HPV Cancer

The experienced cancer specialists at UT Southwestern Medical Center offer the latest advancements in care for cancers caused by human papillomavirus (HPV). Through advanced screening, diagnosis, surgery, radiation therapy, and chemotherapy, we provide the best possible outcomes to help our patients live their healthiest lives.

As the only National Cancer Institute (NCI)-designated Comprehensive Cancer Center in North Texas, we deliver the best cancer care available today and push to discover new treatments. NCI designation means we offer patients the ability to participate in the broadest possible range of clinical trials, with access to potential therapies not available at other facilities.

Specialized Care for HPV-Related Cancer

Human papillomavirus (HPV) is a group of more than 200 viruses, about 40 types of which can be spread through direct sexual contact. Some of these are low-risk HPVs, which can cause genital warts or other noncancerous growths. Other HPVs are high risk and can lead to cancer.

HPV is the most common sexually transmitted infection in the United States. The Centers for Disease Control and Prevention (CDC) estimates that more than 90 percent of sexually active men and more than 80 percent of sexually active women will be infected with at least one type of HPV at some point in their lives. About half of these infections involve a high-risk HPV that can cause cancer. 

UT Southwestern is ranked among the nation’s top 20 hospitals for cancer care (#19) by U.S. News & World Report. Our cancer physicians and their oncology-trained teams provide expert, compassionate care for people of all ages with any type of cancer. As an academic medical center, we’re focused on tomorrow’s cancer care today, by training health care providers and conducting research.

UT Southwestern is also a leader in HPV research. A study led by Dr. Jasmin Tiro found that a multicomponent outreach program increased completion of the three-dose HPV vaccination series that reduces the risk of cervical cancer caused by the virus. Dr. Tiro serves as co-leader of the Population Science and Cancer Control Program.

Cancers Associated With HPV

HPV can cause several types of cancer, including:

• Anal cancer
• Cervical cancer
• Oropharyngeal cancer
• Penile cancer
• Throat cancer
• Tonsil cancer
• Vaginal cancer
• Vulvar cancer

Causes and Risk Factors of HPV-Related Cancer

High-risk HPV infections develop in epithelial cells, which form layers of skin covering the outside of the body. Epithelial cells also line certain surfaces inside the body such as the vulva, vagina, penis, anus, and throat.

When an HPV infects an epithelial cell, the virus produces certain proteins that interfere with normal cell growth. These proteins cause cells to grow uncontrollably and also prevent cells from dying at a normal rate.

In most cases, the body’s immune system recognizes and destroys HPV-infected cells. But sometimes the HPV infection persists and abnormal cells continue to grow. These cells first form precancerous cells and, if undetected, continue to become a cancerous tumor.

Certain factors can increase the risk that an HPV infection will become cancer, such as:

• Tobacco use, including smoking or chewing (for cervical, oropharyngeal, or tonsil cancer)
• Poor oral hygiene (for oropharyngeal or tonsil cancer)
• Weakened immune system
• Chronic inflammation
• Multiple sexual partners

Additional risk factors for cervical cancer include: 

• Early onset of sexual activity
• Multiple sexual partners
• A high-risk sexual partner
• History of sexually transmitted infections
• History of vulvar or vaginal squamous intraepithelial neoplasia or cancer (HPV infection is also the cause of most cases of these conditions)
• Immunosuppression

HPV-Related Cancer: Screening and Prevention

Vaccines are available to prevent infection with the types of HPV that lead to anal, cervical, vaginal, and vulvar precancers and cancers. Gardasil 9® is the HPV vaccine used in the United States.

The CDC recommends the vaccine primarily for boys and girls ages 11 to 12, and the vaccine an be given at any time between the ages of 9 and 26. In fall 2018, the U.S. Food and Drug Administration approved Gardasil 9® for men and women between the ages of 27 and 45.

Screening for cervical cancer is very effective and includes:

• HPV test, which checks for the presence of DNA from HPV in cervical cells
• Pap test, which checks for abnormal cells on the cervix

The primary screening test for anal cancer is a colonoscopy. Find out more about early detection and screening for cancer.

Some ways to decrease the risk of HPV infection include:

• Limiting the number of sexual partners
• Using condoms or dental dams during vaginal, oral, or anal sex

No screening tests are available for throat, oropharyngeal, tonsil, or penile cancer. Learn more about head and neck cancer awareness and prevention.

