HPV-related Cancers

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Support for the HPV Toolkit is provided by Merck Sharp & Dohme Corp., a subsidiary of Merck and Co., Inc.

Anal Cancer

Most anal cancers are squamous cell carcinomas occurring in the anorectal junction (a squamocolumnar transition area similar to that of the cervix).26,27

Estimated incidence and mortality in the U.S. is 6,200 and 800, respectively. Populations at highest risk include men-who-have-sex-with-men (MSM) – who have anal cancer rates 17 times higher than heterosexual men- and HIV-positive individuals.28

Signs and Symptoms29,30:


While there are no consensus guidelines on screening, some experts recommend screening at-risk populations -including MSM and all HIV-positive individuals- with anal cytology.27

Patients with abnormalities detected are referred to high-resolution anoscopy (HRA), a diagnostic procedure analogous to cervical colposcopy.26,30

Vulvar Cancer

Most vulvar cancers (approximately 90%) are squamous cell carcinomas. Other vulvar cancers include adenocarcinomas (that develop in the Bartholin’s glands) and melanoma (most often occurring on the labia minora or clitoris).31

Vulvar cancer incidence and mortality in the U.S. is estimated at 4,500 and 950, respectively.32 About half of vulvar cancers are associated with oncogenic HPV.33

Risk factors for vulvar cancer31:



Vulvar precancers (Vulvar intraepithelial neoplasia or VIN) are often asymptomatic, although some patients experience persistent itching and multifocal lesions that may be lighter or darker than the surrounding skin. 34 Symptoms of invasive vulvar cancer may be similar to the precursor lesions: persistent itching, skin areas that are reddish/pink or darkened, Condyloma-like lesions, dysuria, and vulvar tenderness or pain.32

Vaginal Cancer

80%-90% of vaginal cancers are squamous cell carcinomas, the vast majority of which are related to oncogenic HPV. Incidence and mortality in the U.S. is estimated at 2,700 and 840, respectively.35

Risk factors for vaginal cancer31:



Vaginal precancers (vaginal intraepithelial neoplasia, VaIN) are usually asymptomatic, although some patients experience increased or abnormal vaginal discharge. Symptoms of vulvar cancer include a vaginal mass, abnormal vaginal bleeding/discharge, pain during intercourse, and dysuria.35,36

Head & Neck Cancer

Most HPV-related head and neck cancers are squamous cell carcinomas of the oropharynx. Incidence and mortality or oropharyngeal cancer in the U.S. is estimated at 34,000 and 6,800, respectively.37 Between 1998 and 2004 HPV-related oropharyngeal cancers increased by 225% in the U.S., compared to a 50% decrease in HPV-negative oropharyngeal cancers.38

Risk factors for oropharyngeal cancers:37


Symptoms of oropharyngeal cancers include persistent pain in the oral cavity, lumps or masses in the cheek or neck, dysphagia, pharyngitis, and chronic halitosis.37

Penile Cancer

Virtually all penile cancers (> 95%) are squamous cell carcinomas. Other subtypes include verrucous carcinoma, adenocarcinoma, melanoma, and basal cell cancers.39,40

Penile cancers are rare in most of the developed world. Incidence and mortality in the U.S. is estimated at 1,570 and 310, respectively.39

Approximately half of penile cancers are associated with oncogenic HPV infection, particularly HPV-16.41 Other etiological factors strongly associated with penile cancer include phimosis and balanitis (which many experts associate with higher penile cancer incidence in males who weren’t circumcised in childhood).42 Penile cancer is also more common in the immunosuppressed.

Penile cancers often present as lesions or masses on the glans penis or foreskin. Lesions, which may be flat or elevated, often are reddish in appearance, sometimes irritated or painful, and vary in size and distribution.39,43