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

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Pictured: Bhuvanesh Singh

Neck surgeon Bhuvanesh Singh

Original post: 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 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.

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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.

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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.

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 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.

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Comments

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My husband was diagnosed with oropharyngeal squamous cell carcinoma WITH HPV 16. Does that mean I have hpv? I have always had negative paps.

Katrina, we are sorry to hear about your husband’s diagnosis. We recommend you discuss your concerns with your doctor, who can better answer questions you have about your health and make specific recommendations about any necessary follow up. Thank you for reaching out to us.

I have been having issues since Jan, this year starting with neoplasm at base of tongue had surgery biopsy negative, that was in March 2016, still have swollen lips,collarbone node swollen, lymph node in my upper arm tricep, armpit, have nodule in thyroid right side had biopsy in February negative but now it has grown so we are going to have it removed completely and cut up and biopsied, went to Ent twice one said I had lymphatic tissue on back of throat had scope and he sed it looked good, still have sore throat feels like I bit my tongue get taste of blood, I just recently had curretauge, colscopy tested positive for HPV 16 also the p16 B1 focal positive, idk what is going on with my body I just wish I could get answers of what is going on or happening to me!! I go tomorrow 8th of July for results, so my question is can squamous cells be in my head and neck and what does p16 mean?? Please could someone answer me I've been worried for months now, should I go to a clinical trial and does this hospital and doctors know what they're doing? Thank you

My boyfriend went through treatment for HPV throat cancer over 8 years ago and has been healthy since. We openly talked about his health history, and have been intimate- vaginal sex, a few times anal and oral sex. I wasn't worried at first because everything I was reading at the time makes it sound like "many people carry HPV and never have develop HPV", and "Intimate partners have no greater risk of developing HPV related cancers." Now doing more research and wondering if he has infected me? Have I already put myself in danger?

We recommend you discuss your concerns with your healthcare provider. Thank you for your comment.

hello. I have had a hysterectomy for stage 1 cervical cancer due to HPV16 5 months ago. I now have lesion's in my mouth for 3 months that are growing. I am waiting to see an ENT but not for another 2 weeks. I was wondering if there is a greater risk of getting oral cancer if I have had cancer due to HPV 16?

Hi Patricia, we’re sorry to hear that you’re going through this. If you’re anxious about not being able to see an ENT for two weeks, you may want to try to get in to see your regular doctor or dentist sooner. They should be able to tell you if this is something of concern. Thank you for your comment, and best wishes to you.

I was treated for anal cancer with chemo and radiation a few years back after multiple squamous cell carcinomas were surgically removed over several years. I am now in need of a hemi-thyroidectomy due to a suspicious nodule (bethesda 4) my anal cancer was hpv related, I understand thyroid cancer is not hpv related but could this nodule be connected to the anal cancer ?

Hi, we sent your question to one of our experts in thyroid cancer, and he said it is unlikely that the thyroid lesion is related to HPV. He said that options for a nodule of this type are surgery or having a fine needle aspiration so that the sample can be molecularly tested with ThyroSeqv2. If you’re interested in coming to MSK for consultation, you can call 800-525-2225 or go to https://www.mskcc.org/experience/become-patient/appointment for more information on making an appointment. Thank you for your comment.

If someone is exposed to Hpv16 orally what is the liklihood it will develop into cancer? How long does it typically take to develop into cancer? I have read decades, does that mean 20 years, 30 years or more? Would 30 years be fairly uncommon?

Thank you for reaching out. The risk of developing cancer is increased with HPV16 infection, although the overall risk is still low. It can often take between 10 and 30 years from the time you’re infected until a tumor forms.

You can find additional useful information about HPV and cancer here:

http://oralcancerfoundation.org/understanding/hpv/

https://www.cancer.gov/about-cancer/causes-prevention/risk/infectious-a…

Does having cervical HPV increase a women's chance of acquiring oral HPV+ cancer, if no oral exposure was experienced? Is HPV limited to the area of exposure, so to speak? Same for the reverse, if a person was exposed only to oral HPV, would she have an increased risk in acquiring cervical HPV?

