HPV-Associated Head and Neck Cancer: Unique Features of Epidemiology and Clinical Management

Abstract

Human papillomavirus (HPV) is a recently identified causative agent for a subset of head and neck cancers, primarily in the oropharynx, and is largely responsible for the rising worldwide incidence of oropharyngeal cancer (OPC). Patients with HPV-positive OPC have distinct risk factor profiles and generally have a better prognosis than patients with traditional, HPV-negative, head and neck cancer. Concurrent chemotherapy and radiation is a widely accepted primary treatment modality for many patients with HPV-positive OPC. However, recent advances in surgical modalities, including transoral laser and robotic surgery, have led to the reemergence of primary surgical treatment for HPV-positive patients. Clinical trials are under way to determine optimal treatment strategies for the growing subset of patients with HPV-positive OPC. Similarly, identifying those patients with HPV-positive cancer who are at risk for recurrence and poor survival is critical in order to tailor individual treatment regimens and avoid potential undertreatment.

Keywords: human papillomavirus; oropharyngeal cancer; oropharyngeal squamous cell carcinoma.

Figure 1

The human papillomavirus genome. Abbreviation: LCR, long control region.

Figure 2

Computed tomography scan with contrast demonstrating an HPV-positive tonsillar cancer (blue arrowhead) amenable to transoral robotic resection.

Figure 3

(a) Left neck mass in a patient diagnosed with HPV-positive oropharyngeal cancer; (b) the computed tomography scan correlate demonstrating the cystic appearance of cervical lymph node metastases commonly seen in patients with HPV-positive oropharyngeal cancer.