Uncovering the link between HPV and head and neck cancer

Gaps in our knowledge

It is well-known that HPV can cause cancers of the genital tract - predominantly cervical cancer - and we now know that HPV is also associated with a subset of head and neck cancers. These are cancers that arise in the tonsils and base of the tongue (oropharyngeal cancer). We also know that men are particularly at risk of developing these oropharyngeal cancers.

However, there are still huge gaps in our knowledge about HPV and oropharyngeal cancer. Dr Elizabeth Marsh, Associate Professor in Cellular and Molecular Biology, explains: “Despite a thorough understanding of the natural history of HPV within a cervical infection, it is still not clear how HPV causes head and neck cancer.

"There are also no screening practices, so most head and neck cancers are not diagnosed until they are in late stage. Therefore, we believe our study will not only improve early detection but also help us to understand the pathophysiology of this disease."

Analysing DNA from tonsils

Thanks to work undertaken over the last couple of years, our research team from the Human Science Research Centre have already developed a new screening method that detects HPV in the mouth. It uses a specialist technique called real-time quantitative PCR.

They are now using this screening method to analyse DNA taken from the tonsils and mouths of patients from the Royal Derby Hospital, looking specifically for the presence of HPV.

Dr Marsh explains the approach: “For our clinical study, we are recruiting patients who are having their tonsils removed as a routine operation - so they are otherwise healthy. We collect their left and right tonsils and a swab of the inside of their mouth.”

These clinical samples will enable the researchers to examine the natural history of HPV in the tonsil. This is where oral HPV infections establish and where pre-cancerous changes occur. If a sample tests positive for HPV, they will then identify:

• the viral type
• the amount of virus within the sample
• whether it is an active and pathogenic infection

This should shed light on the viral lifecycle and natural history of HPV within the mouth, which could help develop more effective drugs and treatments.

How lifestyle affects risk

Patients will also be asked to fill in a questionnaire about lifestyle behaviours that are thought to be risk factors for the disease: drinking, smoking and sexual practices.

Through careful analysis of the questionnaire responses combined with the screening results, the team are hoping to find out more about how these lifestyle factors influence the development of HPV.

If a list of risk factors can be identified for oropharyngeal cancer, health professionals and charities could then undertake more accurate and better targeted public health campaigns.