HPV Explained: Causes, Symptoms and Treatment Options

Human Papilloma Virus (HPV) is a type of virus that can infect the skin and the mucosal lining of various areas, including the mouth, throat, genitals and anal region. HPV infections are very common. A significant number of individuals infected with HPV remain asymptomatic. Often, the immune system clears the HPV infection on its own without requiring treatment. However, in some instances, HPV can lead to cancer. It remains unclear why some individuals can eliminate their HPV infection before it develops into cancer while others are not.

Causes of head and neck cancer

• Alcohol and tobacco use, which includes second-hand smoke and smokeless tobacco (often referred to as chewing tobacco or snuff): These are the primary risk factors for head and neck cancers, particularly those affecting the oral cavity, hypopharynx and voice box. Individuals who consume both tobacco and alcohol face a higher risk of developing these cancers compared to those who use either substance alone. The majority of head and neck squamous cell carcinomas in the mouth and voice box are attributed to the use of tobacco and alcohol.
• Infection with cancer-causing strains of human papillomavirus (HPV), particularly HPV type 16
• Occupational exposure: Exposure to certain industrial materials, such as asbestos and synthetic fibres, has been linked to cancer of the voice box. Individuals employed in specific sectors such as construction, metalworking, textiles, ceramics, logging and food processing may face a higher risk of developing cancer of the voice box. Exposure to industrial substances like wood dust, nickel dust or formaldehyde can also increase the likelihood of cancers affecting the paranasal sinuses and nasal cavities.
• Radiation exposure: Radiation exposure to the head and neck, whether for noncancerous conditions or cancer treatment, increases the risk of developing salivary gland cancer.
• Infection with the Epstein-Barr virus: It poses a risk for developing nasopharyngeal cancer as well as cancer of the salivary glands.

Symptoms

Symptoms of head and neck cancer may include:

• Lump in the neck  
• Mouth or throat sore that does not heal and may be painful
• Difficulty in swallowing
• Change or roughness in the voice

How is HPV transmitted to individuals?

HPV is not transmitted through casual physical contact like handshakes or kissing on the cheek or lips. HPV can be transmitted when your skin or mucous membranes come into contact with those of an infected person. This typically occurs through vaginal, anal or oral sex with someone carrying the virus. This means that if you have HPV, your sexual partners may also be infected with the virus. HPV is quite common and often does not produce any noticeable symptoms, making it difficult to determine when the infection began or who may have transmitted it. In some cases, cancer can develop years after sexual contact with an individual infected with the HPV.

Risk factors for HPV infection and head and neck cancer

• HPV is a sexually transmitted infection, and having many sexual partners over a lifetime increases the risk of developing HPV head and neck cancer. Studies indicate that:
• The likelihood of developing HPV-positive cancer doubled for individuals who reported having between one and five oral sexual partners.  
• For those with six or more oral sexual partners, the risk increased five times compared to individuals who have never engaged in oral sex.
• It is important to note that HPV-positive cancer has been observed in individuals who have few or no sexual partners. Other common risk factors include a history of tobacco or alcohol use, previous oral lesions, a family history of thyroid cancer and a history of radiation therapy.

Treatment

The specific treatment plan for each patient is determined by various factors, such as the tumour’s location, the cancer’s stage and the individual’s age and overall health. Treatment options for head and neck cancer may encompass the following:

• Surgery: Here, cancerous tumours that have not spread can be removed.
• Radiation therapy: Cancer cells are destroyed using high doses of radiation.
• Chemotherapy: Here, cancer cells are targeted and destroyed using strong medications, either in the form of pills or administered intravenously (through a needle into a vein).
• Targeted therapy: It targets the genetic mutations that transform healthy cells into cancerous ones.
• Immunotherapy: It stimulates your immune system to combat the disease.
• Robotic procedure: Robotic surgery is much less invasive than traditional tumour surgeries, resulting in fewer complications and quicker recovery, enhancing patients’ quality of life post-surgery. Data shows that patients undergoing trans-oral robotic surgery with reduced adjuvant therapy experience significantly better quality of life, improved oral function, better dietary options and decreased long-term toxicity.

Is head and neck cancer curable?  

It is important to understand the answers to questions such as, is head and neck cancer curable? Or is neck cancer curable?  

Head and neck cancers can be cured effectively with the right treatment. However, treatments like surgery, radiation and chemotherapy may lead to lasting side effects, such as dry mouth, changes in taste and challenges with chewing, swallowing or speaking.

What steps can I take to protect myself from HPV infection?

• Using condoms consistently and correctly can help lower the risk of transmitting HPVs between sexual partners. However, since some areas are not protected by a condom, there is still a possibility of infection.
• It is advised that girls and women aged 9 to 26, as well as boys and men aged 9 to 21, receive the HPV vaccine. The vaccines are both safe and highly effective at preventing HPV infections. These vaccines are among the most effective measures parents can take to prevent cancer in their children.
• Make sure to regularly see your dentist or doctor. Request that they conduct an oral, head and neck examination during each visit.

Recovery from HPV cancer

Research indicates that patients with HPV-positive cancer have a significantly better prognosis and a greater likelihood of complete recovery compared to those with HPV-negative cancer after receiving the same treatment. Consequently, ongoing clinical trials are exploring whether less intensive treatment options, such as reduced radiation or immunotherapy, can be effective for HPV-positive cancer patients.

Survival rate

HPV head and neck cancer survival rate has an 85–90% chance of being disease-free five years after diagnosis. This is in sharp contrast to the typical patient group, which often consists of heavy smokers and drinkers with advanced-stage cancer, who have a five-year survival rate of only 25–40%.

Conclusion

To prevent the rise of HPV head and neck cancer, enhancing vaccination access and addressing parental vaccine safety concerns are essential. With a deeper understanding of the genomic factors involved in HPV head and neck cancer, precision medicine is poised to play a crucial role in patient management. Compared to traditional methods and non-surgical treatments, robotic surgery provides comparable oncological and functional results, potentially improving long-term quality of life. Nonetheless, additional research is necessary to create definitive guidelines on when robotic surgery should be combined with adjuvant therapy.