What are the factors for carcinogenesis in the head and neck?
Cancers that are known collectively as head and neck cancers usually begin in the squamous cells that line the moist, mucosal surfaces inside the head and neck (for example,
inside the mouth, the nose, and the throat).
The factors that are causally linked to the above cancers include smoking and excessive consumption of alcohol. In the past decade, however, oncogenic types of HPV were also linked to head and neck cancers (mostly to orophagyngeal cancers – cancers of the tonsils, base of tongue etc.).
Head and neck cancers caused by oncogenic types of HPV are constantly increasing in the USA. It is believed that a significant percentage (25-35%) of oropharyngeal cancers in the USA are currently caused by HPV (mostly by HPV16).
Where do HPV-related cancers usually appear?
The most common areas are around the base of the tongue and the tonsils.
How is HPV transmitted to the oropharynx?
It is believed that transmission takes place through oral sex. The possibility of transmission by kissing (mouth to mouth) is disputed or considered low.
Statistics show that the possibility of infections and carcinogenesis by oncogenic types of HPV increases depending on the number of sexual partners (and engaging in oral sex).
How common are oropharyngeal HPV infections?
Studies in the USA have shown that:
- Around 7% of the population has HPV in the oral cavity.
- However, only 1% has HPV16, which is the type more frequently implicated in oropharyngeal cancer.
- Sexually active individuals aged 14-44 reported an oral sex experience at a percentage of 80%.
Does HPV cause carcinogenesis in the oropharynx immediately after the infection?
No, it appears that many years have to pass before developing into cancer. From the data we have up to now, in some people it took more than 15 years. Smoking and tobacco chewing appear to be contributing factors in carcinogenesis.
At what ages does oropharyngeal cancer appear?
Oropharyngeal cancer is rare prior to the age of 55. Today, the average age at diagnosis of such cancers is 62 years. However, due to the epidemic outbreak of HPV diseases and changes in sexual habits (more frequent oral sex), it is believed that cancer may appear in younger ages in the future. Oropharyngeal cancer is more common in men than women (3:1 ratio).
Should a couple’s sex life change if an oropharyngeal HPV lesion is discovered?
Nothing needs to change in the sexual behavior of a couple in a long-term relationship. We know that, in long-term relationships, both partners have usually been infected.
What prevention measures can be taken for oropharyngeal cancer?
- Preventive HPV vaccination (best before becoming sexually active).
- Restriction of the number, and careful selection of sexual partners.
- Avoiding smoking and excessive consumption of alcohol.
- Care for maintaining a healthy immune system.
Is there any test that finds lesions?
There is no test to date that is used to prevent oropharyngeal cancer (similar to the Pap and HPV tests).
How can you find out if you should be concerned about any symptom you are experiencing?
If you have symptoms or observe something out of the ordinary you can see an ENT (Ear – Nose – Throat) doctor. Also, your dentist can guide you and refer you to an oral medicine specialist if you feel that you have a problem inside the oral cavity.
You must seek the opinion of a specialist if you see anything suspicious, such as:
- Wound or ulcer that does not heal within 2-3 weeks
- Swelling in the area
- Difficulty swallowing
- Pain during chewing
- Irritated throat, coarseness, coughing
