There are over 100 types of the human papilloma virus (HPV) with more than 40 strains that can infect healthy individuals. HPV lives in mucous membranes and can be passed by genital contact in vaginal, anal and oral sex. Increasingly, these infections are including those of the mouth and throat—signaling that HPV is a growing risk factor for developing head and neck cancer.
What is HPV?
“HPV is the most common sexually transmitted infection in the United States,” says Ann Honebrink, MD, associate professor of clinical obstetrics and gynecology at Penn. “Even without showing symptoms of HPV, people can transmit the virus and barrier methods like condoms don’t work as well to prevent HPV transmission as they do other infections like HIV.”
While HPV can cause symptoms, including genital warts, a person can go for years without ever knowing that they have the human papilloma virus. That, along with the ability of the HPV virus to remain present in a person for a long time, make this virus so prevalent – many individuals can continue spreading the virus without knowing they carry it.
In most cases, the body fights off HPV naturally and eventually the virus is cleared. However, when the body cannot fight off HPV, the virus can persist and also can trigger cellular changes that may lead to cancer. “Some types of HPV must be present in order for women to develop squamous cell cancer of the cervix, the most common type of cervical cancer,” says Dr. Honebrink.
Throat Cancer – HPV’s new connection
While HPV has most been linked to cervical, anus and skin cancers, recent studies suggest the same strain of HPV can also cause throat (oropharyngeal) cancer. “We are seeing more cancer located at the base of the tongue and in the tonsils,” says Jason G. Newman, MD, associate professor of otorhinolaryngology, and head and neck surgeon at Pennsylvania Hospital.
Oropharyngeal cancer develops in the part of the throat including the back of the tongue, back part of the roof of the mouth, the tonsils, and the side and back wall of the throat. “Historically, people who get head and neck cancer are older – over 70 – and have been heavy smokers or drinkers,” says Dr. Newman. “But we are seeing an increase in young, otherwise healthy men and women who develop head and neck cancer related to the HPV virus. This is happening at epidemic levels". Although there is a vaccine that is designed to prevent infections with the high-risk strains of HPV, many patients have not received the vaccine. "This vaccine will literally prevent a patient from getting a cancer related to this virus" says Dr. Newman. "t is a rare opportunity to have such an easy way to prevent cancer".
Treatment for head and neck cancer may include transoral robotic surgery (TORS). TORS is the world’s first group of minimally invasive robotic surgery techniques enabling surgeons to remove tumors of the mouth and throat. This revolutionary breakthrough may result in less damage to the patient's throat and neck than with conventional surgery or with chemoradiation. TORS is performed through the patient’s mouth and provides unprecedented access to the small and often difficult-to-reach areas of the mouth and throat.
Surgeons at Penn Medicine created TransOral Robotic Surgery (TORS) in 2005. The adoption of this highly advanced robotics technique demonstrates Penn Medicine’s commitment to providing world-class health care.
“It’s important to know the signs of head and neck cancer, and to not ignore symptoms that do not go away,” says Dr. Newman. A painless enlarged lymph node in the neck is the most common first symptom in the majority of these cancer. “Treatment options and outcomes improve greatly when cancer is found early.”
The good news is that there is protection for both girls and boys who have not yet encountered the HPV virus. There are two FDA approved HPV vaccines on the market: Gardasil and Cervarix.
Gardasil protects against four major types of HPV: HPV 16 and 18, the two types that cause about 70 percent of cervical cancer, and HPV 6 and 11, which cause 90 percent of genital warts. Cervarix protects against HPV 16 and 18.
HPV vaccines are given as three shots to protect against HPV infection and HPV-related diseases, and they offer the greatest health benefits to individuals who receive all three doses before having any type of sexual activity. This is why the HPV vaccination is recommended for preteen girls and boys at age 11 or 12 years. Over the last year, the age of eligibility for vaccination has move up to 45 years for both men and women.
Here are some facts to keep in mind:
- Nearly 20 million people in the United States are infected with HPV.
- 6.2 million Americans become infected each year with more than 50 percent of sexually active men and women infected with HPV at some time in their lives.
- Most HPV infections do not cause any symptoms and go away on their own.
- HPV can cause genital warts and warts in the oral and upper respiratory tract in both men and women.
There is no treatment for an HPV infection, but many of the conditions it causes can be treated.