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.

Follow-up

Follow-up for these patients is complex, often requiring multiple specialists to treat their disease such as medical oncologists, head and neck radiation oncologists, otolaryngologists, speech language pathologists, and nutritionists. The PCP is not only essential in ensuring that the patient is following up appropriately with specialist services but is also vital in managing any other illnesses or comorbidities that would significantly impact the prognosis. Follow-up with otolaryngology is generally extensive, and patients are seen for many years following treatment for tumor surveillance.

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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