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. | NORTH TEXAS DENTISTRY 13