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Link Between HPV Infection and Oral Cancer

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Human papillomavirus-linked lesions may be either benign or malignant. Read the article to know its pathogenesis, routes of infection, and management.

Medically reviewed by

Dr. Gayathri P

Published At June 30, 2022
Reviewed AtDecember 1, 2022

What Diseases Are Linked to HPV Virus?

Human papillomavirus (HPV) infection in the last few decades has gained the attention of physicians, dental surgeons, and researchers as it is an endemic affecting public health due to its potential linkage to cause cancers. HPV infection has been recognized as a standard and frequent sexually transmitted disease affecting the genitals and oropharyngeal cavity. The increased incidence of HPV-linked squamous cell carcinoma (SCC) in the head and neck region is also attributed to this viral infection.

Epidemiologic data suggest that HPV infections are responsible for making an individual 14-fold more prone to oropharyngeal cancers, cancers of the tonsils, or affecting the base of the tongue more frequently. According to traditional research, the spread of genital and oral HPV infections has been linked to an increased number of partners or high-risk sexual behavior in the younger population. It is prevalent among adults between 20 to 60 years of age.

HPV infections can be mainly distinguished in their ability to be of a high-risk oncogenic type that can predispose the individual to the developmental of malignant lesions, anogenital cancers, and oral squamous cell carcinomas, and the second type of HPV infections has the potential to cause benign papillomas, warts, and hyperplasia in the same regions.

As per research for cervical HPV infections, the virus first penetrates the cutaneous layers of the hands and feet, consequently the mucosal surface of the upper aerodigestive tract and then the anogenital regions and the urethra. This may explain why people with persistent HPV infections may be predisposed to develop cervical or anogenital cancers.

How Is Oral HPV Classified?

The lesions in the oral mucosa may range from the flat, papular, or plaque-like structure that may be grayish, white, or reddish. Clinically, they may be asymptomatic or associated with trouble chewing or swallowing. The oral HPV infections can be grouped as follows:

  • Benign Lesions.

  • Focal epithelial hyperplasia.

  • Squamous cell papilloma.

  • Verruca vulgaris, etc.

  • Potentially Malignant Lesions.

  • Malignant Lesions.

  • Oral squamous cell carcinoma.

  • Verrucous carcinomas.

What Is the Structure and Pathogenesis of HPV?

The HPV proteins are double-stranded DNA viruses surrounded by a material of icosahedral capsid. These capsid proteins are mainly composed of primary (L1) and minor (L2) capris proteins along with capsomeres. The viral replication by this cell machinery is a highly regulated process for the infection of the host cell by producing mature virion particles. Soon after the HPV cells infect the host cell body, the dynamic changes in the leukocytes right from the basal to the superficial layer in the orogenital regions cause a suitable microenvironment for this viral cell replication.

Specific HPV cell receptors (like alpha six integrin, heparan sulfate proteoglycans, and extracellular laminin 5) act to enter the viral pathogen into the host cells through micro-wounds of the epithelium. As the viral genome remains active, the infection spreads up the layers of the basal, parabasal, and then the higher layers of the epithelium with the formation of complete virions. The viral cells then finally undergo desquamation after being expelled from the epithelial layers and then transmitted by direct contact (as in the case of genital warts) or in the form of indirect contact as well.

What Is the Route of Spread?

Though the genital route of HPV infection spread remains sexual, that is due to sexual contact with an infected partner, cases of vertical transmission extending to virgins, infants, and children are also reported and possible. This vertical nonsexual transmission might be feasible as the virus gets inoculated and spreads through three main routes, namely:

  • Periconceptual route - HPV transmission around the time of fertilization.

  • Prenatal route - HPV transmission during pregnancy.

  • Perinatal route - HPV transmission around the time after the birthing process.

How Are Oral HPV Lesions Treated?

HPV lesions genitally are treated by the gynecologist or the general physician suggest the following:

  • Local or systemic administration of cytotoxic and immunomodulatory drugs for treating the infection (for example, Podophyllin, Podophyllotoxin, Cidofovir drug therapies, immunomodulatory drugs like Imiquimod, and targeted molecular therapies).

  • For the elimination of genital lesions, surgical and ablative therapy with electrocautery, cold knife, or laser under local anesthesia may be performed.

  • For lesions like anogenital warts and condylomas, cryosurgery, electrocautery, cryotherapy with liquid nitrogen, or lasers are used.

