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HPV in head and neck cancers

Head and Neck / Non-Gynae

Cytopathology

Max Robinson, School of Dental Sciences, Newcastle University

It is well established that the main cause of cervical cancer is high risk human papillomavirus (HPV) infection, information that has lead to the development of an immunisation program for young women. The literature relating to HPV and head and neck cancer is extensive and the findings are variable.

Nevertheless, head and neck squamous cell carcinomas (SCCs) are known to harbour oncogenic HPV, in particular HPV-16.  Specifically, there is compelling evidence that HPV associated oropharyngeal squamous cell carcinomas are biologically distinct and that these patients have a better prognosis than patients with site matched HPV negative tumours.  This knowledge is a persuasive argument for the identification of HPV related oropharyngeal SCCs in clinical practice.  Although there are currently no recognised international standards for HPV detection in head and neck cancer, two diagnostic algorithms have recently emerged. The first uses p16 immunohistochemistry followed by polymerase chain reaction for HPV DNA. 

The second employs p16 immunohistochemistry followed by detection of HPV DNA by in situ hybridisation. The majority of UK pathology laboratories have the capability of delivering the second algorithm. Furthermore, the techniques employed are automated and are subject to stringent quality assurance measures; features that could deliver routine, accurate and cost effective HPV testing for head and neck cancers.