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Fulltext Exploring the link between human papilloma virus and oral and oropharyngeal cancers

Khode SR, Dwivedi RC, Rhys-Evans P, Kazi R

J Cancer Res Ther, 2014 Jul-Sep;10(3):492-8.
PMID: 25313727 DOI: 10.4103/0973-1482.138213

Squamous cell carcinoma involving the oral cavity (OC) and oropharynx regions are a major cause of morbidity and mortality world-wide. The recent discovery of a strong association between human papilloma virus (HPV) infection and OC and oropharyngeal (OP) cancer has prompted world-wide research into the exact etiology and pathogenesis of these cancers in relation to the HPV. HPV-positive OC/OP cancers generally present at a relatively advanced stage (by virtue of cervical nodal involvement) and are more commonly seen in younger patients without significant exposure to alcohol or tobacco. These factors are implicated in prognosis, regardless of HPV association. In this article, we review the biology and epidemiology, risk factors, association, molecular analyses, treatment response and prognosis of HPV-related cancers. Role of HPV vaccination in HPV-related OC/OP cancers has also been discussed.

Matched MeSH terms: Oropharyngeal Neoplasms/etiology*; Oropharyngeal Neoplasms/mortality; Oropharyngeal Neoplasms/pathology; Oropharyngeal Neoplasms/therapy
Fulltext Haemangiopericytoma of the oropharynx

Balakrishnan R, Abdul-Razak HA, Jaspal S, Subramanian S, Shaharyar AM

Med J Malaysia, 2008 Dec;63(5):413-4.
PMID: 19803304 MyJurnal

Haemangiopericytoma (HPC) is a rare vascular tumor arising from the pericytes of Zimmermann and is characterized by its unpredictable and variable biological behavior. These tumors are common in the trunk and the extremities and less than 16% of the cases occur in the head & neck region. Its occurrence in the oral cavity and pharynx is uncommon. We report an extremely rare case of haemangiopericytoma of the oropharynx arising from the tonsillo-lingual sulcus as a pedunculated mass, which was successfully excised perorally after a preliminary tracheostomy. No recurrence has been noted on a follow-up of more than six years.

Matched MeSH terms: Oropharyngeal Neoplasms/diagnosis*; Oropharyngeal Neoplasms/surgery
Culture-independent studies on bacterial dysbiosis in oral and oropharyngeal squamous cell carcinoma: A systematic review

Gopinath D, Menon RK, Banerjee M, Su Yuxiong R, Botelho MG, Johnson NW

Crit Rev Oncol Hematol, 2019 Jul;139:31-40.
PMID: 31112880 DOI: 10.1016/j.critrevonc.2019.04.018

Imbalance within the resident bacterial community (dysbiosis), rather than the presence and activity of a single organism, has been proposed to be associated with, and to influence, the development and progression of various diseases; however, the existence and significance of dysbiosis in oral/oropharyngeal cancer is yet to be clearly established. A systematic search (conducted on 25/01/2018 and updated on 25/05/2018) was performed on three databases (Pubmed, Web of Science & Scopus) to identify studies employing culture-independent methods which investigated the bacterial community in oral/oropharyngeal cancer patients compared to control subjects. Of the 1546 texts screened, only fifteen publications met the pre-determined selection criteria. Data extracted from 731 cases and 809 controls overall, could not identify consistent enrichment of any particular taxon in oral/oropharyngeal cancers, although common taxa could be identified between studies. Six studies reported the enrichment of Fusobacteria in cancer at different taxonomic levels whereas four studies reported an increase in Parvimonas. Changes in microbial diversity remained inconclusive, with four studies showing a higher diversity in controls, three studies showing a higher diversity in tumors and three additional studies showing no difference between tumors and controls. Even though most studies identified a component of dysbiosis in oral/oropharyngeal cancer, methodological and analytical variations prevented a standardized summary, which highlights the necessity for studies of superior quality and magnitude employing standardized methodology and reporting. Indeed an holistic metagenomic approach is likely to be more meaningful, as is understanding of the overall metabolome, rather than a mere enumeration of the organisms present.

