re: Oral sex is a good way to get cancer

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I don't know what the dysplasia looks like grossly

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Most of the time unless it's a really advanced cancer where it starts to become friable or bleeding you don't see much of a visual change as far the surface.

Most of the time it's either noting asymmetry/fullness between left and right tonsils, base of tongue , etc. , induration., or unfortunately in the case of many of these HPV head and neck cancers -- neck nodal disease.

As more research comes out and if a definitive link is established, It's possible someone could devise a screening test in the future for high risk patients to determine who needs early intervention. But that's a long way away and we currently do not know enough to see if this would be a viable option.

We do currently test all of the oropharyngel cancers here for P16 in order to determine HPV association and prognostic factors. But testing for it in the gen pop is likely not cost effective and may have no clinical bearing in detecting early cancer.

Thanks for the info

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Aren't many forms of dysplasia visible? I keep going back to Barrett's, but that is a dysplasia frequently visible through EGD

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Barrett's happens at the gastroesophageal junction where there's a transition from squamous epithelium to glandular lining. In healthy patients you can distinctly see the transition of this. In barretts chronic reflux irritates the lining of of the squamous epithelium and causes it to change from squamous to more a glandular lining. This in effect moves the transition line up the esophagus and is visibly noted on EGD as abnormal. In addition just via the mechanism of how this occurs, there are a lot of erythematous changes due to the irritation which is also grossly abnormal.

In head and neck cancer you commonly do see dysplastic changes prior to cancer or as a sign of cancer. leukoplakia, erythoplakia, ulcerations are all things to look for in head and neck cancer.

However in the type of the head and neck cancer we are talking about which mainly affects the tonsils and base of tongue. While you can see some signs of dysplasia most commonly you pick it up based on the clinical findings I mentioned before .

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So is the idea of a PAP smear-like test feasible?

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It seems like it would be a lot more difficult because the cervix is easy to directly visualize whereas that's not the case with a lot of the recesses in the oropharynx. (If you're looking for early dysplastic changes, I don't think a blind swab of a tonsil like you'd do for a strep or Mono spot would suffice but I could be wrong).

It's also easy to get a good sample of the cervix whereas there's a lot more surface area in the oropharynx.

Since 90% of people with oral HPV infection clear it within 2 years, maybe efforts in the future will be directed at identifying those that don't clear it (assuming they have HPV 16) and monitoring them more closely though even then I can't really imagine scoping all of them would be reasonable.

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oral sex is a good way to get cancer

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I mean, If I'm forced to get cancer, I can't think of too many better ways to get it

Appreciate response

Let's say same pt asked for serology testing. Comes back positive for 18. You'd decide to wait and observe for hpv to clear since 90% clear. Comes back two years later and remains hpv 18 positive. Would that change your approach?

I honestly don't have a good answer for that. I'd hope that more research came out in that 2 year period

There just doesn't seem to be enough data regarding the progression of known oral HPV 16/18 into malignancy to know how to manage that. There are plenty of studies looking at the presence of HPV at the time of cancer diagnosis, but none looking at the natural progression in head and neck cancer that I could find. And that makes sense as it has only been recognized fairly recently.

You need another break..

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Let's say same pt asked for serology testing. Comes back positive for 18. You'd decide to wait and observe for hpv to clear since 90% clear. Comes back two years later and remains hpv 18 positive. Would that change your approach?

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Probably not. I would guess there's a paucity of studies relating to your questions. I still think we do not know enough about the pathophysiology and natural history of HPV infections in the oropharynx.

Even if HPV clears in a patient, i.e. the virus is no longer present in the tissue, does that preclude an indvidual from developing an oropharyngeal cancer or has permanent damage on the cellular level occurred enough for it not to matter? What percentage of people who remain seropositive for HPV go on to develop cancer? How many of these people would you have to treat in order to prevent one incidence of cancer?


What approach changes would you institute? Tonsillectomies and direct laryngoscopy with biopsies for all people who remain HPV positive after X number of years? Who knows. We don't know enough about the process of how this occurs before we start recommending preventative and treatment strategies.

Maybe some of the above questions have already been answered on in the works. I'm not that up to date on HPV in oropharyngeal cancers at this time. But my guess is that there will likely be a push for expanding the vaccination of people prior to anything more invasive just based on the effect it had on cervical cancer and it being a pretty low risk intervention.