HPV Virus Causes Rise in Throat Cancer

Age and tobacco use are two of the most significant risk factors for cancer, and in general head and neck cancers are no exception. When it comes to throat cancer, though, the number of cases is rapidly climbing among young non-smokers.

Researchers attribute this to the Human Papilloma Virus (HPV), a sexually transmitted virus. There are more than 150 types of HPV. One in particular, known as HPV 16, was recognized in 2007 as a cause of throat (oropharyngeal), genital and anal cancers.

The virus spreads through skin-to-skin contact through vaginal, anal or oral sex and can cause tumors on the base of the tongue, tonsils and voice box that can affect the ability to eat, drink and talk.

Alarming Rate of Increase

"Throat cancer is still relatively rare, and though it is not an epidemic, the rate of increase is alarming." says surgeon Scharukh Jalisi, MD, Chief of Otolaryngology and Medical Director of the Head and Neck Cancer Program at Beth Israel Deaconess Medical Center.

HPV-positive throat cancer is rarely detected early because it advances silently at first.

"Often many years, even decades, go by while the virus is dormant in the body," according to medical oncologist Anupam Desai, MD, who works closely with Jalisi. "Unfortunately, there are no tests for early detection other than visual or physical examination by the patient, doctor or dentist."

When the cancer has advanced, symptoms may include mouth sores or ulcers; earache; painless lumps or swelling in the neck; throat pain and infections; and difficulty with speech, swallowing and breathing.

Treatments for Throat Cancer

Throat cancer is a serious disease, but HPV-positive cases tend to have a more favorable outlook than those not associated with HPV. Early-stage throat cancers are usually treated with either surgery or radiation therapy directed at the tumor and nearby lymph nodes. Jalisi, one of the Boston area's most experienced head and neck surgeons, is a pioneer who introduced to New England robot-assisted, minimally invasive surgical techniques that go through the mouth.

When surgery or radiation is not enough, there are other treatment options.

"That is where chemotherapy comes in, as well as newer immunotherapies (using the body's own immune system to fight disease) that are beginning to have an impact," said Desai.

Later-stage HPV-positive throat tumors—those that are larger and have grown into surrounding tissue and nearby lymph nodes—may be treated with combined surgery, chemotherapy and radiation therapy, according to Dr. Desai. Clinical trials at BIDMC and elsewhere are investigating the potential to combine immunotherapy with other therapies and innovative delivery methods.

Risk and Prevention

Risk factors for HPV-positive throat cancer include oral and anal sex, the number of sexual partners, and having sex with others who have had multiple partners. Additional factors are a weakened immune system and chronic periodontitis (gum disease).

For many adults, with HPV so widespread, prevention is no longer an option, but in 2006, a new vaccine became available to shield the next generation from HPV 16. The National Advisory Committee on Immunization Practices recommends routine vaccination of boys and girls at ages 11-12, and vaccination for people through age 26 if they haven't already had it. For adults age 27-45, the value is greater for those who have had fewer sex partners.

"This is an encouraging time, with new surgical techniques and immunotherapies expanding treatment options for these challenging cancers," says Jalisi. "Our BIDMC program is committed to offering patients the most advanced treatment options."