Dr. Nugent

Oral cancers are being seen in greater numbers throughout the nation, despite the decline in smoking. But what has emerged as a cause for this cancer is not the usual smoking and alcohol drinking associated with head and neck cancers. It may be another factor, the HPV virus, or human papilomavirus, transmitted sexually.

In fact, doctors say that in some geographic areas perhaps as many of half of all head and neck cancers are now attributed to HPV. The most common site of HPV cancer of the head and neck is the back of tongue and tonsils, or oropharynx.

F.W. Nugent, MD, a medical oncologist at Lahey, calls this a “new type of cancer,” and “an explosion in the incidence of it.” Nugent and his colleagues are seeing more of this oral cancer, mostly in younger men who would not usually develop head and neck cancers.

While it’s estimated that close to 80 percent of all adult Americans may be infected with the HPV virus, and many women develop cervical cancer and genital warts as a result, the spike in HPV-related oral cancers may be due, in part, to the sexual revolution of the 70s. People who have had multiple sexual partners and practiced oral sex may be fueling the spike. Deep kissing might also be a source of transmission. These cancers typically take decades to grow before symptoms appear, explaining today’s surge.

“Oral cancer caused by HPV is genetically different than the representative squamous cell carcinomas of the head and neck, which present from smoking and drinking,” Nugent said.

Mostly heterosexual men are affected by this cancer. Nugent rarely sees women with HPV related oral cancer, though women can infect other women. The typical age for his patients is 50s to 60s.  

Common symptoms of this cancer are pain on swallowing or a lump in the neck. The diagnosis must be confirmed by biopsy (examining a sample of the tissue). Presently, treatment is similar for other head and neck cancers, with chemotherapy, radiation, surgery or a combination of these interventions.

“It is easier to cure than other head and neck cancers. A high percentage of patients are cured with treatment,” Nugent said. But it is unknown whether less invasive treatments might also cure the cancer. “Perhaps we might be able to treat this in a gentler manner and still have success,” said Nugent, “because it is different from other oral cancers genetically.” More study is needed.

A vaccine for HPV, Gardisil, was approved for use by the FDA in 2006, and is given to females, age 9 to 26. The vaccine can also be given to boys. Practicing safe sex is also an option for prevention.

“If you vaccinate everyone, you may be able to prevent this cancer in the future,” said Nugent.