Songs for Sound presents:
Supporting MUSC's Cochlear Implant Program
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October:
Environmental Control Measures for House Dust Mite Allergy. What is the Evidence?
November:
Hypoglossal Nerve Stimulation for Sleep Apnea
December:
Management of Acute and Chronic Nasal Fractures
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Our E-Update Newsletters are designed to provide brief, practical, clinical updates in areas where we all struggle in managing our patients. To view past issues, please visit our Archives. |
October 2013
Charleston Swallowing Conference
Head & Neck Oncology Sea to Summit
February 2014
Charleston Sleep Surgery Symposium
March 2014
Pediatric ENT Update
Sinus Masters
April 2014
Temporal Bone Dissection Course
May 2014
Southern States Rhinology Course Charleston Magnolia Conference
July 2014
The Charleston Course: Otolaryngology Literature Update
For program brochure, registration form, and more, please visit
our website.
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We want to hear from you!
We welcome your feedback - answers, questions, input - on our newsletter articles as well as any ENT questions you may have. If there are topics you are interested in learning more about, please
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Dear Colleague,
In this month's ENT E-Update Joshua A. Hornig, MD, FRCS(C) compares and contrasts HPV positive and HPV negative oropharyngeal carcimomas to assist you with timely care for your patients.
More information on Dr. Hornig follows the article below and is on our website.
Please feel free to contact us with feedback or questions about the E-Udate articles, your patients, or any other ENT issue at entupdate@musc.edu.
Paul R. Lambert, MD
Professor and Chair
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Joshua D. Hornig, M.D., FRCS(C)
Director, Microvascular Surgery & Functional Outcomes
Medical University of South Carolina
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HPV Positive and HPV
Negative Oropharyngeal Carcinomas
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The rate of oropharyngeal carcinoma is rapidly increasing in North America in the last several decades. This increase seems to be secondary to the increased rate of HPV related orophayrngeal carcinomas and not due to a change in smoking or drinking prevalence.
Interestingly, the clinical presentation between HPV positive and HPV negative oropharyngeal cancers are strikingly different and can lead to a delay in diagnosis if the proper vigilance is not kept. This short article will compare and contrast the typical HPV positive and HPV negative clinical presentation to assist you in providing timely care for these patients.
The typical epidemiological profile of HPV-negative cancer is in the 7th decade of life, male pre-dominance (3:1 male: female ratio), strong association with tobacco and alcohol use, moderate association with poor oral hygiene, and a diet low in fruit and vegetable consumption. In contrast, HPV-positive cancer patients are characterized by a younger age of onset (6th decade of life), male predominance (3:1 male: female ration), strong associations with sexual behaviors, strong association with marijuana use and inconsistent association with tobacco and alcohol use.
HPV positive oropharyngeal cancer patients typically present at a more advanced clinical stage. However, their T stage is usually lower and they are increasingly likely to have nodal metastasis to the cervical lymph node groups compared to HPV-negative oropharyngeal cancers. Interestingly, there are also differences in histological features. HPV-positive cancers have distinct histological features, such as moderate/poor tumor differentiation and non-keratinizing or basaloid pathology.
One of the most striking differences is in the type of lymphadenopathy that develops. While in the majority of cases the HPV-positive and HPV-negative tumors are indistinguishable from each other, there are is much higher preponderance of cystic lymph nodes in patients with HPV-positive cancers. Interestingly, often the FNA of these cystic lesions can be misinterpreted by the cytopathologist as containing benign looking squamous cells. This is particularly important for the Head & Neck Surgeon as this will lead to an erroneous diagnosis of a branchial cleft cyst. The surgeon must remain hyper vigilant in these cases and ensure a thorough upper aerodigestive examination to rule out a primary. Often once the erroneously diagnosed branchial cleft cyst is removed, then the true diagnosis of squamous cell carcinoma is finally discovered.
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Clinical Pearl: HPV positive carcinoma will often present with a cystic neck mass that can be misdiagnosed as a benign branchial cleft cyst.
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Table 1: Clinical Comparison of HPV-positive and HPV-negative Oropharyngeal carcinomas
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HPV -
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HPV +
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Age
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6th decade
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M:F ratio
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3:1
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3:1
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Tobacco Use
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Strong
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Variable
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Alcohol Use
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Strong
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Variable
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Marijuana Use
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Negligible
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Strong
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Oral Hygiene
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Poor
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Unknown
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Fruit/Vegetable Intake
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Poor
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Unknown
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Sexual Activity
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Negligible
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Strong
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Joshua D. Hornig , M.D., FRCS(C)
Associate Professor; Director, Microvascular Surgery &
Functional Outcomes
Medical University of South Carolina
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About Dr. Hornig...
Joshua D. Hornig , M.D., FRCS(C)
- Associate Professor
- Director, Microvascular Surgery & Functional Outcomes
M.D.: University of Alberta
Residency: University of Alberta
Fellowship: Medical University of SC
Special interests: Endoscopic thyroid and parathyroid surgery, Robotic thyroid and oral surgery, Facial plastic surgery, Head and neck tumors
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