HPV-Positive Oropharyngeal Cancer Q&A with Otolaryngologist Nadir Ahmad, MD, FACS

Nadir Ahmad, MD, FACS

Nadir Ahmad, MD, FACS

What is oropharyngeal cancer?

Oropharyngeal cancer, also known as throat cancer, affects the oropharynx, which is the middle part of the throat including the back of the tongue, tonsils, soft palate and the walls of the pharynx.

Throat cancer is different from oral cancer, which occurs in your lips, gums, tongue, cheeks or the roof or floor of your mouth. Throat cancer and oral cancer do share some common causes, such as smoking, chewing tobacco and alcohol use. However, HPV or the human papillomavirus is now recognized as a high-risk factor for throat cancer.

What is HPV?

HPV is a group of more than 100 different viruses that infects skin and wet surfaces of the body like the mouth, vagina, cervix and anus. In the United States, it is now the most common sexually transmitted disease.

What is the connection between HPV and oropharyngeal cancers?

About 70 percent of oropharyngeal cancers are now caused by HPV, particularly sub-types HPV 16 and HPV 18. What’s surprising is the average age of a patient with HPV-positive throat cancer is 40 to 55, a decade younger than the smoker and/or drinker who traditionally developed this type of disease. Additionally, for reasons still unknown, HPV-associated throat cancer occurs much more frequently in men than in women.

The connection between the two was only made within the last 20 or 30 years, when doctors began seeing more cases of throat cancer in otherwise healthy, young men, who didn’t smoke, chew tobacco or drink heavily. It is speculated that an increase in the number of people engaging in sexual activity, particularly oral sex, with multiple partners may be responsible for the higher rates of HPV-positive oropharyngeal cancer. What’s important to recognize is this virus can lay dormant for years, so a person could become infected at a younger, more promiscuous age, long before it causes any problems later in life.

How does someone get HPV?

Most of us will be infected by HPV at some point in our lives – usually without knowing it, as there are often no symptoms. It has been estimated that more than 90 percent of the United States population has been infected. The viruses are passed through sexual contact, like vaginal and oral sex, and even kissing.

Is HPV dangerous?

Most of the viruses within the HPV family are cleared by the body’s own immune system within one to two years.  It’s the chronic infection, the one the body can’t clear on its own, that raises a person’s risk for HPV-related health problems like cancer. Every year in the United States, about 31,000 women and men are diagnosed with a cancer caused by an HPV infection.

HPV 16 and HPV 18, for example, are known as cancer-causing types and have been clearly linked to cervical cancer and more recently to cancer of the oropharynx (throat, back of tongue, and tonsils).

What are the signs of oropharyngeal cancer?

The most common sign is a large, painless mass on the front of the neck. Other signs may include difficulty swallowing, a feeling like something is stuck in the throat, enlarged lymph nodes, earaches, chronic sore throat and unexplained weight loss.

Remember, though, these signs don’t necessarily mean that you have cancer. But if any are present for longer than two weeks, it’s a good idea to see your doctor to rule out other causes.

What is the treatment for oropharyngeal cancer?

Although treatment for throat cancer is always individualized based the patient’s preferences and needs, it typically includes one or a combination of therapies including surgery, radiation, and/or chemotherapy.

At MD Anderson Cancer Center at Cooper, every patient is partnered with a team of cancer specialists who are devoted to fighting throat cancer. This team reviews your case on a regular basis and makes treatment recommendations for your care that reflect the latest thinking from each specialty. Of course, this is a collaborative process that includes your wants, needs, and input, as well.

When surgery is optioned, I utilize a minimally invasive surgical technique called trans-oral robotic surgery (TORS) to remove tumors from the throat. Robotic surgery makes it much easier to access this challenging area on the body, therefore, minimizing complications and recovery time, as well as, providing a better quality of life afterward.

The good news is HPV-positive throat cancer responds very well to treatment. In fact, we are seeing between 80 to 90 percent cure rate.

How can I lower my risk of giving or getting HPV-related oropharyngeal cancer?

Although the HPV vaccine was developed to prevent cervical and other less-common genital cancers, it is now a highly-recommended preventative measure for oropharyngeal cancer. However, HPV vaccination only works if the series is complete before a person is infected. Usually this means before a person becomes sexually active. The number of doses depends on the age at vaccination. The Centers for Disease Control and Prevention recommend pre-teens, as young as age 9, get two doses of the vaccination, and teens age 15 through adults at 26 receive three doses.

If you’re over the vaccine age limit, you can lower your risk by practicing safer sex, including limiting the number of sexual partners and using condoms and dental dams correctly.

Some parents fear the vaccine is unsafe or will permit promiscuity at an early age?

As a parent and a doctor, I understand these concerns, but they are unfounded. Much like the polio and measles vaccine of generations past, this vaccination will only help prevent children from developing a serious illness later in life. In fact, a recent review by the Centers for Disease Control and Prevention reported that more than 270 million doses of HPV vaccine have been distributed worldwide, and the vaccine is considered “to be extremely safe.”

What does concern me, though, is for a vaccine that is proven effective at preventing HPV infection, and therefore HPV-related cancers, the vaccination rates falls extremely short of the national health policy’s target of 80 percent.

Nadir Ahmad, MD, FACS, is Head of the Division of Otolaryngology-Head and Neck Surgery at Cooper University Health Care and the Director of the Head and Neck Cancer Program at MD Anderson Cancer Center at Cooper. For more information about this topic, click here.

To read Dr. Ahmad’s article on the rise of HPV-related throat cancers, click here.

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