The Swallows Australian Edition Magazine

HPV-Related
Oropharyngeal Cancer
- Assoc Prof Richard
Gallagher
Richard Gallagher is a Head and Neck Surgeon and
Director of Cancer Services and the Head and Neck
Service in the St Vincent’s Health Network Sydney.
Changes in Head and Neck Cancer
Traditionally head and neck cancer has been
related to smoking and drinking alcohol. Over
the past 15 years a big change has occurred.
Increasingly patients are developing
oropharyngeal cancer (arising in the tonsils
and back of the tongue) due to exposure to the
Human Papilloma Virus (HPV). This is a family
of viruses with over 100 recognised types.
There is a lot we do not know about HPV. We
do know that type 16 is the strain which causes
oropharyngeal cancer.
In the 1980’s the HPV virus was recognised as
the cause of cervical cancer in women. It was
also acknowledged that this was a sexually
transmitted virus. Research in the 1990’s led
the development of the HPV vaccine which
became available in 2006.
So why has a virus which causes cervical
cancer suddenly started causing cancer in the
throat? When we become sexually active we
are all exposed to HPV. Since the late 1960’s
oral sex has become increasingly popular.
Gradually it has replaced vaginal sex as the
normal first sexual experience of teenagers
and young adults. Consequently the rate of
oral HPV infection has increased. Most people
who develop an infection will be unaware and
the infection is cleared by the immune system.
Oral infection is more common in men who
have oral sex with women and in women who
have oral sex with women. It is known that as
the number of sexual partners a person has
increases the risk of developing an HPV
related cancer also increases. This is because
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the risk of recurrent infection increases and this
seems to be linked to the development or
oropharyngeal cancer.
What we really do not understand is why the
virus causes cancerous/malignant change in
one person and not another. It is also not clear
why there is a delay of years before a cancer
occurs. Someone can be in a monogamous
relationship for an extended period between
contracting an HPV infection and developing a
cancer.
HPV related oropharyngeal cancer is more
common in men. It typically occurs in a
younger age group than traditional head and
neck cancer. Most patients will be non or
ex-smokers. Surprisingly most patients will
have few symptoms and may present only with
a neck lump (metastatic cancer). The typical
symptoms of a sore throat, difficulty
swallowing and earache are much less
common.
The good news is that people who develop an
HPV related oropharyngeal cancer tend to
have a very good prognosis and should expect
to be cured despite often being classified as
Stage IV cancer. These cancers are very
sensitive to treatment. The benefit is however
negated if the patient is a smoker or continues
to smoke.
Patients will usually be referred to an
ENT/Otolaryngology-Head and Neck Surgeon
who will question and examine the patient.
Investigations will include a biopsy to prove the
diagnosis, CT scan neck and chest, as well as
a full body PET/CT scan. The patient’s case will
then be presented and discussed at a
Multidisciplinary Team Meeting (MTD) which
enables the surgeon, radiation oncologist and
medical oncologist to meet together and make
a recommendation about the best treatment