Most sexually active people will come into contact with Human Papillomavirus (HPV) in their lives, and for many, it will clear without them even knowing they had it. However, there is a link to certain cancers. The connection between HPV and cervical cancer is most widely known, but it is also closely linked to head and neck cancer.
HPV is particularly linked to head and neck cancers that develop in the back of the throat. In most people, HPV clears naturally. In a small number of people, a persistent infection of a high-risk HPV type can cause cell changes that may develop into cancer over many years.
In this blog, we’ll cover more about what HPV is, how it is connected to head and neck cancer, symptoms to be aware of and how treatment may be planned. We also explain how Proton International London treats private patients with proton beam therapy for head and neck cancer.
To find out more about proton beam therapy, seek a second opinion or start a referral, please get in touch.
What is Human Papillomavirus (HPV), and why does it matter?
Human papillomavirus, often shortened to HPV, is a very common group of viruses which attack epithelial cells – the cells that form the protective lining of many parts of the body, including the mouth, throat, cervix, vagina, vulva, penis and anus. There are more than 200 types of HPV, and many cause no symptoms at all.
HPV is usually passed on through sexual contact during vaginal, anal, or oral sex. It is the most common sexually transmitted infection (STI), and most sexually active people will come into contact with HPV at some point in their life.
For most people, HPV infections go unnoticed and are cleared by the body’s immune system, so the person may never know they have had it. But high-risk HPV can persist for years, potentially causing issues later in life.
Certain high-risk strains can lead to genital warts, throat cancer or cancers of the cervix, anus, and genitals, if the infection persists.
Is there a connection between HPV infection and cancer?
There is a very strong connection between persistent HPV infection and certain cancers, such as cervical cancer, and head and neck cancer.
The key word is “persistent”. Most HPV infections do not cause symptoms or result in cancer. Most people’s immune systems clear HPV without treatment and without long-term effects.
The risk is linked to infections that remain in the body and cause changes in epithelial cells over time. When HPV remains active in cells, it can interfere with the normal systems that help control how cells grow and repair themselves. Over many years, this can allow abnormal cells to multiply and, in some cases, develop into cancer.
High-risk HPV strains are responsible for virtually all cases of cervical cancer, as well as the majority of vaginal, vulvar, anal, penile, and oropharyngeal (throat) cancers.
The high risk types most often discussed are HPV 16 and HPV 18. HPV 16 is particularly associated with HPV related throat cancer and oropharyngeal cancer.
Which types of head and neck cancer are HPV related?
The incidence of HPV-related head and neck cancers has doubled in the past 20 years (source: The Lancet). HPV primarily causes specific types of head and neck cancer that develop in the oropharynx, which includes the back of the throat, the base of the tongue, and the tonsils.
HPV is not considered a main cause of all head and neck cancers. Cancers in other areas, such as the larynx, salivary glands, nasal cavity or oral cavity, are more often linked with other risk factors, including tobacco and alcohol.
HPV related throat cancer
HPV-related throat cancer, medically known as oropharyngeal cancer, originates in the back of the throat, primarily the tonsils and base of the tongue. A large proportion of cases are caused by high-risk strains of the human papillomavirus (most notably HPV-16) and is usually transmitted through oral sex.
Oral cavity cancers
Oral cavity cancers are malignancies that start in the lips, tongue, cheeks, floor of the mouth, gums, or hard palate.
The most common form is squamous cell carcinoma. Risk factors include tobacco and alcohol use, HPV infection, and betel nut chewing. Early detection via professional dental exams is critical.
Laryngeal cancers
Laryngeal cancer is an abnormal growth of cells in the larynx (voice box), most commonly presenting as persistent hoarseness, difficulty swallowing, or ear pain. Primarily caused by tobacco and alcohol use, it is highly treatable if caught early using surgery, radiation, or chemotherapy.
Who is at risk of HPV related head and neck cancer?
People at the highest risk of HPV-related head and neck cancers (specifically oropharyngeal cancers) are those with multiple lifetime sexual partners and men in their 40s to 60s, who have engaged in oral sex or intimate kissing.
While most people contract HPV and clear it naturally, a small percentage develop persistent infections that can take 10 to 30 years to develop into cancer.
What are the symptoms of HPV related head and neck cancers?
HPV related head and neck cancers can be difficult to notice at first because they can develop in areas that are not easy to see, such as the tonsils or base of the tongue.
