HPV-related oropharyngeal cancer: a review on burden of the disease and opportunities for prevention and early detection

Abstract

The incidence of oropharyngeal cancer (OPC) related to infection with human papillomavirus (HPV) is rising, making it now the most common HPV-related malignancy in the United States. These tumors present differently than traditional mucosal head and neck cancers, and those affected often lack classic risk factors such as tobacco and alcohol use. Currently, there are no approved approaches for prevention and early detection of disease, thus leading many patients to present with advanced cancers requiring intense surgical or nonsurgical therapies resulting in significant side effects and cost to the health-care system. In this review, we outline the evolving epidemiology of HPV-related OPC. We also summarize the available evidence corresponding to HPV-related OPC prevention, including efficacy and safety of the HPV vaccine in preventing oral HPV infections. Finally, we describe emerging techniques for identifying and screening those who may be at high risk for developing these tumors.

Keywords: HPV; Oropharyngeal cancer; detection; prevention; screening; vaccination.

Figure 1.

Patient with osteoradionecrosis of the mandible from radiation therapy.

Figure 2.

Patient with T1N2A oropharyngeal cancer status post definitive chemoradiation. (a) Distal chip video laryngoscopy revealed post-treatment radiation edema with no evidence of mucosal disease delineated by red arrows. (b) NBI revealed a mucosal abnormality delineated by blue arrows. Biopsy was consistent with high-grade dysplasia. Image is borrowed with permission from Dr Peter Belafsky.

Figure 3.

This intraoperative image shows the use of lifetime tissue autofluorescence for identification of pathologic mucosa. A laser is aimed at the surface and the signal returning from the tissue is interpreted. The signal for pathologic mucosa has been shown to be distinctly different than normal and is demonstrated by a different shade on the color scale. Such an approach could be very useful in cancer screening. However, small submucosal lesions may avoid detection.