Human papillomavirus (HPV) and oropharyngeal cancer. An update on prevention from the CDC.

Human papillomavirus (HPV) can cause serious health problems, including genital warts and certain cancers. However, in most cases HPV goes away on its own before causing any health problems. The same types of HPV that infect the genital areas can also infect the mouth and throat. Some types of oral HPV can cause cancers of the head and neck. Other types of oral HPV can cause warts in the mouth or throat.

HPV can cause cancers in the back of the throat (oropharynx), most commonly in the base of the tongue and tonsils. These cancers are called “oropharyngeal cancers.” Cancer caused by HPV often takes years to develop after initially getting an HPV infection.  It is unclear if having HPV alone is sufficient to cause oropharyngeal cancers, or if other factors (such as smoking or chewing tobacco) interact with HPV to cause these cancers. 

Signs and symptoms oropharyngeal cancersmay include persistent sore throat, earaches, hoarseness, enlarged lymph nodes, pain when swallowing, and unexplained weight loss. Some individuals have no signs or symptoms.

Knowing whether one has cancer caused by HPV may help physicians determine the prognosis for survival.  Head and neck cancers caused by HPV infection tend to respond better to current treatments as compared to head and neck cancers caused by tobacco or alcohol use.  There are also new treatment options such as vaccine clinical trials and de-intensification radiation protocols available to patients whose cancers are caused by HPV.

About 7% of people in the USA have oral HPV. But only 1% of them have the type of oral HPV that is found in oropharyngeal cancers (HPV type 16). Oral HPV and cancers of the oropharynx are about 3 times more common in men than in women. About 8,400 people are diagnosed in the USA with cancers of the oropharynx caused by HPV. 

It is uncertain how people get oral HPV. Some studies suggest that oral HPV may be passed on during oral sex (from mouth-to-genital or mouth-to-anus contact) or open-mouthed (“French”) kissing, others have not. The likelihood of getting HPV from kissing or having oral sex with someone who has HPV is not known. One can reduce the risk of getting HPV by using condoms and dental dams during oral sex, since they serve as barriers, and can stop its transmission from person to person.

There is no FDA-approved test to diagnose HPV in the mouth or throat.  Medical and dental organizations do not recommend screening for oral HPV.

HPV vaccines that are now on the market were developed to prevent cervical and other genital cancers. It is possible that HPV vaccines might also prevent oropharyngeal cancers, since the vaccines prevent an initial infection with HPV types that can cause oropharyngeal cancers, but studies have not yet determined if HPV vaccines will prevent oropharyngeal cancers.

Psychological disorders ( including depression and PTSD) and social withdrawal in laryngectomees

The loss of voice and a decrease in physical functioning due to breathing through a stoma are known to result in long-term changes in daily and professional life. There is growing evidence that head and neck cancer patients including laryngectomees are more often anxious and distressed than other cancer patients. Prevalence rates of psychiatric problems in laryngeal cancer patients vary from 20% to 60 %, if nicotine dependence is taken included. Studies reported depression in 4-20% of head and neck cancer patients, anxiety disorder and phobia in 2 - 6%,  adjustment disorder in 4 - 13%, post traumatic stress disorder (PTSD) in 1 -2% and alcohol dependence in 5-33%.

Several recent studies from the University of Leipzig in Germany explored the role of psychological problems in laryngectomees.

Psychological disorders were diagnosed in about a quarter of patients during the first year after laryngectomee according to a new study by Keszte et al. These were evenly distributed among males and females. However, women suffered more often from PTSD and generalized anxiety disorder. Alcohol dependency developed in 80% of the patients who had acquired no voice 80% following laryngectomy. Only 7% of individuals with any mental disorder received psychotherapy one year after laryngectomy. None of the patients diagnosed with alcohol dependency received psychotherapy or psychiatric treatment.

Another study by Danker et al. found that more than 40% of larngectomees withdrew from conversation. Only one-third of all laryngectomees regularly took part in social activities. About 87% perceived stigmatization because of their changed voice and more than 50% felt embarrassed because of their tracheostoma. Almost one-third of the patients had increased anxiety and depression.

These studies illustrates that only one in twelve patients who suffered from psychological disorders following laryngectomy receive adequate psychotherapeutic support. Because mental health seems to be related to successful voice restoration, more effort is needed to promote speech rehabilitation after laryngectomy.  Also more programs are needed to combat alcohol dependency. The studies also highlights the urgent need for psychological and social support programs for laryngeal cancer patients.