Human Papillomavirus and Oropharyngeal Cancer: What You Need to Know in 2009

Abstract

Oropharyngeal cancer has demonstrated a steady increase in incidence over the past 20 years in contrast to declining numbers of head and neck squamous cell carcinoma (HNSCC) overall. Recent evidence has found that high-risk strains of human papillomavirus (HPV) are the likely cause of the changing epidemiology of oropharyngeal cancer. HPV-associated oropharyngeal cancer has a molecular, epidemiological, and clinical profile that is distinct from non-HPV HNSCC. Clinicians managing oropharyngeal HNSCC need to be aware of differences in the HPV HNSCC population which may impact treatment outcomes. Testing of HNSCC tumor tissue for HPV using validated and precise techniques should be performed when feasible.

Human Papilloma Virus Attributable Head and Neck Cancer in the Sudan Assessed by p16INK4AImmunostaining

“…Several authors have emphasized that a hallmark of the presence of HPV in cancer could be found in p16 nuclear or cytoplasmic overexpression, so that p16 could be considered a useful surrogate marker for HPV (Gillespie et al, 2009;Goon et al, 2009).…”

The Role of Human Papillomavirus in Head and Neck Cancers

“…A survey of the Surveillance, Epidemiology and End Results (SEER) database revealed that the incidence rates for HPV at the base of the tongue and in the tonsils increased by 2% and 4%, respectively, between 1973 and 2001 in younger US populations (ages 20-44 years). At the same time, the incidence in all other oral and pharyngeal sites remained constant or decreased (Gillespie et al, 2009). Other countries, such as Sweden, have seen a similar increase in the incidence of tonsil cancer from 1997-2002; HPV could be isolated in 23% of specimens in the 1970s, 28% in the 1980s, 57% in the 1990s and 68% in specimens since 2000 (Hammarstedt et al, 2006).…”

“…Some evidence has indicated that some subtypes of HPV are linked to head and neck cancer, especially those arising from some oropharyngeal subsites (e.g., tonsil and the base of the tongue) (Gillespie et al, 2009). The overall HPV prevalence in HNSCC ranges from 3% to 40% and could vary more according to the specific site.…”

“…Although studies have shown no concordance regarding some of these epidemiological aspects, we may have to look at HPV-positive and HPV-negative HNSCCs in a separate manner in the future, including scientific, diagnostic, epidemiological and clinical aspects and the management of treatment. The main factors studied are heavy or no tobacco/marijuana exposure, heavy or mild alcohol consumption, poor or intact dentition, low or high oral sex exposure, age > 50 years or < 45 years, lower or higher socioeconomic status and deceasing or increasing incidence (Gillespie et al, 2009). The epidemiological trend suggests that HPV-positive HNSCC occurs more often in younger patients (age < 50 years), which differs from the typical characteristics of head and neck cancer (which is more frequent in men above 40 years old).…”

“…The epidemiological trend suggests that HPV-positive HNSCC occurs more often in younger patients (age < 50 years), which differs from the typical characteristics of head and neck cancer (which is more frequent in men above 40 years old). The tumors associated with the presence of HPV usually appear strawberry-like and exophytic on gross inspection and occur more frequently in the tonsil and the base of tongue with a basaloid aspect, poor differentiation and cystic changes within metastatic lymph nodes (Gillespie et al, 2009). In addition, gene expression profiles are known to be different in HPVpositive OPCs compared with HPV-negative cases (Lajer & Von Buchwald, 2010).…”