272 - Head and Neck Cancer

Question 1

What two tests need to be done to see if a cancer is HPV related?

Answer 1

• p16
  
  • Sensitive, but not specific; do this first
• HPV ISH
  
  • Do this if p16 is positive

Gold standard is E6/E7 mRNA detection

Question 2

What is the pathophysiology of HPV-driven squamous cell carcinoma?

Answer 2

Usually caused by HPV-16

HPV infects cells…

• Viral protien E6 inhibits p53
  
  • -> uncontrolled proliferation
• Viral protien E7 inhibits RB
  
  • -> Uncontrolled proliferation
  • -> Activation of E2F
  • -> p16 increases in reaction to try to control the cell cycle
• Thank you @Lauren Smith!*
• p16 is a surrogate marker for HPV+ oropharyngeal carcinoma*

Question 3

What is field cancerization?

Answer 3

The “field” of tissue all exposed to the carcinogen may have multiple sites of pre-malignant lesions/high-risk areas

Leads to high recurrence rate following resection

Ex: smokeless tobacco can increase cancer risk in multiple sites in the oral cavity

Question 4

What head and neck malignancies are associated with heavy tobacco and alcohol use?

Answer 4

• Tobacco
  
  • Smokeless -> oral cavity, oropharynx
• Alcohol
  
  • Upper digestive tract

Alcohol and tobacco compound on each other

Question 5

In which patient populations is HPV-driven head and neck cancer most common?

Answer 5

Young, otherwise healthy patients

Prognosis is good

Question 6

What is the general treatment for head and neck cancer?

• Early:
• Locally advanced:
• Metastatic/recurrent:

Answer 6

• Early: Cured with radiation or surgery
• Locally advanced: Multi-modal
• Metastatic/recurrent: Palliative chemo, immune or targeted therapy

Note: Surgery and radiation used to be standard of care; now we use more chemo in an effort to avoid loss of organ function, disfigurement

Question 7

What anatomic sites in the head and neck are typically affected by EBV-related carcinoma?

Answer 7

Nasopharynx

Question 8

What percentage of patients with 1 smoking-related malignancy will develop another?

Answer 8

15-20%

Due to field cancerization; multiple areas of pre-malignant/malignant tissue due to exposure to the same carcinogen

Question 9

What anatomic sites in the head and neck are typically affected by HPV squamous cell carcinoma?

Answer 9

Oral / oropharynx

vs. EBV = nasopharynx

Question 10

“keratin peals” are associated with what type of cancer?

(broadly)

Answer 10

Squamous cell carcinoma