Globally, it is recognized that two types of squamous carcinoma occur in the head and neck – the first type occurs usually in elderly males and is associated with smoking and alcohol consumption. These tumours in general show evidence of keratinization. The second type occurs in a younger age group; 40 to 55 years, with little tobacco exposure. These tumours are generally non-keratinising. HPV can be detected in these tumours. A higher frequency of oral sex and higher number of sexual partners is thought to contribute to the increase in incidence of these tumours.
It is important to distinguish these tumours as those that are HPV related have an excellent response to radiotherapy as well as chemotherapy drugs and will have a better overall prognosis than tumours which are not HPV related. Minimally invasive surgery may also be considered. EGFR mutations are often detected in the HPV associated tumours. This supports the use of targeted chemotherapy drugs such as cetuximab.
In the laboratory, p16 immunohistochemistry as well as HPV genotyping on the tissue biopsy sample can be performed to assess for HPV. EGFR mutations can be detected in the tissue sample or by detecting mutations in cell free DNA in the peripheral blood.
- Kobayashi K, Hisamatsu K, Suzui N, Hara A, Tomita H, Miyazaki T. A Review of HPV-Related Head and Neck Cancer. J Clin Med. 2018;7(9):241. Published 2018 Aug 27. doi:10.3390/jcm7090241