Symposium on Neoplastic Hematology and Medical Oncology
Head and Neck Squamous Cell Carcinoma: Update on Epidemiology, Diagnosis, and Treatment

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Abstract

Squamous cell carcinoma arises from multiple anatomic subsites in the head and neck region. The risk factors for development of cancers of the oral cavity, oropharynx, hypopharynx, and larynx include tobacco exposure and alcohol dependence, and infection with oncogenic viruses is associated with cancers developing in the nasopharynx, palatine, and lingual tonsils of the oropharynx. The incidence of human papillomavirus–associated oropharyngeal cancer is increasing in developed countries, and by 2020, the annual incidence could surpass that of cervical cancer. The treatment for early-stage squamous cell cancers of the head and neck is generally single modality, either surgery or radiotherapy. The treatment for locally advanced head and neck cancers is multimodal, with either surgery followed by adjuvant radiation or chemoradiation as indicated by pathologic features or definitive chemoradiation. For recurrent disease that is not amenable to a salvage local or regional approach and for metastatic disease, chemotherapy with or without a biological agent is indicated. To date, molecular testing has not influenced treatment selection in head and neck cancer. This review will focus on the changing epidemiology, advances in diagnosis, and treatment options for squamous cell cancers of the head and neck, along with data on risk stratification specific to oropharyngeal cancer, and will highlight the direction of current trials.

Section snippets

Clinical Issues in HNSCC

With the recognition of high-risk HPV infection (primarily type 16) as a risk factor for development of HNSCC and its prognostic importance, there is increasing interest in approaching HNSCC as 2 distinct types, HPV-positive and HPV-negative disease. This distinction is driving advances in our understanding of the biology, mutational landscape, predictors of response to treatment, and survival outcomes for these 2 distinct types of HNSCC.

De-escalation of the current standard chemoradiation

HPV Testing

There is a distinct biology and molecular phenotype among HPV-positive OPSCCs when compared with HPV-negative HNSCCs (Table 1).11, 12 It is critical to understand the HPV types and their role in carcinogenesis. Human papillomavirus is a small-DNA virus with predilection to cutaneous or mucosal squamous epithelium located in the cervix, anogenital region, and a subset of HNSCCs arising from the oropharynx.13, 14 The oncogenic types HPV-16, HPV-18, HPV-31, and HPV-33 are sexually transmitted and

Treatment Advances in HNSCC

Surgery, radiation, and chemotherapy in various combinations are utilized in the management of HNSCC, depending on TNM stage and primary site.3, 26 Limited or early-stage disease (stage I and II) is the presenting stage in approximately 40% of patients and is usually treated with surgery or radiation alone.3, 26 For most patients with locally advanced disease (stage III and IVA/B), resectable or unresectable, treatment entails platinum-based chemoradiation, with or without induction

Conclusion

The growing burden of OPSCC in the United States has important public health and clinical implications. It is important to recognize HPV-negative and HPV-positive HNSCC as 2 biologically and clinically distinct entities, with HPV-positive tumors having more favorable survival outcomes. This difference has resulted in the formulation of risk stratification parameters for prognosis. Current clinical trials are using risk stratification to define eligibility for evaluation of deintensification

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