270 - Head and Neck Cancer

Question 1

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

Answer 1

• p16 staining
  
  • p16 is upregulated in response to HPV antigen
  • 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 protein E6 inhibits p53
  
  • -> uncontrolled proliferation
• Viral protein E7 inhibits RB
  
  • -> Uncontrolled proliferation
  • -> Activation of E2F
  • -> p16 increases in reaction to try to control the cell cycle

p16 is a surrogate marker for HPV positive 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 treatment
• 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 pearls” are associated with what type of cancer?

(broadly)

Answer 10

Squamous cell carcinoma