From the Guidelines
HPV-related oropharyngeal carcinoma presents with distinct clinical features, including a painless neck mass, small primary tumor, and advanced nodal stage, despite which it has a significantly better prognosis compared to HPV-negative tumors. Patients typically present with a painless neck mass, which represents metastatic lymph node involvement, often as the first and only symptom 1. The primary tumor is frequently small and hidden in the tonsillar crypts or base of tongue, making it difficult to detect on initial examination. Other symptoms may include sore throat, difficulty swallowing, ear pain, and a feeling of something stuck in the throat.
Key Characteristics
- Unlike traditional head and neck cancers, HPV-related oropharyngeal cancer affects a younger patient population (40-55 years old) with less significant tobacco and alcohol exposure 1.
- These patients often have a history of multiple sexual partners or oral sexual practices, reflecting the sexually transmitted nature of HPV.
- Clinically, HPV-positive tumors tend to present at an advanced nodal stage despite smaller primary tumors (T1-T2, N2-N3) 1.
Prognosis and Treatment
- Despite this advanced presentation, HPV-positive oropharyngeal cancers have a significantly better prognosis with higher response rates to treatment and improved survival compared to HPV-negative tumors 1.
- This improved outcome is attributed to different tumor biology, with HPV-positive tumors showing enhanced radiosensitivity and better response to chemotherapy.
- The use of transoral robotic surgery (TORS) has been recognized as a useful treatment modality in the management of early-stage HPV-positive oropharyngeal squamous cell carcinoma, with a 5-year overall survival (OS) of 88% (95% CI, 78% to 98%) in selected early T-stage patients treated with upfront TORS 1.
From the Research
Clinical Features of HPV-Related Oropharyngeal Carcinoma
- HPV-positive oropharyngeal squamous cell carcinoma (OPSCC) has distinct clinical features, including a higher prevalence in younger individuals and a better prognosis compared to HPV-negative OPSCC 2, 3, 4.
- Patients with HPV-related OPSCC tend to be relatively young, less exposed to tobacco and alcohol, and have a relatively high socioeconomic status and education level 3.
- The neck metastases in HPV-related OPSCC tend to be aggressive and cystic 3.
- HPV-related OPSCC is often detected at an advanced stage due to a lack of symptoms in the early stages, highlighting the need for diagnostic biomarkers to aid in earlier detection 2, 4.
Diagnosis and Treatment
- The diagnosis of HPV-related OPSCC is often made using immunohistochemistry with p16 ink4a (p16) protein, which is an excellent surrogate of HR HPV infection 5.
- The eighth edition of the American Joint Committee on Cancer and the Union for International Cancer Control has separate staging systems for HPV-positive and HPV-negative OPSCC 2, 4, 5.
- Treatment for HPV-related OPSCC may include radiation therapy, chemotherapy, and surgery, with ongoing trials examining the potential for treatment de-intensification to improve quality of life while maintaining acceptable survival outcomes 2, 3, 4, 6.
- Radiation therapy guidelines for HPV-positive OPSCC recommend concurrent cisplatin for patients receiving definitive radiation therapy with T3-4 disease and/or 1 node >3 cm, or multiple nodes 6.