Matched MeSH terms: Oropharyngeal Neoplasms/microbiology; Oropharyngeal Neoplasms/epidemiology*
Fulltext Detection of human papillomavirus in oropharyngeal squamous cell carcinoma

Fauzi FH, Hamzan NI, Rahman NA, Suraiya S, Mohamad S

J Zhejiang Univ Sci B, 2021 4 13;21(12):961-976.
PMID: 33843162 DOI: 10.1631/jzus.B2000161

Worldwide there has been a significant increase in the incidence of oropharyngeal squamous cell carcinoma (OPSCC) etiologically attributed to oncogenic human papillomavirus (HPV). Reliable and accurate identification and detection tools are important as the incidence of HPV-related cancer is on the rise. Several HPV detection methods for OPSCC have been developed and each has its own advantages and disadvantages in regard to sensitivity, specificity, and technical difficulty. This review summarizes our current knowledge of molecular methods for detecting HPV in OPSCC, including HPV DNA/RNA polymerase chain reaction (PCR), loop-mediated isothermal amplification (LAMP), p16 immunohistochemistry (IHC), and DNA/RNA in situ hybridization (ISH) assays. This summary may facilitate the selection of a suitable method for detecting HPV infection, and therefore may help in the early diagnosis of HPV-related carcinoma to reduce its mortality, incidence, and morbidity.

Matched MeSH terms: Oropharyngeal Neoplasms/diagnosis; Oropharyngeal Neoplasms/virology*
Clinicopathological features of squamous cell carcinoma of the oral cavity and oropharynx in young patients

Martinez RC, Sathasivam HP, Cosway B, Paleri V, Fellows S, Adams J, et al.

Br J Oral Maxillofac Surg, 2018 May;56(4):332-337.
PMID: 29628167 DOI: 10.1016/j.bjoms.2018.03.011

Our aim was to examine the clinicopathological features of squamous cell carcinoma (SCC) of the oral cavity and oropharynx in a group of young patients who were dignosed during a 15-year period (2000-2014). Patients' clinical details, risk factors, and survival were obtained from medical records. Formalin-fixed, paraffin-embedded, tissue was tested for high-risk human papillomavirus (HPV). The results were compared with those of a matching group of older patients. We identified 91 patients who were younger than 45 years old, and the 50 youngest patients were studied in detail. The male:female ratio was 2:1, with more tumours located in the oral cavity than in the oropharynx (35 compared with 15). HPV-related SCC was restricted to the oropharynx. When matched for site, stage and HPV status, five-year overall survival was similar in young and matched older patients (log-rank test, p=0.515). Our findings suggest that young patients with oral SCC have a disease profile similar to that of older patients with the condition. It is plausible that prognostic information generally available for oral cancers is applicable to young patients with the disease.

Matched MeSH terms: Oropharyngeal Neoplasms/etiology; Oropharyngeal Neoplasms/pathology*
Fulltext Combined effects of smoking and HPV16 in oropharyngeal cancer

Anantharaman D, Muller DC, Lagiou P, Ahrens W, Holcátová I, Merletti F, et al.

