Human papillomavirus (HPV) is best known for its link to cervical cancer in women. However, the virus can also cause cancer in men, particularly in the middle part of the throat behind the mouth.
This type of cancer, known as oropharyngeal cancer (head and neck), affects areas including the tonsils, the base of the tongue, and the soft palate.
Valerie Salano, an ENT surgeon at the Aga Khan University Hospital, explains the link between HPV and head and neck cancer in men, how the virus is transmitted, which symptoms to watch out for, and how men can reduce their risk.
Which throat cancers are most strongly linked to HPV?
“When it comes to head and neck cancers, HPV is mainly linked with oropharyngeal cancers, which involve the tonsils, the base of the tongue and the soft palate, the soft part at the back of the roof of your mouth,” says Dr Salano.
HPV can also occur in other parts of the head and neck, such as the larynx and hypopharynx, but these areas are less commonly associated with the virus.
How does HPV get into the mouth and throat?
HPV can be transmitted through sexual contact, including oral sex. When a person performs oral sex on someone with a genital HPV infection, the virus can come into contact with cells in the mouth and throat.
“Anyone sexually active, especially through oral sexual contact, could have been exposed to HPV,” says Dr Salano.
Having several sexual partners can increase the opportunity to be exposed to different types of HPV.
“If you perform unprotected oral sex on someone with an HPV infection in the genital area, you are exposing the oral cavity and its cells to HPV,” she says.
But does having HPV mean that a man will develop oropharyngeal cancer?
“No,” says Dr Salano, noting that the body’s immune system naturally clears it. The concern is a long-lasting infection with a high-risk type of HPV that remains in the body for a prolonged period.
“You can have HPV in your system, and then, after some time, it can be cleared naturally,” she says.
One of the high-risk types associated with oropharyngeal cancer is HPV-16, which can cause abnormal cell changes if the infection remains in the body for a long time.
So, how can HPV eventually lead to cancer?
When a high-risk type of HPV remains in the body for a long time, it can interfere with the normal controls that regulate the growth of infected cells.
The cells may begin to grow and divide abnormally. Over time, these changes can accumulate and, in some cases, develop into cancer.
“However, there needs to be a long-lasting infection with a high-risk type, such as HPV-16, for us to be concerned about the changes that can eventually lead to cancer,” says Dr Salano.
What symptoms should men watch for?
Any persistent symptoms in the mouth, throat or neck should be assessed by a doctor.
Warning signs include pain or difficulty swallowing, a sore or ulcer at the back of the mouth or throat that does not heal, a growth around the tonsil or one tonsil becoming larger than the other.
“You may experience persistent pain when swallowing or have an ulcer at the back of your throat or mouth that does not heal. You may also notice a growth on your tonsil or find that one tonsil is larger than the other,” says Dr Salano.
A persistent sensation of a lump in the throat or a painless swelling in the neck that continues to grow may also require assessment.
“You may feel as if there is a lump in your throat or develop a painless swelling in your neck that has been there for quite a while and continues to grow,” she says.
Why does throat cancer cause ear pain, and what does that mean?
Persistent ear pain does not necessarily mean that there is a problem with the ear itself. Some of the nerves that supply the throat also supply the ear. Therefore, a problem in the throat can cause what doctors call ‘referred pain’, where pain is felt in another part of the body.
“A person can have pain in the ear, but when you examine the ear, it is fine. This is referred pain, because the nerve that supplies the throat also supplies the ear,” says Dr Salano.
Further examination may then identify a problem in the throat.
Is there a routine screening test for HPV-related throat cancer in men?
Currently, there is no screening programme for HPV-related oropharyngeal cancer in men that is comparable to cervical cancer screening.
Therefore, men should seek a medical assessment if they develop persistent symptoms, rather than waiting for a screening appointment.
“If you have symptoms such as a persistent lump in your throat or neck, or persistent ear pain, it is best to have it checked by your doctor,” says Dr Salano.
The doctor will take a detailed medical history and examine the patient before deciding whether further tests are needed.
Men should therefore provide a full medical history, including information about smoking, alcohol use, sexual history, and conditions that affect the immune system, such as HIV.
This information can help to guide the assessment of persistent throat or neck symptoms, and determine whether further examination or testing is required.
How can men reduce their risk of HPV-related cancers?
The HPV vaccine can help to prevent infection with the types of HPV that cause cancer, and it is most effective when administered before exposure to the virus.
Adopting safer sexual practices can also reduce the risk of HPV transmission, although it does not eliminate it.
Avoiding tobacco and limiting alcohol consumption can further reduce the risk of throat cancer and other head and neck cancers.
Dr Salano says that men should seek medical attention instead of ignoring persistent symptoms.
How common are HPV-related head and neck cancers in Kenya?
It is difficult to establish the extent of HPV-related oropharyngeal cancer in Kenya because HPV testing is not routinely performed on every patient with throat cancer.
Tobacco and alcohol remain important risk factors for throat cancers in Kenya, particularly among men, but HPV-related cancers are also being identified.
“Most of the oropharyngeal cancers we see are still in men, but we find them to be more linked to tobacco and alcohol. At the same time, we are seeing HPV, but testing is not usually done routinely,” says Dr Salano.
While a biopsy can confirm that a patient has cancer, the tissue is not always tested further to establish whether HPV is involved.
“Most institutions do not routinely test tissue samples for HPV after confirming that a patient has cancer,” she says.