hpv associated oropharyngeal cancer

Author : Updated :

HPV Associated Oropharyngeal Cancer

Benjamin L. Judson, M.D.10/19/2013

333 Cedar StreetNew Haven, Connecticut 06510

Author : Updated :

No conflict of interest.

Benjamin L. Judson, M.D.10/19/2013

3.3.

• Types 6 and 11– Recurrent respiratory papillomatosis

• Types 16 and 18 – Previously no role in head & neck

HPV in the Head & Neck

4.4. Head & Neck Cancer

melanoma thyroid oral cavity, pharynx,

larynx

lymphoma colon lung0

50000

100000

150000

200000

250000deaths new cases

Cancer Facts and Figures 2011, American Cancer Society

5.

Oropharynx-tonsils-base of tongue

Larynx

Nasopharynx

Hypopharynx

Oral Cavity

6.6. Smoking Prevalence: 1965 - 2005

7.7. Different Incidence

Chaturvedi AK, et al. J Clin Oncol 2008; 26: 612–19.

Oropharynx

Oral Cavity, Larynx, Nasopharynx, Hypopharynx

8.8.

Chaturvedi A K et al. JCO 2011;29:4294-4301

Increase in HPV Associated Oropharyngeal Cancer

9.9.

Pytynia KB et al. Oral Oncol. 2014 Jan 21.

10.

Oropharynx-tonsils-base of tongue

Larynx

Nasopharynx

Hypopharynx

Oral Cavity

11.11. Changing Face of Head and Neck Cancer

Sturgis EM, Cinciripini PM. Trends in head and neck cancer incidence in relation to smoking prevalence: an emerging epidemic of human papillomavirus-associated cancers? Cancer. 2007 Oct 1;110(7):1429-35. Review.

12.12.

• Risk increases with number of lifetime – vaginal-sex partners (26 or more) – oral-sex partners (6 or more)

Different Risk Factors

D’Souza et al. Case-control study of human papillomavirus and oropharyngeal cancer. N Engl J Med 2007; 356:1944–1956.Sikora AG et al. Bidirectional association of anogenital and oral cavity/pharyngeal carcinomas in men. Arch Otolaryngol Head Neck Surg. 2009 135(4):402-5.

13.13.

Smaller primary tumor

Different Presentation

Straetmans JM et al. Laryngoscope. 2009 Oct;119:1951-7.Gillison ML et al. JNCI. 2008;100(4):261-269. 

Bulky/cystic nodal metastasis

14.14.

• Trans oral vizualization is limited:

Different Presentation

15.15. Different Histology

Basaloid poorly

differentiated

P16 + HPV +

16.16. Different Survival

Ang KK et al. N Engl J Med 2010;363:24-35

17.17. Different Risk with Tobacco Exposure

Ang KK et al. N Engl J Med 2010;363:24-35

18.18.

• HPV is causing an epidemic of oropharynx cancer

• Affects men more than women

• Risk of HPV causing oropharynx cancer surpassing that of cervical cancer

Conclusion

19.19.

• Thank you!