Ear, Nose and Throat - U.S.A.  (ENT USA)
Human Papillomavirus - HPV & Oral Cancer
Human Papillomavirus
HPV & Oral Cancer
  
     
Large Oral Papilloma
      
Large Papilloma From the Oral Pharynx

(Pictures on the left shows a large papilloma in the oral pharynx.)

Click on Pictures to Enlarge



Tongue CancerHuman Papillomavirus (HPV) is the most common STD in the United States.  There are 6.2 million new infections each year.  Most HPV infections spontaneously clear on their own, 70% within one year and 90% within two years.  View Report    Over 40 different types of HPV infect the mucosal areas of the body. 
View Abstract   View Abstract 

The skin can also become infected, for example plantar warts are caused a variety of the HPV virus.  In this case, only skin to skin contact or walking on an unclear surface can result in an infection. 

Substantial evidence is mounting that the Human Papillomavirus or HPV is playing an increasing important role in oral cancer.  On the rise are cancers of the tonsils and base of tongue.  Infections with HPV-6 and HPV-11 are known causes of genital warts(1).  It has been shown that 70% of cervical cancers are caused by HPV-16 and HPV-18.  Frisch and Biggar (2) reported that patients with anogenital squamous cell carcinoma had a 4.5 increased risk of developing tonsillar cancer.  

Of the 29,627 cases of oral cancer in 2003, up to 12% were caused by HPV.  The incidence is approximately, one-third of the 11.820 cases of vaginal cancer caused by HPV in the same year.   View Report - Table 1

Sexual transmission is associated with infection of the upper respiratory tract.   D'Souza, et. al. (4) found that HPV associated oral pharyngeal cancer was associated with greater than 25 life-time vaginal-sex partners and greater than 6 life-time oral sex partners.  However, they could not rule out transmission by direct mouth to mouth contact.  It has also been reported that poor oral health which causes dental problems and gum disease can increase the risk of HPV infection.   Thus, brushing one's teen will lower the risk of HPV.   View Time News Report

D'Souza (4) demonstrated that HPV is by far the major risk factor for developing oropharyngeal carcinoma.  He demonstrated HPV-16 in 72% of 100 pathology specimens studied.  He found that patients who developed HPV had an odds ratio of developing oropharyngeal cancer of 32.2, as heavy alcohol use had an odds ratio of 2.5, and heavy smoking (greater than 20 pack year) had an odds ratio of 2.8.  The interaction between HPV, tobacco and alcohol is unclear. 

Chemock et. al (5) found Human Papilloma Virus in 63.5% of oropharyngeal squamous cell carcinoma tumors in Whites and 11.5% of tumors in African Americans.

Haddad (6) reports that HPV associated oral carcinoma occurs in a higher proportion of men, at a younger age and at a more advanced stage than non-HPV associated oral carcinoma.  He also states that HPV oral carcinomas are believed to have a better prognosis. 

A new vaccine, Gardasil, protects against four of the most common HPV viruses which causes genital warts and cervical cancer.  Since the cancer risk for men for oropharyngeal cancer, anorectal cancer and penile cancer is about the same incidence as for cervical cancer, some doctors are now considering giving   the vaccine to men (6). 

 
 
If a patient has a papilloma on his tonsil should he have his tonsils removed?  Although tonsillar cancer is the most common cancer caused by HPV, removal of the tonsils in patients with papilloma is probably not indicated.  The type of HPV viruses which usually cause papillomas are HPV-6 and HPV-11.   Cancers are associated with HPV-16 and HPV-18.  In addition, a tonsillectomy is not a risk free surgery and should not be undertaken lightly.   Patients should still be periodically followed for the possible development of other manifistations of HPV.

If there is concern regarding the aggressiveness of the lesion, serotyping the virus in the papilloma is indicated. 

(The picture on the right shows a papilloma on the right tonsil.)

 


  References: (Full Text Available)

  1. Masters C  Oral Sex Can Add to HPV Cancer Risk.  Time Magazine  May 11, 2007
     
  2. Frisch M, Biggar RJ,  Aetiological Parallel between tonsillar and anogenital squamous-cell carcinomas.  Lancet  1999, 354(9188) pp 1442-1443.   READ FULL TEXT
     
  3. Mork j, Lie AK, Glattre E, et.al.,  Human Papillomavirus Infection as a Risk Factor for Squamous-Cell Carcinoma of the Heald and Neck.  NEJM  2001,344(15) pp1125-1132
     
  4. D'Souza G, Kreimer AR, Viscidi R, et. al.,  Case-Control Study of Human Papillomavirus and Oropharyngeal Cancer.  NEJM  2007, 356(19) pp 1944-1956 
     
  5. Chernock RD, Zhang Q, El-Mofty SK, Thorstad WL, Lewis JS Jr. Human papillomavirus-related squamous cell carcinoma of the oropharynx: a comparative study in whites and african americans. Arch Otolaryngol Head Neck Surg. 2011 Feb;137(2):163-9
     
  6. Haddad, Robert,   Human Papillomavirus Infection and Oropharyngeal Cancer   2007 Medscape CME Course

 

  
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