years ago and had a loop excition but fortunately no invasive lesion (carcinoma) existed in the sample. She now has a small child. Many thanks.

Thanks so much for your questions, Hope. Here's what Dr. Singh had to say:

1. Yes, an MRI can reveal cancer if the lesion is large enough.
2. White plaques are called leukoplakia and can represent premalignant lesions. It does not appear the HPV-associated tumors are proceeded by leukoplakic areas or other precursor lesions. See #3 for additional information.
3. Symptoms can be vague but may include sore throat, trouble swallowing, and lumps in the neck. An examination by an experienced physician is usually able to diagnose these cancers. Supplemental examinations, such as CT, MRI, and/or PET scans, can be used to supplement findings on clinical examination and are typically ordered by the treating physician based on information he/she thinks is required.

My husband was diagnosed with HPV -16 tonsil and tounge cancer in 2009.
He was treated with chemo /radiation and the cancer recruited
11 months later,he had a radical neck dissection in 2010 and developed many complications ,he was 53 at onset.
He was never able to eat normally again and fought everyday to survive,he died October 24 ,2013 . My question is do you have any research on inheriting this cancer ,or passing on to children,both my sons have had the guardasil vaccine.
Also ,any research on spouses getting the cancer?

Dear Hildi, thank you so much for sharing your experience and asking your questions. We reached out to Dr. Singh, and here's what he had to say about your questions: "There is no data to suggest inheritance of HPV cancers or transmission to children. Although there is a potential for exposure, the risk is low and there is no data to suggest an association with head and neck cancers. A key reason for this is that while exposure to HPV is common, the vast majority of people clear the virus and acquire immunity to it." Thanks again for your comment.

Thank you very much for your answer. One more question please. Even though you mention that the HPV vaccine is only useful before a person is exposed to the virus and that the main proven benefit of the HPV vaccine is that it prevents cervical cancer and genital warts, do you still recommend the vaccine to an adult that was diagnosed with HPV16 virus in the cervix (i.e. the vaccine does more good than harm?). I don't really understand the meaning ... once the benefits of the HPV vaccine begin to take effect, we’ll see a significant reduction in the incidence of HPV-positive oral cancers. Thanks a lot.

Hope, we can't provide specific medical advice, and it's best to discuss any concerns with your regular doctor. However, Dr. Singh responded to a similar Facebook comment that "since there are many different types of HPV, adults may have a putative benefit by getting vaccinated to cover strains they have not been exposed to-- but this is no data to support this at present." That said, head and neck cancers are primarily associated with HPV type 16, the same one that causes cervix cancers.

In terms of the question about seeing a significant reduction in HPV-positive oral cancers once the vaccine begins to take effect, what that means is that as more people get the vaccine, there will over time be a decrease in the proportion of people getting HPV and, therefore, a reduction in the number of associated cancers.

Hello
I have had issues with my throat for years such as hoarsness and lump feeling alot of times when i swallow and a tightening constriction suffocating feeling at times. I had a scope by ent back in 2008 and the dx larngeo reflux disease but also stated i had extra lumpy tissue irritated and swollen at the base of my tongue and back of throat. I forgot what the medical term was but they didnt seem to worry. I also have alot of drainage and most of the time my throat feels swollen and i dont know if allergies or what. I had an indirect scope early 2012 or 2013 and the ent said all looked fine but over the year the tightening feeling feels worse and on my right side when i swallow at the base of my tongue the lump feeling feels more prominant. I can swallow food and drink ok i dont think anything gets stuck but its so uncomfortable feeling this lump or sensation on one with the suffocating cinstriction feeling at times. Sometimes it will let up a little and feel a little better but its there most of the time. I havent noticed and swelling on my neck or lympynodes but i do have tones of raised flesh colored tissue bumps at base of tongue when i extend and say ahh. Ive had these forever but looks like they are worse. I noticed a few minths ago a small bump that is actually white that resembles a whitehead on my tongue in the center of my tastebuds. It hasnt grown but hasnt gone away and doesnt hurt. Im 37 female and the last minth ive been to my pcp i forgot to mention thus but they never said nothing when looking in my throat with a Light. Can you offer advice? Would a doctor notice something sich as cancer while examining the throat or woukd it take a laryngeoscopy to detect? What do you think the chances of this being cancer is?

Dear Renee, unfortunately we are unable to offer personal medical advice on our blog. We recommend you follow up with your personal physician.

If you would like more information about risk factors for head and neck cancer and how it is diagnosed, you may visit: http://www.mskcc.org/cancer-care/adult/head-neck

Also, you may be interested in attending our CancerSmart lecture on this very topic to be held on October 23. To learn more and register, visit:
Head and Neck Cancers: Present Successes, Future Possibilities
http://www.mskcc.org/events/program/head-and-neck-present-successes-future-possibilities?dtstart=1414101600&dtend=1414107000

Thanks for reaching out to us.

Is there any link between HPV and thyroid cancer?
As a child I had over 30 warts on my hands. As a young adult I had HPV and just now after 10 years had a recent recurrence. I also just had a thyroid lobectomy and pathology came back as thryroid cancer. I was just wondering if there is any research on possible link?

Maria, we sent your question to thyroid cancer expert James Fagin, who said there is no known link between HPV and thyroid cancer. Thank you for your comment.

My husband was diagnosed with Squamous Cell Carcinoma on April 1 of this year. He had a tumor very close to his voice box that traveled to his lymph node. They didn't do surgery to remove the tumor at the base of his tongue do to might having to remove his voice box. He did get his cancer from HPV. He had 37 radiation treatments and 3 very high dose of chemo. He never smoked and drank very little. He has since had his pet scan and all was great news, No sign of Cancer. It's been over a month now and we went to see all of his Doctors today and the Chemo Dr released him for 3 months and his Radiation Dr released him for 6 months..Great news. Then seen his Ear, Nose and Throat Dr. The exam went really well as far and the tumors, have shrank and no need for surgery but while examining him today he noticed that my husband has a pretty good size Polyp in his nose. He ordered a CT scan which we also did today. The Dr. is going to do surgery to remove it in the near future. My question is..Can a Polyp in his nose have cancer cells? Seems everything I have read tends to say that nose polyps don't have cancer.

Maude, thank you for reaching out and glad to hear the treatment seems to have been successful. Your husband's own doctors are in the best position to answer that specific question about the polyp. You also might call the National Cancer Institute’s Cancer Information Service at 800-4CANCER (800-422-6237). To learn more about the CIS, including Live Chat help and how to send them an email message, go to http://www.cancer.gov/aboutnci/cis/page3.

If you would like to make an appointment with a Memorial Sloan Kettering physician, please call our Physician Referral Service at 800-525-2225 or go to http://www.mskcc.org/cancer-care/appointment. Thanks for your comment.

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