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neo_oropharyngeal

oropharyngeal cancer

introduction

  • 0.7% of men will develop oropharyngeal cancer (prior to widespread HPV vaccination)
  • there appears to be 2 distinct groups of oropharyngeal cancer:
      • now accounts for ~70% of oropharyngeal cancers
      • has the better 5 year survival rate (75-80% for stage III/IV), and accounts for over 60% of the tumours
      • expression of viral E6 and E7 oncoproteins that inactivate tumour suppressor proteins p53 and retinoblastoma protein (pRb), respectively, is necessary for malignant behaviour of these tumours
      • tobacco-related carcinogens may render HPV-positive tumours less responsive to Rx
      • ~7% of the adult population have oral HPV 1)
        • 10% of men and ~4% of women have it
        • risk of oral HPV (prior to widespread HPV vaccination) 2):
          • 15% of men if smoke and 5 or more oral sex partners
          • 7.4% of men who do not smoker but had 5 or more oral sex partners
          • 7.1% of men if smoke and 2-4 oral sex partners
          • 4% of men who do not smoker but had 2-4 oral sex partners
          • 1.5% of men who had less than 2 oral sex partners
          • 1.8% of female smokers who had less than 2 oral sex partners
          • 0.5% of female non-smokers who had less than 2 oral sex partners
      • 1% of the adult population have oral HPV type 16 which is associated with over 90% of oropharyngeal squamous cell carcinomas
      • it appears oral HPV infection is predominantly sexually transmitted
      • current smoking and intensity of smoking were independently associated with oral HPV infection, particularly among women
      • peak ages for oral HPV infection were 30–34 years and 60–64 years. This bimodal age pattern was particularly striking among men.
      • the number of HPV-positive oropharyngeal cancers diagnosed each year will surpass that of invasive cervical cancers by the year 2020
      • HPV-positive oropharyngeal tumours were increasing in incidence, now exceeding the number of these tumours caused by tobacco and alcohol abuse
    • hpv-negative, alcohol or cigarette related tumours:
      • 5 year survival rate 45-50% for stage III/IV3)
      • a 2013 study showed 55% patients with HPV-positive cancers were alive two years after a recurrence, compared with 28% of those with HPV-negative cancers
2)
Annals of Oncology 2017
3)
NEJM 363:1 July 1 2010
neo_oropharyngeal.txt · Last modified: 2017/10/21 22:16 by 127.0.0.1

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