Int J Epidemiol, 2016 Jun;45(3):752-61.
PMID: 27197530 DOI: 10.1093/ije/dyw069

BACKGROUND: Although smoking and HPV infection are recognized as important risk factors for oropharyngeal cancer, how their joint exposure impacts on oropharyngeal cancer risk is unclear. Specifically, whether smoking confers any additional risk to HPV-positive oropharyngeal cancer is not understood.
METHODS: Using HPV serology as a marker of HPV-related cancer, we examined the interaction between smoking and HPV16 in 459 oropharyngeal (and 1445 oral cavity and laryngeal) cancer patients and 3024 control participants from two large European multi-centre studies. Odds ratios and credible intervals [CrI], adjusted for potential confounders, were estimated using Bayesian logistic regression.
RESULTS: Both smoking [odds ratio (OR [CrI]: 6.82 [4.52, 10.29]) and HPV seropositivity (OR [CrI]: 235.69 [99.95, 555.74]) were independently associated with oropharyngeal cancer. The joint association of smoking and HPV seropositivity was consistent with that expected on the additive scale (synergy index [CrI]: 1.32 [0.51, 3.45]), suggesting they act as independent risk factors for oropharyngeal cancer.
CONCLUSIONS: Smoking was consistently associated with increase in oropharyngeal cancer risk in models stratified by HPV16 seropositivity. In addition, we report that the prevalence of oropharyngeal cancer increases with smoking for both HPV16-positive and HPV16-negative persons. The impact of smoking on HPV16-positive oropharyngeal cancer highlights the continued need for smoking cessation programmes for primary prevention of head and neck cancer.

Matched MeSH terms: Oropharyngeal Neoplasms/pathology*; Oropharyngeal Neoplasms/virology
Fulltext Human Papillomavirus 16 E6 Antibodies in Individuals without Diagnosed Cancer: A Pooled Analysis

Lang Kuhs KA, Anantharaman D, Waterboer T, Johansson M, Brennan P, Michel A, et al.

Cancer Epidemiol Biomarkers Prev, 2015 Apr;24(4):683-9.
PMID: 25623733 DOI: 10.1158/1055-9965.EPI-14-1217

BACKGROUND: The increasing incidence of oropharyngeal cancer in many developed countries has been attributed to human papillomavirus type 16 (HPV16) infections. Recently, HPV16 E6 serology has been identified as a promising early marker for oropharyngeal cancer. Therefore, characterization of HPV16 E6 seropositivity among individuals without cancer is warranted.
METHODS: A total of 4,666 controls were pooled from several studies of cancer and HPV seropositivity, all tested within the same laboratory. HPV16 E6 seropositive controls were classified as having (i) moderate [mean fluorescent intensity (MFI) ≥ 484 and <1,000] or (ii) high seroreactivity (MFI ≥ 1,000). Associations of moderate and high HPV16 E6 seroreactivity with (i) demographic risk factors; and seropositivity for (ii) other HPV16 proteins (E1, E2, E4, E7, and L1), and (iii) E6 proteins from non-HPV16 types (HPV6, 11, 18, 31, 33, 45, and 52) were evaluated.
RESULTS: Thirty-two (0.7%) HPV16 E6 seropositive controls were identified; 17 (0.4%) with moderate and 15 (0.3%) with high seroreactivity. High HPV16 E6 seroreactivity was associated with former smoking [odds ratio (OR), 5.5; 95% confidence interval (CI), 1.2-51.8], and seropositivity against HPV16 L1 (OR, 4.8; 95% CI, 1.3-15.4); E2 (OR, 7.7; 95% CI, 1.4-29.1); multiple HPV16 proteins (OR, 25.3; 95% CI, 2.6-119.6 for three HPV16 proteins beside E6) and HPV33 E6 (OR, 17.7; 95% CI, 1.9-81.8). No associations were observed with moderate HPV16 E6 seroreactivity.
CONCLUSIONS: High HPV16 E6 seroreactivity is rare among individuals without diagnosed cancer and was not explained by demographic factors.
IMPACT: Some HPV16 E6 seropositive individuals without diagnosed HPV-driven cancer, especially those with seropositivity against other HPV16 proteins, may harbor a biologically relevant HPV16 infection.

