54. The role of HPV in oropharyngeal malignant diseases.

what are the different types of HPV

• HPV (1, 4) = plantar warts

• HPV (6, 11) = anogenital warts (condyloma acuminatum)

• HPV (16, 18) = cervical/anal/penile cancers + oropharyngeal cancers

Describe HPV + malignancies

• SCC is >90% of head and neck cancers

• most caused by tobacco and alcohol use

What is the epidemiology of HPV positive malignancies

• HPV + cancers mostly happen in young, non smokers + more likely to have cervical lymph node metastases

• most often tonsils, base of tongue and soft palate → tonsillar tissue contains deep invaginations can capture virus + facilitate into basal cells

What is the pathomechanism of HPV 16

• HPV 16- 80% of HPV + oral cancers

• transmission occurs during vaginal delivery or genital-oral or through saliva

• high risk HPV16 produces oncogenes E7 and E6

• → inactivates tumour suppressors Rb and p53

• → DNA damage, no DNA repair

• → premalignant/ malignant lesions

What are the risk factors of HPV positive malignancies

• sexual habits → oral sex, multiple partners, no condom

• poor oral hygiene

• immunosuppression

How do you diagnose HPV positive malignancies

• History

• ENT examination (of mouth, pharynx, neck, palpation)

• Endoscopy (laryngo-/pharyngoscopy, indirect/direct laryngomicroscopy)

• Imaging (X-ray, CT, MRI, PET-CT)

• Biopsy (e.g. FNAB)

• Laboratory tests (in situ hybridization, PCR)

What is the prevention of HPV positive malignancies

• HPV vaccine

  • Gardasil 9 protects against HPV- 6, 11, 16, 18, 31, 33

• safe oral sex

What is the treatment of HPV positive malignancies

• radiotherapy

• advanced stages → chemotherapy, surgery