HPV infection and nose, mouth and throat cancers: what do we need to know?

HPV is a very common virus, making up a family of more than 100 different varieties. Depending on the type and family to which the viral strain you come in contact with belongs, the effects of infection are very different: 

• non-symptomatic in some cases;
• responsible for verrucoid lesions in others;
• cause of malignant tumors in more severe cases, predominantly belonging to strain 16.

In particular, HPV is responsible for almost all cervical cancers, about 95% of cancers of the anus, 26% of cancers of the oropharynx in Italy and 70% in the US, 65% of vaginal cancers, 50% of vulvar cancers and 35% of penile cancers.

HPV is spread when diseased skin and mucous membranes come into contact with those of a healthy person, for example, during vaginal, anal, and oral sex. For this reason, the habit of practicing with multiple partners and promiscuity of sexual intercourse are considered high-risk behaviors. 

The infection is often asymptomatic, and tumors sometimes develop long after infection, so the patient often does not realize he or she has contracted it and the doctor cannot date when the virus was contracted.

Secondary prevention, represented by annual gynecological checkups according to the guidelines, pap test and HPV test, even for women vaccinated against the virus, is therefore essential. 

For men, on the other hand, no special testing is necessary since there is no standardized routine screening method, but vaccine is still recommended as a method of primary prevention of the disease.

To date, there is no cure for HPV infection. People often recover without symptoms and without even realizing it: about 90% of infections have a spontaneous course with resolution by the production of antibodies by the immune system. 

However, some viruses, such as HPV 16 and 18, are more aggressive than others. Infection does not evoke a detectable immune response that can also lead to reactivation of the virus over time.

Primary prevention is vaccination, in addition to adopting healthy lifestyles: cervical cancer can be prevented by a vaccine against the most common HPV types, recommended for males and females. 

In addition, whenever you have vaginal, anal, or oral intercourse, it is recommended that you use a condom or thin rectangular sheets of soft latex or silicone that cover the mucous membranes during oral sex. 

Most patients who contract the infection overcome it without sequelae. However, some people are unable to heal, and the virus lurks in the cells, creating a kind of chronic inflammatory stimulus that over the years causes cellular damage to the point of tumor degeneration. 

When a tumor is diagnosed among those that can be correlated with the virus (e.g., of the oropharynx or cervix), the intracellular presence of HPV is also tested: this is the only way to ascertain the involvement of the virus.

Patients with HPV related to oropharyngeal cancer respond better to cancer treatments than those with the same non-HPV cancer. The treatment decision is made based on the stage, location, size, and general condition of the patient, while also considering any other conditions the patient may have.

Studies show that patients who have had HPV-related cancer, regardless of severity, have a significant likelihood of developing other HPV-related cancers up to 25 years after diagnosis.

Heavy smokers and drinkers are at higher risk of developing mouth, nose, and throat cancers, and, although HPV-related oropharynx cancers can arise independently of these risk factors, they: 

• worsen inflammation;
• increase the risk of cancer occurrence;
• worsen the prognosis once they arise. 

Indeed, it has been shown that patients who are heavy smokers and heavy drinkers live shorter lives and are more likely to develop cancers that respond less effectively to treatment. 

Oropharyngeal cancers caused by the papilloma virus can be prevented by abstaining from smoking and alcohol and vaccinating against HPV: it has been shown that as the number of antibodies increases, the chance of developing a virus-related cancerous lesion decreases. Vaccination makes it possible to: 

• achieve a 100% response to infection, preventing the virus from escaping the immune system;
• promote significantly greater antibody production with a persistent immune response over 14 years after vaccination without immunological boosters;
• prevent virus reactivation even in patients already exposed to the virus.

The newest commercially available HPV vaccine, Nonavalent, is available at the HPV Vaccine Center at Ospedale San Raffaele. This is the most comprehensive formulation protecting against infection with 9 HPV strains, unlike the previous quadrivalent vaccine. In fact, in addition to types 16, 18, 6, and 11, it protects against infection of an additional 5 high-risk viral strains - 31, 33, 45, 52, and 58 - reducing neoplastic risk by additional 10-15%.

For individuals who for some reason did not fall under the free SSN vaccination call in the 9-12 age group, there is the option of vaccination at a reduced cost compared to individual purchase. This option is open to both males and females up to the age of 45.