Diagnosis of HPV-Related Cancer

UT Southwestern’s experienced cancer specialists conduct a thorough evaluation, which includes a:

• Physical exam
• Discussion of personal and family medical history
• Discussion of symptoms and risk factors

We often recommend further tests to confirm a diagnosis. Depending on the type of HPV-related cancer that is suspected, patients might need to have one or more of the following tests:=

• Biopsy: Our doctors take a small tissue sample that a pathologist analyzes under a microscope for the presence of cancer.
• Colposcopy: We apply vinegar to the cervix, vulva, and/or vagina and examine the areas with a microscope. Biopsies of concerning areas may be performed.
• Endoscopy: We use an endoscope (a thin, flexible tube tipped with a lighted camera) inserted into the anus or the vagina to check for precancerous or cancerous cells.
• Laryngoscopy: We sometimes use an endoscope, which is inserted through the nose, for a closer look into the throat.
• Pelvic exam: Doctors conduct an internal and external exam of a woman’s reproductive organs, including the vulva, vagina, cervix, uterus, and ovaries.
• Computed tomography (CT) scan: CT uses specialized X-rays with or without a contrast agent to produce cross-sectional 3D images of internal structures.
• Magnetic resonance imaging (MRI) scan: An MRI uses radio waves and a strong magnet, with or without a contrast agent, to produce detailed images that can show the presence of cancer and whether it has spread to nearby lymph nodes.
• Positron emission tomography (PET)/CT scan: Using small amounts of radioactive materials and a special camera, PET scans produce highly detailed images that can detect cancerous cells. At UT Southwestern, we use combined PET and CT scanning equipment to produce enhanced images to help detect abnormal tissue that might be cancer. PET scanning shows body functions such as blood flow and sugar metabolism, and CT scans provide detailed anatomical information on organs, bones, soft tissue, and blood vessels.
• Ultrasound: Using sound waves and a computer, our imaging technicians produce images of internal structures.

Treatment for HPV-Related Cancer

Treatment options vary based on the type and stage of cancer, which includes its size, location, and whether it has spread.

We use the following treatment options for HPV-related cancers, sometimes in combination:

• Surgery: Patients with early-stage cancers might need only surgery, whereas advanced cancers might require other treatments after surgery, known as adjuvant therapy. 
• Radiation therapy: Our doctors use radiation, treatment with high-energy waves such as X-rays or gamma rays, to treat cancer. Radiation therapy can destroy cancer cells left after surgery, and it can also treat inoperable tumors. 
• Chemotherapy: Anticancer medications work to destroy cancer cells and prevent them from spreading. We sometimes use chemotherapy during radiation therapy or surgery to destroy as many cancer cells as possible. Chemotherapy can also treat cancer that has spread to other areas of the body (metastatic) or cancer that returns after treatment (recurrent). 
• Chemoradiation: Chemotherapy given at the same time as radiation therapy is known as chemoradiation. This combination treatment can be given before surgery to shrink the tumor or after other treatments to lower the risk of recurrent cancer. We sometimes use chemoradiation as adjuvant therapy after surgery or radiation or for metastatic or recurrent cancer.
• Immunotherapy: This type of medication enhances the immune system’s natural ability to destroy cancer cells. Immunotherapy is FDA-approved only for a subgroup of patients with recurrent cervical cancer.
• Targeted therapy: Certain anticancer medications target a specific characteristic of a cancer cell, which can be detected through specialized testing. Targeted therapy is frequently used in patients with recurrent cervical cancer. People whose cancers have these characteristics can be treated with targeted therapy, usually in combination with radiation or chemotherapy. We sometimes use targeted therapy as adjuvant therapy after surgery or radiation or for metastatic or recurrent cancer.
• Reconstructive surgery: Patients with advanced throat cancers might need reconstruction after cancer surgery. Our plastic surgery and ENT experts work together to restore swallowing and other oral functions for a more natural appearance of the throat and neck.

For patients who are having radiation therapy for throat cancers, we recommend having any necessary dental work done before treatment. Radiation treatment slows healing and can cause other side effects. Learn more about cancer and transplant dental care.

Support Services

We offer a variety of cancer support services for patients and their families, such as:

• Oncology rehabilitation
• Integrative therapies
• Nutrition counseling
• Support groups

Clinical Trials

As a medical research institution, UT Southwestern frequently conducts cancer clinical trials, giving our patients access to the newest treatments. Patients should speak with their doctors about the availability of clinical trials.