Human Papillomavirus and Head and Neck Cancer

  • Shao Hui Huang
  • Patrick Gullane
  • Brian O’Sullivan
Chapter

Abstract

Human papillomavirus (HPV) is responsible for a subset of mucosal head and neck cancer (mainly in oropharynx) as well as benign lesions such as recurrent respiratory papillomatosis. HPV-related (HPV+) head and neck cancer mainly arises from the oropharynx and has much lower prevalence in the oral cavity, larynx, hypopharynx, and larynx. Epidemiological studies show the incidence of HPV-related (HPV+) oropharyngeal cancer (OPC) rising in many countries in the world. Currently there are no established screening tools to facilitate early-diagnosed HPV+ OPC. HPV+ OPC has a unique clinical behavior that contrasts traditional HPV– patients. HPV+ OPC patients often present as an “unknown primary” with enlarged cervical lymph nodes. Delayed diagnosis may occur due to patient-related factors as well as clinician-related factors, such as unfamiliarity with potential initial presentations of HPV+ OPC, resulting in delayed referral from the family doctor to otolaryngologists and/or technical challenges in obtaining tissue or misdiagnosis by the otolaryngologist. An HPV+-specific TNM staging system will be included in the upcoming 8th edition UICC/AJCC TNM classification. HPV+ OPC has a remarkably good outcome in the low-risk group, and there is a strong likelihood that we are overtreating this subset using treatments designed for traditional HPV– OPC. A risk-stratified treatment algorithm is currently under testing. Counseling HPV+ patients is important to dispel stigmata and myths about this newly identified fast rising disease entity.

Keywords

Human papillomavirus Head and neck cancer Diagnosis Treatment Counseling 

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Copyright information

© Springer International Publishing AG 2018

Authors and Affiliations

  • Shao Hui Huang
    • 1
  • Patrick Gullane
    • 2
  • Brian O’Sullivan
    • 3
  1. 1.Department of Radiation OncologyThe Princess Margret Cancer Centre/University of TorontoTorontoCanada
  2. 2.Department of Otolaryngology—Head and Neck Surgery, Wharton Chair in Head and Neck SurgeryPrincess Margaret Cancer Centre, University of TorontoTorontoCanada
  3. 3.Department of Otolaryngology—Head and Neck Surgery, Bartley-Smith/Wharton Chair in Radiation Oncology, and Department of Radiation OncologyThe Princess Margret Cancer Centre/University of TorontoTorontoCanada

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