Human Papillomavirus-Associated Head and Neck Cancer

Juan C. Nogues, BS; Scott Fassas, MD; Collin Mulcahy, MD; Philip E. Zapanta, MD

J Am Board Fam Med. 2021;34(4):832-837.

Diagnosis

While it is important to know the common clinical presentation, a high index of suspicion is necessary when patients have presentations concerning for a neck mass. If a lesion is identified, suspected but not visualized, or the patient endorses troublesome symptoms, a low threshold for referral to an otolaryngologist for further workup is necessary. Workup includes imaging and visualization of primary sites via endoscopy, although OPSCC can only be diagnosed via biopsy of a primary or metastatic lesion. Following the biopsy, tumor samples will undergo either polymerase chain reaction amplification of HPV DNA or in situ hybridization to determine if it is HPV-positive or HPV-negative.

1 2 3 4 5 6 7 8

Next Section

Table 1. Proposed HPV Screening Tools ¹²
Screening Tool	Concept	Limitation
Oral HPV screening	Sample patient's saliva and test for high-risk HPV viral DNA	Although this can detect the presence of HPV DNA, the majority of individuals will go on to clear the virus without progressing to carcinoma
HPV serology	Asses serum levels of antibodies to high-risk HPV strands	Serum antibody levels represent the cumulative exposure to HPV but are not specific to exposure at a particular anatomic site (oropharynx, cervix, etc.) and do not reflect expression of HPV-related oncoproteins E6 and E7, which are necessary for carcinogenesis
Transcervical ultrasound	Ultrasound of the head and neck can be used to assess individuals with neck masses or those who are found to be at high risk via other screening methods. It may help detect small tumors in earlier stages and improve morbidity	Although ultrasound is relatively inexpensive and can be done quickly in the office, it is not practical for universal screening and relies on either the symptom of a neck mass or other screening method to prescreen high-risk individuals
Mucosal imaging	Direct visualization of subclinical lesions via endoscopy	There are no identifiable premalignant lesions, and as with the limitations of ultrasound, there needs to be a prescreening method to identify high-risk individuals before subjecting them to this more invasive procedure. Additionally, many of these tumors arise from tonsillar crypts and cannot be easily identified on surface-level examination