I have been reading about HPV's and oral cancer but I am still a bit confused. I am wondering if there is a certain type of oral cancer that is related to HPV? I have never had a positive test for HPV and I have never been a smoker or heavy drinker sometimes I really wonder why or how I got this. I know I will never have a definitive answer, but I am just not sure how HPV relates to cancer of the head and neck?

Good point. The information out there is indeed confusing.

After doing some research and reading some papers this is how I interpret the facts: The connection between HPV and cancer of the oropharynx (tonsils and base of tongue) has been proven beyond doubt. I believe the article from May 07 in the New England Journal of Medicine is crucial to make this particular connection air tight.

As far as other types of oral cancer go, as long as there is not evidence of a similar caliber as the NEJM article I am not worrying about it.

Johannes
HPV+, high grade anal pre-cancer

HPV, when infecting cells and causing them to become malignant, becomes a carcinoma of those types of cells. So in the oral environment which is lined with squamous cells, it becomes squamous cell carcinoma, variously abbreviated in the literature as SCC or OSSC (oral SCC). Have an oncogneic version of HPV (of which only a handful of the more than 112 versions cataloged so far are) does not mean that you will develop a cancer from it. Your immune system may eradicate the virus, or cells that contain it in their process of conversion, prior to the establishment of any malignancy.

http://www.oralcancerfoundation.org/HPV/index.htm

Having said that, there are anatomical sites in the oral cavity that HPV positive SCC likes to appear on; the base of the tongue and the lingual tonsils which are also on the base of the tongue, the tonsils, the tonsillar pillar, and behind that the tonsillar crypt, and lastly the oropharynx, which is the part of the pharynx that you visualize as the very back wall of your mouth. (If you look upwards from there you are looking into the nasopharynx and below that on the way down to the larynx or voice box just the pharynx itself.

These are not absolutes, and HPV positive tumors have been seen in less than 5% of the cases in other oral sites such as the anterior tongue.

HPV16 is the main bad guy, but we also see HPV33, 35, 11, and 18 occasionally - but more than 90% of the time 16 is the one. I talked with doctor Gillison at Johns Hopkins about this just this morning, as it related to eradication of HPV16 via the vaccine. My question to her was, if we eradicate HPV16 over the next generation via vaccination, would another version just take its place and cause the same numbers of oral cancers. Her answer was that in HPV type replacement opportunistically does not take place. So in the future (in a generation or more) getting rid of these cancers that are HPV caused is a reality that is possible.

The article mentioned in the above post can be read in full on the page linked to above.

One of my main questions about HPV which I cannot get an answer about and I am thinking of calling John Hopkins MYself is ....." IS there a Blood test to see if you carry the HPV Virus in General ?" does anyone have an answer for this ? Brian or Gary maybe ?

My understanding is that unless the samples from your original biospy still exist, they can't test for it post treatment. Brian may have more up to date information.

This whole subject interests me greatly since I had a tonsil cancer and haven't smoked for many years (1976) or drank for over a decade.

There is no blood test for HPV - that is not where it lives, you have to look at cells, as in the the HPV test from Digene which is being used to test for cervical cancer which has now become the national standard of care along with your pap. So you would have to have tissue from a place where it likes to go.

Confounding this further you could have it on tonsil cells but not anal or cervical cells, or any possible variation of this. So where are you going to collect it from? Even if you are positive for HPV, the test used in cervical is not specific for HPV type.... (So this test isn't valuable in oral cancer), that has to be done through a PRC test. Only a handful of HPV's are oncogenic, and even if someone has one of those there is no guarantee they will develop cancer. Any pathology department can do PRC testing, but it is expensive, and given that you may not be collecting cells from an area that currently is infected with HPV.... you are chasing your tail.

I was just wondering .. I had some Female issues ,as you know I had a hysterctomy almost 2 months ago. I had some changes to the cells of the cerivx...wasnt dysplsia at this time ...( and now is gone so dosent matter ) but the step before . however there wasnt any HPV . So I was curious just to see if there was a blood test .

Just weird all these weird issuse , which I am sure are not related. I was just myself trying to find a correlation.


Shar

If your original pathology slides are still available, Hopkins will do the PCR test on that material if there is no other tumor material available. Many centers do keep biopsy material, path slides etc. from cancer cases for a number of years (our local hospital, for example, keeps them 10 years) so an inquiry about this would not be out of the question.

If material can be located, then a visit to this Hopkins web site:

http://pathology.jhu.edu/labservices/hpv.cfm

will give the instructions on how to arrange the test. In some case insurance may pay, however in light of your possible future eligibility for a therapeutuc vaccine it would be well worth the cost even if you had to pay yourself.

Gail

In a conversation today with a virologist from NCI I was told that a blood sample could show only antibodies to HPV, meaning that at some point in your past you had an HPV infection. The antibodies are there forever. The antibodies can be sorted by strain of HPV. But since we do not know for sure if it goes dormant in your body and becomes active sometime down the road, or even multiple times down the road - or if you just get re-infected with it over and over because it is so common, there is no blood test to detect an active HPV infection. So an in situ hybridization catalyzed signal amplification test on a group of cells is the gold standard for finding it, and identifying type. The issue is where to collect it from in the mouth if there is no actual lesion to capture it from.