Clinical implications of human papillomavirus in head and neck cancers

Abstract

Human papillomavirus (HPV) is now recognized to play a role in the pathogenesis of a subset of head and neck squamous cell carcinomas (HNSCCs), particularly those that arise from the lingual and palatine tonsils within the oropharynx. High-risk HPV16 is identified in the overwhelming majority of HPV-positive tumors, which have molecular-genetic alterations indicative of viral oncogene function. Measures of HPV exposure, including sexual behaviors, seropositivity to HPV16, and oral, high-risk HPV infection, are associated with increased risk for oropharyngeal cancer. HPV infection may be altering the demographics of HNSCC patients, as these patients tend to be younger, nonsmokers, and nondrinkers. There is sufficient evidence to conclude that a diagnosis of HPV-positive HNSCC has significant prognostic implications; these patients have at least half the risk of death from HNSCC when compared with the HPV-negative patient. The HPV etiology of these tumors may have future clinical implications for the diagnosis, therapy, screening, and prevention of HNSCC.

Fig 1

A human papilloma virus (HPV) –positive tumor by (A) hematoxylin and eosin, (B) in situ hybridization (ISH), and (C) p16 immunohistochemistry. ISH provides localized detection of HPV DNA in the context of preserved tissue architecture. HPV hybridization signal is seen as punctate nuclear staining. The corresponding p16 immunohistochemistry stain is strong and diffuse in part C.