A painless lump in the side of the neck that does not go away is one of the more common first signs of HPV-related throat cancer. That is part of why this cancer is easy to miss: it often turns up in people who feel well, have never smoked, and are not expecting a mouth or throat problem.
The link between human papillomavirus (HPV) and cancer at the back of the mouth is now well established. Looking ahead, the HPV types behind most of these cancers are covered by the vaccine given free to Australian adolescents.
The cancers HPV is linked to sit further back
Doctors separate cancers of the mouth itself (the tongue, floor of the mouth, gums, cheeks and lips) from cancers of the oropharynx, the part of the throat just behind the mouth that includes the tonsils and the base of the tongue. HPV is mainly linked with the second group.
Australian data show how much this has changed. In Queensland tumour samples, the share of oropharyngeal cancers containing HPV rose from 45 per cent in 2009 to 2011 to 68 per cent in 2019 to 2021 (Yaksich and colleagues, International Journal of Cancer, 2026). HPV-16 was by far the most common type found. The same study found HPV was more common in tumours from men than women. Nationally, an analysis of Australian Cancer Database figures (Fan and colleagues, Oral Diseases, 2023) found oropharyngeal cancer in men rose by about 5 per cent a year between 2007 and 2017, with a much slower rise in women.
Most HPV infections never cause harm
HPV is a very common group of viruses spread through intimate skin contact. Most infections are cleared by the immune system and cause no problems. In a small minority, a high-risk type persists and, over many years, interferes with the normal controls on cell growth. That long delay means a cancer found in someone in their fifties or sixties may relate to an infection decades earlier. Having had HPV, or having it now, does not mean you will develop cancer.
How HPV-related throat cancer tends to differ
| Cancer linked mainly to smoking and alcohol | HPV-related oropharyngeal cancer | |
|---|---|---|
| Usual site | Tongue, floor of mouth, cheeks, lips | Tonsils and base of tongue |
| Who it often affects | People with a long history of smoking or heavy drinking | Often people who have never smoked |
| Common first sign | An ulcer, lump or red or white patch in the mouth that does not heal | Often a painless lump in the neck |
| Outlook | Varies with stage and site | Generally better than HPV-negative throat cancer |
A few details sit behind that table. In an Australian series of 515 patients (Hong and colleagues, Head and Neck, 2016), about a third of people with HPV-positive throat cancer had never smoked. In a United States study of 101 people with HPV-associated throat cancer (Raman and colleagues, American Journal of Otolaryngology, 2019), 65 first presented with a neck lump, which also means a sizeable minority did not. And in an analysis of patients from a large treatment trial (Ang and colleagues, New England Journal of Medicine, 2010), people with HPV-positive tumours had better three-year survival than those with HPV-negative tumours.
Symptoms that should not be left to wait
Most of these have harmless causes. What matters is that they persist. See your GP or dentist if any of the following has not settled within 3 weeks:
- a lump in the neck, even if it is painless;
- a sore throat, or a feeling of something stuck when you swallow;
- pain or difficulty swallowing;
- an ulcer or a red or white patch in the mouth that has not healed or has changed (our guide to mouth ulcers explains which ones are usually harmless);
- hoarseness or a change in your voice;
- an ear ache on one side without an obvious cause.
A neck lump or ongoing throat or swallowing symptoms should be seen by a GP, who can arrange tests or a referral. A dentist can examine the mouth, but the oropharynx is partly out of view.
The vaccine is the main form of prevention
Under the National Immunisation Program, a single dose of HPV vaccine is given free at school to boys and girls aged 12 to 13. People who missed it can have a catch-up dose up to age 25. The vaccine used in the program covers nine HPV types, including 16 and 33, the two most common types found in the Queensland throat cancer samples. Vaccination works best before any exposure to the virus, which is why it is given in early adolescence. The program began with girls and was later extended to boys, so many adult men were never offered it. Your GP can advise on whether vaccination makes sense for you.
There is currently no screening test for oral HPV or for throat cancer in the way there is cervical screening. Not smoking and keeping alcohol within recommended limits lower the risk of the other group of mouth cancers and help oral health generally.
Where a dental visit fits
At a routine examination, the dentist or OHT looks at the tongue, floor of the mouth, cheeks, palate and the visible part of the throat, and may feel the neck and under the jaw. It takes a minute or two and does not hurt. Anything unusual can be photographed, reviewed or referred. Our oral cancer screening guide explains what is checked. This check complements, rather than replaces, seeing a GP about a neck lump or throat symptom.
Common questions
Can a dentist test me for HPV?
No. There is no routine, validated oral HPV test for screening. A dentist looks for changes in the tissues and refers you if anything needs further investigation.
I missed the vaccine as a teenager. Is it too late?
A catch-up dose is available up to age 25 under the national program. Beyond that, it depends on your circumstances, so speak with your GP.
How often should my mouth be checked?
The soft tissue check happens at your regular examination, at the interval your dentist recommends. People at higher risk may be seen more often.
Reading about cancer can be unsettling, but the steps are simple: keep up regular check-ups, talk to your GP about vaccination, and get any symptom that lasts more than 3 weeks looked at. If you are due for a check, see our current offers or book with our general dentists in Melrose Park.
