Abstract
The Human Papilloma Virus (HPV) is an oncogenic virus which is associated with the development of head and neck squamous cell carcinoma (HNSCC), predominantly within the oropharynx. Approximately 25% of oropharyngeal squamous cell carcinoma (OPSCC) cases worldwide are attributable to HPV infection, with an estimated 65% in the United States. Transmission is via exposure during sexual contact, with distinctive anatomical features of the tonsils providing this organ with a predilection for infection by HPV. No premalignant lesion is identifiable on clinical examination, thus no comparative histological features to denote the stages of carcinogenesis for HPV driven HNSCC are identifiable. This is in contrast to HPV-driven cervical carcinoma, making screening a challenge for the head and neck region. However, HPV proffers a favorable prognosis in the head and neck region, with better overall survival rates in contrast to its HPV negative counterparts. This has resulted in extensive research into de-intensifying therapies aiming to minimize the morbidity induced by standard concurrent chemo-radiotherapy without compromising efficacy. Despite the favorable prognosis, cases of recurrence and/or metastasis of HPV positive HNSCC do occur, and are linked with poor outcomes. HPV 16 is the most frequent genotype identified in HNSCC, yet there is limited research to date studying the impact of other HPV genotype with respect to overall survival. A similar situation pertains to genetic aberrations associated in those with HPV positive HNSCC who recur, with only four published studies to date. Somatic mutations in TSC2, BRIP1, NBN, TACC3, NFE2l2, STK11, HRAS, PIK3R1, TP63, and FAT1 have been identified in recurrent HPV positive OPSCC. Finding alternative therapeutic strategies for this young cohort may depend on upfront identification of HPV genotypes and mutations which are linked with worse outcomes, thus ensuring appropriate stratification of treatment regimens.
Highlights
Oncogenic Human Papilloma Virus (HPV) is associated with the development of squamous cell carcinoma of the anogenital and the head and neck region (Bansal et al, 2016)
Further analysis has illustrated that carcinogenesis due to HPV within the oropharynx is most prominent in the tonsil and base of tongue (Haeggblom et al, 2017; Marklund et al, 2020)
The global incidence of HPV positive oropharyngeal squamous cell carcinoma (OPSCC) is increasing with figures estimating that 25% of OPSCC cases worldwide are attributable to HPV infection, in contrast to North America which has a higher prevalence of approximately 65% (WHO, 2014; Stein et al, 2015)
Summary
Oncogenic Human Papilloma Virus (HPV) is associated with the development of squamous cell carcinoma of the anogenital (cervical, vaginal, vulvar, penile, and anus) and the head and neck region (Bansal et al, 2016). HPV positive head and neck squamous cell carcinoma (HNSCC) are most commonly found within the oropharynx (Elrefaey et al, 2014). 15% of patients with HPV positive OPSCC progress to recurrence or local and/or distant metastasis (Masterson et al, 2014; Gleber-Netto et al, 2019). The purpose of this article is to review HPV carcinogenesis within the head and neck region, focusing on pathological and molecular discrepancies in contrast to the cervical region. There is a limited field of knowledge at present pertaining to the HPV genotypes and DNA mutations identified in those with HPV positive OPSCC who develop local recurrence and/or distant metastasis.
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