Dear Bethany, we sent your question to Richard Wong, one of our doctors who is an expert in head and neck cancers, and he said, “There is evidence that a woman who has acquired cervical HPV infection has a higher chance of also having detectable HPV infection in the oral cavity. A study by Fakry and Gillison published in 2006 in the Journal of Clinical Microbiology suggests that 25.5% of women with cervical HPV also were found to have oral HPV, in contrast to 7.9% for women without cervical HPV having oral HPV. These figures pertain to viral infection only, and do not reflect the risk of developing cancer.” We recommend that you discuss any concerns that you have with your doctor. Thank you for your comment, and best wishes to you.

i had BOT HPV cancer.treatment ended 18 months ago,do i still have the HPV in my system,like can i give it to my wife from sex or myself from sperm

Dear Jeff, we recommend that you discuss this with your doctor. Thank you for your comment.

I was recently diagnosed with squamous cell carcinoma at the base of the tongue and on right side lymph nodes. They just did a neck resection and in a weeks time will do the surgery on the base of the tongue. I’m scared because I don’t know what to expect after surgery. Is there severe pain? Will my tongue be extremely swollen? What should I expect to wake up to?

Dear Tracey, we’re sorry to hear about your diagnosis. We recommend that you discuss your concerns with your healthcare team. Thank you for your comment, and best wishes to you.

What is the best way to get information about the most progressive treatments for HPV related squamous cell carcinoma with an unknown primary? I’ve been diagnosed as Stage I but the treatment is still very aggressive, although the radiologist has acknowledged I’m likely being over treated. How can I get more informed on the options given my specifics? I’m interested in your work on potential deintensification. Thank you-

After a successful treatment for hpv16 tonsil cancer, am I now free of the virus - in other words, did the treatment eradicate the virus?

Dear Terri, we are not able to answer individual medical questions on our blog, but in general the purpose of treatment for HPV-related cancers is to get rid of the cancer, not the virus. We recommend you discuss this further with your healthcare provider.

Thank you for your comment, and best wishes to you.

If the Hpv16 marker is found on the biopsy of squamous cell throat cancer is that proof positive that that is the cause of the cancer, or could it also be a result of exposure to asbestos, perc, herbicides, or prolonged exposure to smoke from oil fires?

Dear Michael, the presence of the HPV16 marker in an oropharyngeal cancer is considered to be highly suggestive that the cancer’s origin was driven by the human papilloma virus. However, in some cases, someone may have additional risk factors such as a history of significant tobacco exposure, in which case it is possible that the cancer may have two factors contributing to its formation. There has not been any strong scientific data to support any causal relationship between other environmental factors, such as those that you listed, and oropharyngeal carcinoma. Thank you for your comment, and best wishes to you.

Quick run down, I have read numerous articles about the 1st sign of HPV related oral squamous cell carcinoma is a enlarged lymph node on the neck/under jaw. I am 36 years old and had a painless, enlarged level 2 lymph node, had it biopsed by fine needle aspiartion, it showed no sign of SCC. We had it completely removed and it came back as a benign reactive lymph node. My question to the dr's is, as I am having difficulty finding research on this, when the full removal of lymph node is done and results show a benign reactive node, is this typically suffecient to rule out SCC, or what further testing is typically done to rule it out.

Dear Nathan, we’re sorry to hear you’re going through this. There are many causes of enlarged lymph nodes in the neck and jaw that are not cancer, but if you are still concerned after your biopsy or if you know that you have HPV, you may want to seek a second opinion. If you are interested in coming to MSK for a consultation, you can call 800-525-2225 or go to https://www.mskcc.org/experience/become-patient/appointment for more information. Thank you for your comment and best wishes to you.

I have a great question for the Dr.'s. Would testing a benign reactive level 2 lymph node for HPV 16 be helpful if the patient believes he could have oral squamous cell carcinoma. ? And since the lymph node has been determined to be benign, can HPV 16 even be tested in that node since its not cancerous.

If someone is exposed to HPV31 orally what is the liklihood it will develop into cancer? The strain hpv 31 can delevop Oropharynx cancer or only hpv16???

Dear Carlos, HPV 31 is considered one of the high-risk strains that can turn into cancer, including oropharynx cancer. However, it’s important to note that most HPV infections are cleared by the immune system and do not lead to cancer. If you have any concerns about your exposure or any symptoms of cancer, we recommend that you speak to a healthcare professional. Thank you for your comment and best wishes to you.