HPV+ Oral Cancer

The prevalence of HPV+ oral cancer continues to rise.  Learn more here about OPC detection, presentation, and who is at risk.

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About HPV+ Oropharyngeal Cancer

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Source: Oropharynx Cancer and HPV in 2019

www.slideshare.net/doctorbobm/oropharynx-cancer-and-hpv-in-2019

  • HPV is the most common sexually transmitted infection in the world, with 79 million Americans currently infected

  • While the rates of other head & neck cancers have steadily decreased, HPV now causes over 70% of oral cancer cases.

  • The rate of HPV-oropharyngeal cancer (OPC) has increased a staggering 225% over the past 30 years and is now the 6th most common cancer worldwide.

HPV+ OPC Detection

Presentation of Oral Cancer

Men develop OPC at a rate 4.2 times higher than women.  It is now the 8th most common cancer in men and the most common cancer of the upper aerodigestive tract.

More than 90% of OPC are squamous cell carcinoma. This means that they begin in the flat, squamous cells found in the mouth and throat lining. The most common locations for cancer in the oral cavity are:

•    Tongue

•    Tonsils

•    Oropharynx

•    Gums

•    Floor of the mouth

Patients with HPV+ OPC are less likely to have a history of tobacco exposure and are also less likely to use alcohol compared with HPV-negative OPC patients or those with squamous cell carcinoma at other subsites of the head and neck.

What is Oral Cancer

Cancer is a disease where cells in the body grow out of control.

Oral cancer is a disease where cancer cells form in the mouth, lips, cheeks, gums, tongue, hard palate, tonsils and the throat.

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Current Screening Methods

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Late Detection

Current screening methods for oral cancer offer little to no early detection capabilities.

Some pre-cancers and cancers can be found early during routine oral exams by a dentist, doctor, dental hygienist, or by self-exam. During the exam, the doctor will feel for any lumps on the neck, lips, gums, and cheeks. They will likely also examine the area behind the nose, the larynx (voice box), and the lymph nodes of the neck. 

However, this implies that the cancer must already be in the lesion stage to get discovered by a physician. Over 64% of dentists are not confident in their ability to identify early OPC with visual inspection, and over 70% feel that OPC before the T1 lesion stage is nearly impossible to identify. 

Later detection leads to increased mortality and likelihood of disfiguring surgery.

Currently, the overall 5 year survival rate for Americans with oral cancer is only 57%, and the death rate is so high because the cancer is discovered so late in its development.

However, if the cancer is diagnosed at an early stage, the overall 5-year survival rate increases to 85%. Unfortunately, only about 29% of oral and oropharyngeal cancers are diagnosed at this stage.

For cancer that has spread to surrounding tissues or organs/lymph nodes, the 5-year survival rate is 67%. About half of oral cancers are diagnosed at this stage.

 

Treatment options are mostly based on what stage the cancer has progressed to, but stage III and IV cancers often require invasive surgery.

Source: Oral Cancer Foundation

www.oralcancerfoundation.org/facts/

HPV Information

What is HPV?

Human Papillomavirus, or HPV, is a DNA virus that infects skin and wet surfaces of the body like the mouth, vagina, cervix and anus. There are over 100 types of HPV, and it is the most common sexually transmitted disease in the United States and worldwide. Of these 100 types, about 40 can infect the genital areas: some are deemed “low-risk” and only cause genital warts, while others are “high-risk” and can cause cancer. The high-risk HPV types may also cause a form of throat cancer, called oropharyngeal cancer, which is becoming more common in the US and Europe.

What is oral HPV?

The same high-risk types of HPV that infect genital areas can affect the mouth and throat, resulting in what is called oral HPV. Some types of oral HPV can cause cancers of the oropharynx (back of the throat, including the base of the tongue and tonsils). Cancers of the oropharynx are known as oropharyngeal cancers (OPC). 

Who is at risk?

Since HPV is transmitted through sexual contact, the number of lifetime sexual partners is a risk factor for development of HPV+ oral cancer. Research has shown that the risk for developing HPV+ oral cancer is 5 times higher for people who reported 6 or more oral sexual partners compared to those who have not had oral sex. Many people are exposed to HPV at some point, and about 10% of men and 3.6% of women have oral HPV. Infection is more common amongst older individuals, and men are more likely to get infected with HPV (including the “high-risk” cancer-causing types) compared to women.