Head and Neck Surgeons See Rise in Oropharyngeal Cancers Caused by HPV

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Otolaryngologist Yash Patil, MD. Photo by Cindy Starr / Mayfield Clinic.

A national discussion about human papillomavirus (HPV), the sexually transmitted virus that can lead to cervical cancer in women, ignited recently after Republican presidential challengers lambasted candidate Rick Perry for his 2007 executive order that required vaccinations against HPV for girls entering the sixth grade in Texas. That discussion, while valuable, involves only part of the story of HPV, however. The virus is linked not only to cervical cancer but also to a small but growing incidence of throat cancer among both men and women.

Yash Patil, MD, an otolaryngologist with the UC Gardner Neuroscience Institute and Assistant Professor of Otolaryngology at UC, said that although the actual rate of head and neck cancer in the general population is low, leading to about 15,000 deaths in the United States each year, he is seeing increasing numbers of patients with throat cancer who test positive for the HPV virus.

“Head and neck cancer typically affects patients who smoke and drink excessive amounts of alcohol,” Dr. Patil said. “But with HPV virus, we’re starting to find that we have an entirely different subset of patients who are younger and healthier and who have never smoked or drunk excessively.”

Among patients who develop oropharyngeal cancer – cancer of the tonsils and the base of the tongue — Dr. Patil said, “We are finding that almost three-quarters of samples collected from these patients show positivity for HPV.”

Ohio State University researchers reported last week in the Journal of Clinical Oncology that in a sampling of 271 patients who were diagnosed with oropharyngeal cancer from 1984 to 2004, HPV was found in 16 percent of tumor samples from the 1980s and in 72 percent of samples collected after 2000. The researchers estimated that the incidence of these cancers has increased from .8 per 100,000 people in 1988 to 2.6 per 100,000 people in 2004.

Signs of HPV infection have been seen in tissue samples taken from healthy people as well as from patients with head and neck cancer. However, the vast majority of individuals who test positive for HPV will not go on to develop cancer.

Although some observers have suggested that throat cancer caused by HPV is emerging as a sexually transmitted disease, the result of increasing acceptance of oral sex among young people, Dr. Patil believes that it is too early to make such a claim and that doing so is stretching scientific fact.

“I think at this point it is a little early to say that oropharyngeal cancer – specifically tonsil cancer or base-of-tongue cancer — is some type of sexually transmitted disease,” Dr. Patil said. “That is way too much of a reach. But I do think it is worth pointing out to younger people that HPV is a sexually transmitted disease and that most certainly they should be cautious of choosing their lifestyle or their sexual partner.” Nevertheless, the public – and especially physicians — should be aware of the link between HPV infection and oropharyngeal cancer, Dr. Patil said. The most common symptom of cancer of the throat is not a sore throat but rather an enlarged lymph node, the result of metastasis from the throat.

Most people are aware that smoking is carcinogenic,” Dr. Patil said. “But people are not thinking of cancer when they see younger patients with HPV infection. Nobody is thinking about the fact that this patient does not have a sore throat, or that the lump in their neck isn’t just a swollen lymph node caused by infection. These patients actually have a cancer that has spread to a lymph node. The cancer has already spread before the throat cancer is diagnosed.”

Non-smoking, non-drinking patients who develop throat cancer often ask Dr. Patil whether anything in their sexual history has given them a predilection for developing throat cancer. That question cannot be definitely answered, Dr. Patil said, because there are different subtypes of HPV and because the mechanism of transmission of HPV is not completely understood.

“We also see other diseases in the throat caused by HPV infection, specifically in very young children, who obviously have no sexual history,” Dr. Patil said. “In these instances, the mode of spread might be maternal-fetal.”

HPV is currently being studied by researchers in the departments of Otolaryngology, Radiation Oncology and Hemotology-Oncology, along with colleagues at Cincinnati Children’s Hospital Medical Center. Any time a cancer is removed or biopsied at University Hospital or Cincinnati Children’s, tissue is collected and preserved in a tumor bank. This allows individual cancers to be used multiple times, in current and future studies.

Patients who are diagnosed with oropharyngeal cancer at UCNI are tested for HPV positivity. “We know that this subset of patients responds differently to treatment,” Dr. Patil said. “The presence of HPV in these patients helps guide our treatment.”

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