HPV Oral Cancer

Human Papillomavirus (HPV) and Oral, Tongue, Tonsil and Oral Pharyngeal Cancer

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 and cervical cancer(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.

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.

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.

Haddad (5) 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 (5).

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

Click on Pictures to Enlarge

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 causes papillomas are HPV-6 and HPV-11 but tumors are associated with HPV-16 and HPV-18. In addition, a tonsillectomy is not a risk free surgery and should not be undertaken lightly. If the patient still wishes to be considered for a tonsillectomy, removal of the papilloma and serotyping the virus is indicated.

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

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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. Haddad, Robert, Human Papillomavirus Infection and Oropharyngeal Cancer 2007 Medscape CME Course

Date page was last edited 08/20/2008 Number of page views since 6/26/2008 Hit Counter

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