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

Index: Clinical Practice Guidelines for Oropharyngeal Cancer

Resource Appropriate Oropharyngeal Cancer Guideline Scenarios