Smoking rates have declined over the past two decades, and so have the rates of smoking-related throat cancer. But cancer of the middle throat – or oropharynx – is rising sharply. The reason: human papillomavirus (HPV).
HPV-related throat cancer patients are usually non-smoking, white, heterosexual males in their 50s or 60s, says Neil Gross, M.D., professor and director of clinical research in the Department of Head and Neck Surgery at MD Anderson.
"We used to see mostly smokers. Now we see mostly nonsmokers, and their throat cancers are almost uniformly HPV-related."
Experts are not sure why HPV-related throat cancer mostly strikes white males who don't smoke. Women can also get the disease, but it's less common.
How does HPV cause throat cancer?
The HPV virus spreads to the oropharynx through oral sex or intimate kissing.
The oropharynx, which includes the area in the back of the tongue and the tonsils, has an uneven surface with deep crevices that make it a good environment for the virus to lodge.
Gross compares the surface to a "cauliflower." He says it has similarities to the surface of the cervix, a common site for HPV infection in women.
The virus can lay dormant in cells for years if the body doesn't clear it. In some cases, it causes cancer. Once that happens, the cancer can be relatively slow-growing. It can take months to become noticeable -- most people don’t notice it until it becomes a lump in the neck.
"That means the cancer has spread to a lymph node," says Gross.
What are the symptoms of HPV-related throat cancer?
A lump in the neck is the most common and most obvious symptom of HPV-related throat cancer.
In some patients, the cancer can cause ear pain as it presses on nerves that lead to the ear. But, it typically does not cause any pain or difficulty swallowing, even when it becomes large and visible.
"Because the cancer often develops in a crevice, people don't usually feel it. It can be painless," says Gross.
He says sometimes the swelling and discomfort are misdiagnosed as an infection. He's had many patients who have been treated with several rounds of antibiotics, or even had teeth removed, due to a mistaken diagnosis.
"They do well once they get the proper treatment, but it is always frustrating that there has been a delay," he says.
If you have a lump in your neck that has you concerned, Gross suggests seeing an ear, nose and throat specialist.
Reduce your risk for HPV-related throat cancer
Nearly every male and female will be infected with HPV in their lifetime. Most people clear the virus within a couple of years and never know they had it. You can protect yourself and prevent infecting someone else by:
- Getting the HPV vaccine. All males and females ages 9–26 should get the HPV vaccine. It is most effective when given at ages 11–12, before puberty. Unvaccinated men and women ages 27–45 can also get the HPV vaccine and should talk to their doctor about the benefits of the vaccine. "There's still time for a lot of people to get vaccinated after age 27. The vaccine can be preventive in patients who are older," says Gross.
- Paying attention to symptoms. Don't ignore a lump in the neck bigger than a grape. "A lump in the neck is not normal," says Gross. And don't ignore ear pain beyond what you would expect from a minor infection, or pain that does not respond to treatment within two weeks. The earlier cancer is detected, the better the chance that it can be treated successfully.
There currently is no screening test to detect HPV in the throat. But getting vaccinated against the virus and being aware of changes in your body can protect you against HPV-related throat cancer.