272 - Head and Neck Cancer Flashcards
What two tests need to be done to see if a cancer is HPV related?
- p16
- Sensitive, but not specific; do this first
- HPV ISH
- Do this if p16 is positive
Gold standard is E6/E7 mRNA detection
What is the pathophysiology of HPV-driven squamous cell carcinoma?
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*
What is field cancerization?
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
What head and neck malignancies are associated with heavy tobacco and alcohol use?
- Tobacco
- Smokeless -> oral cavity, oropharynx
- Alcohol
- Upper digestive tract
Alcohol and tobacco compound on each other
In which patient populations is HPV-driven head and neck cancer most common?
Young, otherwise healthy patients
Prognosis is good
What is the general treatment for head and neck cancer?
- Early:
- Locally advanced:
- Metastatic/recurrent:
- 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
What anatomic sites in the head and neck are typically affected by EBV-related carcinoma?
Nasopharynx
What percentage of patients with 1 smoking-related malignancy will develop another?
15-20%
Due to field cancerization; multiple areas of pre-malignant/malignant tissue due to exposure to the same carcinogen
What anatomic sites in the head and neck are typically affected by HPV squamous cell carcinoma?
Oral / oropharynx
vs. EBV = nasopharynx
“keratin peals” are associated with what type of cancer?
(broadly)
Squamous cell carcinoma