on the left shows a large papilloma in the oral pharynx.)
Click on Pictures to Enlarge
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.
Over 40 different types of HPV infect the
mucosal areas of the body.
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
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
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
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.
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.
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)
Masters C Oral Sex Can Add to HPV Cancer
Risk. Time Magazine May 11, 2007
Frisch M, Biggar RJ, Aetiological
Parallel between tonsillar and anogenital squamous-cell carcinomas.
Lancet 1999, 354(9188) pp 1442-1443.
READ FULL TEXT
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
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
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
Haddad, Robert, Human
Papillomavirus Infection and Oropharyngeal Cancer 2007
Medscape CME Course
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