Human papillomavirus associated head and neck cancer
- Robert I Haddad, MD
Robert I Haddad, MD
- Associate Professor of Medicine
- Harvard Medical School
- Section Editors
- Bruce E Brockstein, MD
Bruce E Brockstein, MD
- Section Editor — Cancer of the Head and Neck
- Clinical Professor of Medicine
- University of Chicago Pritzker School of Medicine
- David M Brizel, MD
David M Brizel, MD
- Section Editor — Radiation Therapy
- Leonard R Prosnitz Professor of Radiation Oncology
- Professor of Otolaryngology Head & Neck Surgery
- Duke University Cancer Institute
- Marvin P Fried, MD, FACS
Marvin P Fried, MD, FACS
- Section Editor — Head and Neck Surgery
- Professor and University Chairman, Department of Otorhinolaryngology - Head and Neck Surgery
- Montefiore Medical Center, Albert Einstein College of Medicine
Human papillomavirus (HPV) infection is the most commonly diagnosed sexually transmitted disease in the United States. HPV infection has been etiologically linked with condyloma acuminatum, squamous intraepithelial lesions, and anogenital malignancy, including cervical, vaginal, vulval, penile, and anal carcinoma.
Many patients with oropharyngeal squamous cell carcinomas, particularly those arising in the base of the tongue and in the tonsillar region, do not have the traditional risk factors associated with head and neck cancers (eg, smoking, smokeless tobacco, alcohol consumption). Epidemiologic and molecular studies have identified the HPV-16 genotype of HPV as a causative agent in many of these patients . Other high-risk HPV genotypes, such as HPV-18, 31, or 33, are also causative but are less common. These high-risk HPV infections may also rarely cause cancers at other head and neck sites.
The role of HPV infection in head and neck squamous cell carcinoma is presented here. Other risk factors for head and neck cancer are discussed separately. (See "Epidemiology and risk factors for head and neck cancer", section on 'Risk factors'.)
BIOLOGY OF HPV
HPV are small deoxyribonucleic acid (DNA) viruses that are widely distributed in vertebrates. These viruses contain an 8 kilobase long, double-stranded, circular DNA genome. The papillomavirus genome comprises early and late genes that encode early proteins E1-E7 and late proteins L1-L2. The early proteins are nonstructural proteins involved in replication and transcription of the genome (E1-E5) or in host cell tumoral transformation (E6 and E7), whereas L1 and L2 are the structural capsid proteins of the virion.
The HPV E6 and E7 oncogenes encode proteins consisting of approximately 151 and 98 amino acids, respectively. These genes are largely responsible for the onset and persistence of the malignant process in both head and neck and anogenital cancers.
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- BIOLOGY OF HPV
- HPV associated cancers
- - Oropharyngeal carcinoma
- - Non-oropharyngeal carcinoma
- Prevalence of oral HPV infection
- DIAGNOSIS AND BIOMARKER ANALYSIS
- OROPHARYNGEAL CARCINOMA
- Clinicopathologic features
- Staging and prognosis
- - At presentation
- - Risk subgroup identification
- - Prognosis after recurrence
- NON-OROPHARYNGEAL CARCINOMA