Matched MeSH terms: Oropharyngeal Neoplasms/immunology; Oropharyngeal Neoplasms/virology*
Epstein-Barr virus (EBV) in Malaysian upper-aerodigestive-tract lymphoma: incidence and sub-type

Peh SC, Sandvej K, Pallesen G

Int J Cancer, 1995 May 4;61(3):327-32.
PMID: 7729943

Epstein-Barr virus (EBV) type B, a less potent transformer of B lymphocytes than type A, has rarely been detected in EBV-associated neoplasms except in AIDS-related lymphomas, in which about 50% of the cases contained this sub-type. In this study we analyzed the association of EBV and the distribution of virus sub-types in Asian non-Hodgkin's lymphoma (NHL) of the upper aerodigestive tract. We studied archival material of 29 NHL cases from Malaysia. B- and T-cell associated antigens were demonstrated by immunohistochemistry, and EBV early RNA EBER-1 was demonstrated using the RNA in situ hybridization technique. EBV was detected in the majority of tumour cells in 11/13 T-NHL but in only 1/16 B-NHL. EBV was sub-typed by single-step polymerase chain reaction of the EBNA-2 gene. This was successful in 9/10 cases of EBER-1-positive tumours and all contained type-A virus only. Our results showed a preponderance of T-cell lymphoma of the upper aerodigestive tract in the ethnic Chinese group of Malaysian patients, and EBV was strongly associated with T-NHL but not with B-NHL. Our results suggest that type-A EBV is the prevalent sub-type in Asian NHL of the upper aerodigestive tract, similarly to findings in Asian nasopharyngeal carcinoma.

Matched MeSH terms: Oropharyngeal Neoplasms/immunology; Oropharyngeal Neoplasms/epidemiology; Oropharyngeal Neoplasms/pathology; Oropharyngeal Neoplasms/virology*
Fulltext Paediatric transoral robotic-assisted adenotonsillectomy: a new anaesthetic experience in Malaysia.

Zawiah Kassim, Fauziah Ahmad, Rusnaini Mustapha Kamar, Karis Misiran

Journal of Clinical and Health Sciences, 2019;4(2):91-96.
MyJurnal

Safety and feasibility of transoral robotic surgery (TORS) in adults for otolaryngology surgery,
mainly in the treatment of oropharyngeal carcinoma and obstructive sleep apnoea has already
been established several years ago. However, less is known with respect to the role and safety
of TORS for otolaryngology surgery in the paediatric age group and its description in the
literature is currently insufficient. As paediatric patients are unique in their anatomy, physiology
and pharmacological kinetic, special attention and consideration has to be applied when using
TORS, hence this increases the perioperative challenges. Herewith we present our experience
in anaesthetising a paediatric patient for TORS adenotonsillectomy which is the first not only
in our centre but in Malaysia. Our major obstacle was the limited airway access as the area of
concern was shared by the anaesthesiologist, surgeon and also the robotic system.
Haemodynamic stabilisation was a challenge compared to the conventional method as the
operative time increased due to robot docking time and the new surgical learning process. In
our opinion, the key point for the success of TORS adenotonsillectomy in paediatric patients is
good communication and teamwork between all personnel involved in the surgery.

Matched MeSH terms: Oropharyngeal Neoplasms
Fulltext Commando in locoregional recurrence of oropharyngeal carcinoma

Abdul Azim Al-Abrar Ahmad Kailani, Ahmad Kusyairi Khalid, Mohd Razif Mohamad Yunus, Irfan Mohamad

Journal of Clinical and Health Sciences, 2020;5(2):61-65.
MyJurnal

Squamous cell carcinoma is the most common malignant neoplasm of the upper aerodigestive
tract, and presentation is usually at the late stages when the diagnosis is made. Recurrence
after 1st therapy is common especially in the locoregional area of the tumour. For cancers
affecting the oral cavity, oropharynx, and mandible, “COMMANDO” (Combined
Mandibulectomy and Neck Dissection Operation) is one of the surgical approaches which
constitutes of primary tumour resection, mandibulectomy and neck dissection. We describe a
case of rapid locoregional recurrence following 1st surgical procedure of bilateral tonsillectomy
and extended neck dissection of oropharyngeal squamous cell carcinoma in a young healthy
individual without history of alcohol and tobacco abuse involving the right buccal region which
after positron emission tomography was done, showed involvement of right pterygoid muscles,
right-sided tongue muscle, and right mandible. The patient underwent redo salvage surgery
and reconstruction with anterolateral thigh flap.

Matched MeSH terms: Oropharyngeal Neoplasms