HPV-related Oropharyngeal cancer

HPV 16 & 18 are associated with oropharyngeal cancer
Sexually transmitted
Mostly non-smoking, healthy young adults, more common males
P16 is a surrogate marker for HPV (sensitivity 100%, has false +ves)
May present with a small primary and large, often cystic, cervical metastases
HPV status has prognostic value
- Different biological behaviour from tobacco-induced oropharyngeal cancer
- Better prognosis, even with advanced-stage disease
- Volume and extent of nodal metastases do not have same negative impact on outcome
- HPV + patients with a significant smoking history probably have same prognosis as HPV –
- Prognostic value of p16 status may not apply to suboptimally treated patients in resource constrained settings
Affects staging
- Different N-staging for HPV+ vs HPV-
- Same T-staging for HPV+ and HPV-
- Stage IV only assigned to patients with distant metastases
HPV status does not influence choice of primary treatment at this time