As discussed in Part One of this blog, HPV is the leading cause of oropharyngeal (tonsils and base of the tongue) cancer. Oral cancer caused by HPV is very serious, and most patients aren’t even diagnosed until they present with symptoms because the symptoms are often painless and subtle. Physicians are enlisting the help of the dental profession in assisting with detection, diagnosis, and referral for treatment. In this blog, we’ll discuss the difficulty in diagnosis, symptoms, and treatments of HPV related oral cancer.
Difficult to Diagnose-
HPV is present in millions of males and females. In most cases, it clears on its own and treatment isn’t necessary. It rarely causes any symptoms making it very difficult to detect. There are many oral cancer detection kits on the market, but none are accurate in detecting HPV related cancers. Paying close attention to the patient’s medical history and any unusual lumps or lesions is imperative in helping with detection. It’s necessary to have a conversation regarding the seriousness of HPV related oral cancers and the availability of the HPV vaccine.
Symptoms are rare, and if they do appear, it’s most likely that the cancer has been present for a while. While the symptoms listed aren’t necessarily linked to HPV oral cancer, it’s prudent to take detailed notes and have the patient return to your office if any of the following are present for two to three weeks or longer.
- A painless lump present on the outside of the neck with a duration of at least two weeks
- Numbness in the lips or mouth
- A persistent cough or coughing up blood
- A unilateral earache lasting for at least two weeks
- A recurrent ulcer or sore that doesn’t heal after two weeks
- A black, red, or white discolored patch on the soft tissue
- Difficulty in swallowing or the feeling that something is stuck in the throat
- Unilateral painless and inflamed tonsil. Both tonsils should be approximately the same size
- An ongoing sore throat or hoarseness
If oral cancer is suspected, it’s crucial that the patient is referred to an oral surgeon, periodontist, or an ENT immediately. Upon examination by a specialist, a laryngoscope or pharyngoscope may be utilized to explore the base of the tongue and tonsillar areas. A biopsy of the suspect tissue will be taken. Depending on the results of the biopsy, a treatment plan will be created which may include surgery, radiation therapy, chemotherapy, or all three. Sometimes, surgery is sufficient. With any treatment, reconstructive surgery may be necessary.
HPV related oral cancers can be prevented with the vaccine and safe sex practices. Although this discussion may be awkward, it’s necessary to educate patients and parents about the devastation caused by this growing crisis.