Human papillomavirus and head and neck cancer

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.