Symptoms may include:
- A painless lump or swelling in the neck
- A sore throat that does not go away
- Difficulty swallowing
- Ear pain, particularly on one side, without an obvious ear infection
- A change in voice quality
- A feeling that something is stuck in the throat
- One tonsil appearing larger than the other
- Unexplained weight loss
- Mouth ulcers, red or white patches, or sore areas that do not heal
These symptoms do not necessarily mean cancer. However, if symptoms are persistent, worsening or unusual for you, it is important to seek medical advice.
How can HPV related head and neck cancer be treated?
HPV-related head and neck cancers often respond well to treatment, which primarily involves a combination of surgery, radiation, and chemotherapy. Because these types of tumours can respond well to treatment, oncologists sometimes consider reducing treatment intensity to help protect swallowing, speech and overall quality of life.
Here’s a more in-depth look at the specific treatments used to address HPV related cancers:
- Transoral Robotic Surgery (TORS): Minimally invasive robotic surgery is frequently used to remove tumours located in the back of the tongue or tonsils, often avoiding the need for large, traditional open incisions.
- Radiation Therapy: High-energy radiotherapy beams are used to destroy remaining cancer cells. The duration and approach will depend on the individual’s circumstances and will be agreed with their clinical team.
- Chemotherapy: Often combined with radiation therapy to make tumours more vulnerable. The exact dosage and combination are tailored to the patient’s cancer stage and overall health.
- Emerging Biomarker Testing: Advanced techniques, like cell-free HPV-DNA blood tests (ctHPV-DNA), are increasingly used to assess your response post-surgery and predict any potential relapse early.
- Proton Beam Therapy: An advanced form of radiotherapy, proton beam therapy uses high-energy protons to destroy cancer cells. Unlike standard X-ray (photon) radiotherapy, proton beam therapy can stop precisely at the tumour, with no ‘exit dose’ beyond it, preserving healthy surrounding tissues.
How Proton International London supports patients with head and neck cancer
Proton beam therapy is an advanced form of radiotherapy that uses protons rather than conventional photon-based X-rays to target cancer cells. This targeted approach can help reduce the risk of side effects by protecting important structures in the head and neck.
Read more about how proton beam therapy works.
Proton International London is the UK’s only private proton beam therapy centre, located at University College Hospital London. We work alongside NHS teams and world-leading clinical experts. Access to proton beam therapy remains limited, making our location in central London significant for patients seeking private treatment.
If you or a family member are facing a diagnosis, it can be a lot to take in. You may be comparing treatment options or wondering whether proton beam therapy could be appropriate.
Our team is here to provide clear information, guide you through the referral and assessment process, and help you understand the next steps.
Contact us today to find out more or start a referral.
Frequently asked questions about HPV related head and neck cancer
How does HPV actually cause cancer?
Human Papillomavirus (HPV) causes cancer when a persistent infection with “high-risk” viral strains forces healthy cells to mutate. The virus does this by producing two specific proteins, E6 and E7, which hijack the cell’s machinery, disable natural tumour-suppressing systems, and allow damaged cells to multiply uncontrollably.
What is the difference between HPV positive and HPV negative cancer?
The fundamental difference lies in the cancer’s underlying cause and molecular makeup. HPV-positive cancers are driven by an active Human Papillomavirus infection that alters tumour-suppressing genes, typically resulting in a tumour with a more favourable prognosis. HPV-negative cancers are triggered by lifestyle or genetic mutations (like tobacco or alcohol use).
HPV status can affect how the cancer behaves and how clinicians assess the diagnosis. Your clinical team will explain what your HPV status means in your individual case.
Can the HPV vaccination help prevent head and neck cancer?
The HPV vaccine can help reduce the risk of certain HPV-related cancers, including some oropharyngeal cancers (cancers of the throat, tonsils, and base of the tongue). It does not protect against all HPV strains, but vaccination can be an important part of cancer prevention strategies for eligible age groups. In the UK vaccination is recommended for children aged 12 to 13 years old and people up to 45 years at higher risk from HPV infections.
Vaccination against HPV is most effective when given before individuals become sexually active, as it prevents new HPV infections but does not treat existing ones.
Does HPV 16 pose a higher cancer risk than other types?
HPV 16 poses a significantly higher cancer risk than other types. It is the single most carcinogenic strain of the human papillomavirus, and is inherently more aggressive and responsible for the majority of all HPV-linked cancers globally.
