North Texas Dentistry Volume 8 Issue 2 2018 ISSUE 2 DE | Page 13

HPV-associated head and neck cancers
(squamous cell carcinoma) are primarily
located in the oropharynx. There has
been an increase in incidence likely due
to changing sexual behavior, i.e., inci-
dence in oral sex practices. Patients with
HPV-positive oropharyngeal carcinoma
have a higher number of sexual partners,
particularly oral sex partners.
Oropharyngeal HPV positive tumors tend
to be smaller than HPV-negative tumors
(“T” staging), but more likely to have
spread to the lymph nodes (“N” staging).
Prognosis is significantly better for HPV-
positive (than HPV-negative) tumors,
including better locoregional control, bet-
ter overall survival (82% 3-year survival
versus 57%), and fewer deaths. HPV pos-
itive cancers have a bette r response to
therapy, including radiation therapy
alone, surgery with or without adjuvant
radiotherapy or a combination of radia-
tion and chemotherapy. These patients
are less likely to present with second
malignancies and less prone to field can-
cerization.
Traditional lip split mandibulotomy approach
for tonsil or base of tongue cancers.
With the increasing prevalence of
oropharyngeal cancers, a quick visual
inspection of the tonsils, base of tongue,
Tonsil specimen after surgical resection.
and oropharynx may be warranted while
performing an oral cancer screening.
Current standards of treatment for HPV-
positive oropharyngeal carcinomas is
multi-modal, including surgery, radia-
tion, and chemotherapy. TransOral
Robotic Surgery (TORS) has revolution-
ized surgery for oropharyngeal cancer
treatment, as now we can have surgical
access to the oropharyngeal tissues with-
out the morbidity of a traditional
approach.
The question many may be wondering is,
what association does HPV have in rela-
tion to oral cancers? Although oral can-
cer is the eleventh most common cancer
in the world, HPV does not appear to
cause other head and neck cancers
including sites such as the oral cavity, lip,
larynx, nose, and salivary glands.
Approximately, only 4-8% of oral cancers
are found to have high risk HPV DNA.
Oral cavity cancers are well known to be
caused by tobacco, alcohol, and the areca
nut, but the clinical picture in relation to
HPV is unclear, but does not appear to be
caused by HPV as frequently as oropha-
ryngeal cancers.
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