“Without wanting to get too specific, this particular cancer is caused by HPV [human papillomavirus], which actually comes about from cunnilingus.”
So said the legendary American actor Michael Douglas in an interview with the British Guardian newspaper in 2013 when discussing his 2010 diagnosis and treatment for Stage 4 Oropharyngeal cancer. At the time Douglas’ statement drew some criticism as in his 70’s and 80’s heyday he was well known for his fast living, drinking and smoking. Many people assumed that it was these habits that had caused his throat cancer. We now know of course that he was right.
In Australia today, HPV is believed to be responsible for more than 70% of the type of throat cancer known as oropharyngeal cancer. These are cancers affect the base of the throat, the tongue, and the tonsils.
What is HPV?
HPV stands for human papillomavirus. There are over 100 different types of HPV. Many are completely asymptomatic, others cause skin warts, some cause cancers of the cervix, anus and penis. Some “high risk” variants can infect the mouth and genitals. This sexually transmitted infection is extremely common affects four out of five sexually active men and women by the time they reach 25. Even “High Risk” HPV often shows no symptoms and the body’s immune system clears it away by itself in the vast majority of cases.
Sometimes the body’s immune system cannot clear HPV, usually the high-risk types. This is called a “persistent” HPV infection and it is in these cases that cancers of the tongue and tonsils (oropharyngeal SCCs) can occur 20-30 years later.
How is HPV transmitted?
HPV is spread through intimate contact with genitals and mucous membranes during sexual activity including oral sex and sexual intercourse.
Who is at risk of HPV?
Anyone can be exposed to HPV, even from their first sexual activity with one partner. There is a greater risk of men developing HPV related throat cancer (6 times that of women). Having a higher number of lifetime sexual partners also significantly increases the risk for both men and women.
It can take up to 30 years for HPV related throat cancer to appear and it is therefore most common in adults between the ages of 40 – 60 years, while the fastest growing demographic are otherwise healthy men aged between 35 -55 years.
What protection is there?
We now have an HPV vaccine that provides protection against nine of the most high-risk HPV types. It is only effective if given prior to exposure to HPV through sexual activity and is recommended that all children aged between 12-13 are immunised with the vaccine. The vaccine is included as part of the free National Immunisation Program Schedule at schools and is also free for anyone under the age of 20 if they were not vaccinated at school.
While condoms offer some protection during sexual intercourse, they are often not used during oral sex and of course are useless during the riskiest activity, cunnilingus. If you want prevention against HPV, using dental dams is an option but is unlikely to prove popular for most people.
What are the symptoms of oropharyngeal cancer?
The most important advice for those of us who haven’t got the protection of immunisation is DO NOT IGNORE THE SYMPTOMS OF THROAT CANCER.
Symptoms for oropharyngeal cancer vary but those to be aware of include:
- A sore throat that lasts more than 2 weeks
- Sore throat that only affects one side
- Especially if it travels to your ear
- A persistent change in your voice
- Swollen lymph nodes
- Pain when swallowing
- Difficulty eating
- Loose teeth
- Blood in the mouth or saliva
- Numbness in the mouth
- White or red patches on the tongue or tonsils
How is oropharyngeal cancer diagnosed?
If you get any of the symptoms above insist that your GP refer you urgently to an ENT Head and Neck Surgeon like A/Prof John McGuinness, for further investigation.
During your examination we can easily examine the “at risk” areas of the tonsil and tongue base using a tiny endoscope. This takes only a few minutes and can be performed at your first office visit. We will also take a small tissue sample or biopsy for examination and diagnosis.
Further specialist imaging tests including a CT scan, MRI, and PET scan may be required. These investigations determine the location, stage, and spread of the cancer.
Can oropharyngeal cancer be cured and how is it treated?
The treatment and prognosis are dependent on the nature of the cancer, the tumour’s size, and its spread. When determining your treatment plan, A/Prof McGuinness will also take your overall general health into consideration.
Overall HPV related throat cancers respond very well to treatment with between 90-95% of diagnosed cases having a five-year, disease-free survivorship rate. A Prof McGuinness can treat many of these cases with Trans-Oral Robotic Surgery decreasing the need for radiation therapy and chemotherapy.
What should you do if you have symptoms of oropharyngeal cancer?
If you are experiencing symptoms that have been listed in this article and have not sought medical attention, you should arrange a consultation with your family doctor. If they believe you require specialist attention, please request a referral, and contact the My ENT Specialist team who will be able to arrange for a consultation with A/Prof McGuinness.