With Head & Neck Surgeon and Cancer Specialist Peter Vosler, MD

HPV, or human papillomavirus, is a common sexually transmitted disease that has long been connected with increased chance of cervical cancer in women. But did you know that HPV has also been shown to cause oral and throat cancers too?

With incidences of these HPV-related oral and throat cancers on the rise, we spoke with Peter Vosler, MD, a board-certified head and neck surgeon specializing in complex head and neck cancers, to learn more.

How common are HPV-related mouth and throat cancers?

Fortunately, these are very uncommon cancers. About 1.7% of men have it, or 1 in 60 men, and about 0.7% of women have it, or 1 in 140 women.

But we're seeing an annual increase of 5%.

How common is HPV?

HPV is very common in our society. Approximately, 65-99% of people are infected with HPV. And if you've had more than four sexual partners, the chance at that point is over 99%.

How is it spread?

The HPV itself is spread through sexual contact, usually oral sex from a man on a woman.

Do all throat HPV infections lead to cancer?

No. The vast majority of throat HPV infections do not lead to cancer. There is one subtype of HPV, HPV 16, which accounts for about 90% of the cancers, and only 1% of infected people have this type of virus.

Who is at greatest risk?

Men in their 40s to 60s, usually non-smoker and high socioeconomic status. And people who've had more than four sexual partners.

How long after an HPV infection does it take for cancer to develop?

It usually takes a long time before people develop cancer from HPV. The virus has to first stick to the tonsil tissue in the back of the throat, and then it takes some time to transform. It usually takes at least 10 years, but probably closer to 20-30 years.

So it's not because of a recent sexual partner.

It's definitely not because of a recent sexual partner.

Patients will often ask, "Did someone go outside of the marriage or the relationship to get this?" And no, it's probably something that happened when they were in their 20s.

If someone has an HPV-related cancer, is their spouse or partner also going to get it?

It is very unlikely. People who have this cancer do not transmit the cancer. And it's likely that they acquired the HPV virus decades ago, so they're no longer infectious.

How would someone know if they have HPV-related oropharyngeal cancer?

The initial symptom that patients with HPV-related oropharynx cancer have is a painless neck mass. Some patients also have symptoms of difficulty swallowing, voice changes, or ear pain on the side of the neck mass. But a biopsy is the only way to determine if the mass is caused by HPV.

Is this a treatable cancer?

It is a very treatable cancer. About 90 to 95% of patients that have this are successfully treated, and have a five year survival rate of 90, 95%. So very highly treatable.

What does treatment look like?

Treatment involves either surgery or a combination of radiation therapy and chemotherapy. If it's a small tumor that has only one node involved, then surgery is a good option. However, if it's a larger tumor and multiple lymph nodes are involved, then radiation and chemotherapy are probably preferable.

If someone finds a mass on their neck, what should happen next?

If the mass doesn't go away within 1-2 weeks, then you should be seen by a head and neck cancer surgeon. For my patients, I begin by obtaining a focused history and performing a physical exam focusing on the tonsils and the base of the tongue. Then, I biopsy any masses in the tonsil and perform an ultrasound-guided biopsy of the neck mass.

It's incredibly important to see someone who specializes in head and neck cancer care to ensure you get a proper and timely workup. And if there are any concerns, it's incredibly important that you are seen by not just a head and neck cancer surgeon or a radiation oncologist or a medical oncologist or a speech pathologist, but all of them.

At The Brian D. Jellison Cancer Institute we have all those specialties. We meet on a weekly basis at a multidisciplinary tumor conference to go over all our patients, to make sure that we have the best treatment plan for every patient and a consensus among our specialists.

 

Can the HPV vaccine help prevent these cancers?

We're optimistic that the HPV vaccine will help prevent these cancers. However, it will take decades before we see that manifest. Right now, children and people up to age 45 are getting vaccinated, so it's probably going to take another 20-30 years before we see a decline in the overall incidence of this cancer.

Hear more from Dr. Vosler on this recent episode of SMH Healthcasts.

 

 

Written by Sarasota Memorial copywriter Philip Lederer, MA, who crafts a variety of external communications for the healthcare system. SMH's in-house wordsmith, Lederer earned his Master's degree in Public Administration and Political Philosophy from Morehead State University, KY, and has the muscle mass of a heavy reader.