  • The management of oral HPV infections is usually based upon the complete elimination of the virus by follow-up of the HPV DNA test in the patient after eight to 12 months following antiviral therapy.

  • Tested antiviral drugs like Acyclovir and Ribavirin are proved to effectively reduce the viral load, as suggested by the physician.

Conclusion:

To conclude, HPV lesions need the earliest possible diagnosis and drug-based or surgical intervention by the oral surgeon and the gynecologist or physician to establish a long-term prognosis for these individuals and prevent these lesions from potentially developing into fatal cancers. In addition, the dental or maxillofacial surgeon can diagnose the HPV infection by oral sampling, which involves biopsy or cytology procedures to prevent and estimate the risk of oral cancers.

Frequently Asked Questions

1.

How Long Does It Take for HPV to Cause Mouth Cancer?

A person can have an HPV infection for up to ten years before developing cancer. Each year, the CDC projects that around 11,600 Americans will receive a head and neck cancer diagnosis.

2.

Is It True That All HPV Strains Cause Mouth Cancer?

Infection with any possibly cancer-causing HPV type does not predict cancer risk. This is due, in part, to the fact that certain HPV kinds are far more carcinogenic than others. In fact, one kind, type 16, is estimated to cause more than 90 percent of all HPV-driven oropharyngeal malignancies.

3.

Which Malignancies Are Associated With HPV Infection?

 
Women are more likely to develop cervical cancer from HPV, while men are more likely to develop oropharyngeal malignancies (cancers of the back of the throat, including the base of the tongue and tonsils).

4.

Is It Possible to Have Oral HPV Without Developing Cancer?

When an oral HPV infection occurs, the majority of people never go on to develop the malignancy. The majority of infected individuals, however, often recover from the infection on their own within a year or two of contracting it, without the need for any kind of therapy or treatments.

5.

What Proportion of HPV Causes Cancer?

Around 60,000 men and 570,000 women are thought to get HPV-related cancer each year, making high-risk HPVs responsible for around five percent of all malignancies globally

6.

What to Do to Find Out if A Person Has HPV in Mouth?

There is no test that can tell if someone has HPV in the mouth. A cancer screening may lead to the dentist or doctor finding lesions.

7.

Is It Possible to Treat Oral HPV?

Infection with oral HPV is currently untreatable. The majority of infected individuals, however, often recover from the infection on their own within a year or two of contracting it, without the need for any kind of therapy or treatments.

8.

How Can HPV Mouth Cancer Appear?

A lump that is uncomfortable and does not go away in three weeks is one of the warning signs of oral cancer. When trying to swallow, individuals may experience difficulties or the sensation that their food is stuck together.

9.

How Often Is HPV Cancer of the Mouth?

According to CDC data, seven percent of people have oral HPV, but just one percent of those people have the kind of oral HPV linked to head and neck cancer. These oral malignancies might only be brought on by HPV if they persist in the body for many years, typically decades. Even then, only a very tiny percentage of individuals will experience an HPV infection that progresses into an oral cancer.

10.

Is Oral HPV Dangerous?

Oropharynx malignancies can be brought on by HPV infections in the mouth and throat. In the United States, oropharyngeal malignancies are considered to be 70 percent HPV-related.

11.

Why Is the Body Not Getting Rid of HPV?

Some people's bodies may have an immune system that makes it simpler for them to fight HPV than others. They believe that some lifestyle choices, such as smoking, might make it more difficult for the body to eliminate HPV.

12.

Can Oral HPV Be Transmitted by Kissing?

While kissing may or may not represent a major risk of HPV infection. The following are the very effective transmission pathways:
 - Vaginal.
 - Anal.
 - Oral sex.

13.

What Vitamins Should One Take to Combat HPV?

The following vitamins help in combating HPV
 - Antioxidants like vitamin C support a healthy immune system.
 - Another antioxidant, vitamin E, may promote the immune system. 
 - Beta-carotene.
 - Zinc.
 - Selenium.
 - Lycopene and other nutrients.

14.

What Kind of HPV Is Present in the Mouth?

Most HPV-related oral malignancies are caused by the HPV strain known as HPV 16. Symptoms of oral cancer are common, especially as the disease progresses. An uncomfortable or painful lump that does not go away after three weeks is one of the signs and symptoms of oral cancer.
Source Article IclonSourcesSource Article Arrow
Dr. Achanta Krishna Swaroop
Dr. Achanta Krishna Swaroop

Dentistry

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