The Viral Connection of HPV with Cancer
Cervix, vagina, anus, and oral cavity cancers have been associated with the human papillomavirus or HPV. Human papillomavirus (HPV) is so common that nearly sexually active people are exposed to it at some point. While most people never know they have the virus, some with high-risk HPV infections experience the cervix, anus, vulva, vagina, penis, or oropharynx (back and sides of the throat, tonsils and base of the tongue) or a combination of these cancers. Low-risk HPV types can cause genital warts that can be seen in the genital and anal areas, as well as in the mouth and throat.
Mamta Singhvi, a radiation oncologist in Los Angeles and a board member of the American Society for Sexual Health, reports that there is likely to be some form of genital HPV infection in the teens or early twenties. In most healthy young people, the immune system destroys the HPV virus within a few years. However, some HPV infections persist, according to the Centers for Disease Control and Prevention (CDC), HPV infections cause cancer in more than 20,000 women and 13,000 men each year in the USA. This article contains information about the connection between HPV and cancers of the cervix, vagina, anus and oral cavity and what it can do to prevent it.
Cervical Cancer and HPV
The cervix is the passageway from the uterus to the vagina. It consists mostly of connective tissue and muscle, and when viewed from the vagina, it looks a bit like a donut. The American Cancer Society estimates that approximately 13,170 new cases of invasive cervical cancer will be diagnosed in the US in 2019, and approximately 4,250 women will die of cervical cancer. Almost all cases are caused by early infection with high risk strains of the HPV virus. According to Singhvi, people who have more sexual partners and start having sex at a younger age may have a higher risk of HPV infection. Smoking also increases the risk of HPV because it impairs the immune system and makes it more difficult to fight the virus. However, as an HPV vaccine, it is possible to reduce the risk of cervical cancer by using condoms, in a monogamous relationship, and by regular cervical cancer screenings. The sooner precancerous cell changes are found, the more they can be treated.
“Only if someone goes away without control for years or has a particularly aggressive type of HPV that turns into cancer,” says Singhvi. Women often have no symptoms of early-stage cervical cancer. However, after the cancer has progressed, warning signs may appear. There are possible symptoms of cervical cancer and these are:
- Vaginal bleeding after sex
- Pain during sex
- Unusual bloody vaginal discharge between periods
- Bleeding longer or heavily than normal periods
- Postmenopausal bleeding
Most precancerous symptoms can be detected with a Pap smear before the condition progresses to cancer. According to the cervical cancer screening guidelines of the American College of Physicians, women should start receiving Pap smears at the age of 21 and have the test every three years until the age of 29. Between the ages of 30 and 65, a Pap test combined with HPV testing every five years or a Pap test every three years should be done if an HPV test is not available. If the Pap smear has abnormal results, the doctor orders a test to determine if the HPV strain is high or low risk. If there is a high-risk strain, in-office procedures such as LEEP (loop electric excision procedure) to remove bad cells can allow healthy tissue to grow in place. David Chelmow, head of obstetrics and gynecology at Virginia Commonwealth University School of Medicine in Richmond, recommends more frequent Pap and HPV testing after these procedures until the results are clear. If the risk of HPV infection turning into cancer is higher, more frequent screening may be required. Risks include having a weak immune system, having a human immunodeficiency virus (HIV), or taking immunosuppressant medications.
Vaginal Cancer and HPV
Each year, about 5,350 women are diagnosed with vaginal cancer in the United States, and about 1,430 people die from the condition. HPV is found in most cases of vaginal cancer, according to the American Cancer Society, although it is not the only risk factor: Smoking doubles the risk of vaginal cancer. Debbie Saslow, senior director of HPV-related and American Cancer Society women’s cancers, notes that the signs and symptoms of vaginal and vulva cancers are similar to cervical cancer. These symptoms are as follows:
- Abnormal vaginal bleeding
- Pain, especially during sexual intercourse
- Unusual vaginal discharge
If a person has any of these symptoms, they should consult their doctor immediately.
Anal Cancer and HPV
Another cancer that can be caused by HPV is anal cancer. According to the American Cancer Society, there are about 8,300 new cases of anal cancer each year in the United States, with approximately 5,530 cases in women and 2,770 in men. In addition, approximately 1,280 people die from anal cancer every year in the USA. Joel Palefsky, an infectious disease specialist and professor of medicine at the University of California in San Francisco, reports that anal sex is not the only way to get HPV that causes anal cancer. Women can get this virus even without having anal sex, and there is a clear relationship between infection in the cervix and infection in the anus.
Other risk factors are chronic inflammation, skin tears near the anus, being HIV positive, and taking immunosuppressant medications. Additionally, women with cervical cancer, precancerous cervical cells, or HPV-related cancer or precancer of the vulva are at slightly higher risk. Doctors don’t have specific guidelines for when to screen for anal cancer. All women should go to primary health care institutions for screening. The average healthy woman does not need to be screened unless she is in a risk group or has symptoms. HIV-positive patients should be screened annually for anal cancer, and those who are at high risk but do not have HIV should be screened every two to three years. Like cervical cancer, anal cancer shows no symptoms until it progresses. In its advanced stages, there are symptoms of anal cancer. These symptoms are as follows:
- Lumps near the anus
- Tenderness or hard spots in the area
- Anal bleeding or discharge
- An unusual change in bowel movements (constipation or loose stools)
Hemorrhoids that don’t go away after treatment
He reports that anal cancer has been discovered in many patients after experiencing recurrent anal bleeding and undergoing surgery to remove hemorrhoids. Doctors can detect anal cancer with digital anorectal examination. During this test, the doctor uses a gloved finger to feel a lump or lump that could indicate cancer. Another type of scan known as cytology is similar to a Pap smear. The doctor uses a swab to collect anal cells to look for precancer or changes that suggest cancer.
Oropharyngeal Cancers and HPV
According to CDC estimates, approximately 14,800 HPV-related oropharyngeal (mouth and throat) cancers are diagnosed in men in the United States each year, and another 3,400 cases are diagnosed in women. Frequent, heavy alcohol consumption and tobacco use also increase the risk of oropharyngeal cancer, but cancer is linked to HPV infection in all three cases, according to the American Cancer Society. There are symptoms that may indicate oropharyngeal cancer, and these include:
- Sore throat that doesn’t go away
- Pain or difficulty swallowing
- Trouble opening mouth completely
- A lump in the throat or neck area
- A white patch on the tongue or elsewhere in the mouth that doesn’t go away
However, like many cancers, oropharyngeal cancers have a higher chance of recovery when caught early, so a person should consult a doctor if they have any of these signs or symptoms.
Preventing HPV Infection
Both American Obstetricians and Gynecologists and the CDC recommend vaccination against HPV at age 11 or 12 for both boys and girls, but it can be done as early as 9 years old and as late as 45 years old. The vaccine, Gardasil 9 (human papillomavirus 9-valent), currently available in the United States, protects against infections caused by both HPV 16 and 18, which causes most of the virus-related cancers and five other types that can cause cancer. These types are 31, 33, 45, 52 and 58. Other ways to reduce the risk of HPV infection are to use latex condoms each time you have sex and to have sex only with someone who has sex with you.