White Paper High-Risk Patients Part 1

Early detection of HPV16-induced tumours

Guidelines for identifying high-risk patients

It is not possible to predict who will definitely develop HPV-related tumours, regardless of whether patients are affected by certain risk factors or not. Screening and early detection, including serological testing, should therefore be available to all patients.

However, patients with certain medical histories develop HPV16-induced tumours more frequently than the general population. For these patients, it is therefore very important to be informed about the options and possible benefits and to make use of regular cancer screening.

Patients with HPV-induced cervical cancer

Few people consider that women with cervical cancer have an up to four times higher risk of developing a tumour in the mouth and throat in subsequent
years.1

One would sooner expect that surrounding organs such as the uterine cavity, bladder and anus are affected. Follow-up care therefore focuses on examinations of the genital region. But lymph nodes, lungs, kidneys, liver, bones or brain can also be affected.

Once a relapse or metastasis is suspected, relatively non-specific tumour markers such as CEA or CA 125 or imaging methods are generally used.

However, examinations above the thorax and hence of the mouth and throat are not usually performed. Patients with cervical carcinoma in situ and those with invasive cervical carcinoma have an almost similarly elevated risk of developing a tumour in these areas.2

Further studies show that tumours in the mouth and throat, especially in the area of the tonsils, are found more frequently in patients with cervical carcinomas.3

As shown in Figure 2, the majority of women with a tumour in the pharyngeal region were found to have had suspicious PAP smears for several years. Less frequently, tumour growth in the pharynx was observed without the PAP smear showing any abnormalities.3, 4

Due to the localization of the tumours in areas typical of HPV, such as the tonsils, the authors assume in their publications that these are HPV-induced tumours, albeit without explicit confirmation.

Recommendations for the doctor’s practice

To improve early detection and prognosis for these patients, we recommend

  • Regular screening for cancer in the mouth and throat for patients with a history of cervical carcinoma
  • Advise patients with abnormalities in the mouth and throat to take up cancer screening in the genital area
  • For patients with treated cervical carcinoma, offer appropriate aftercare to ensure that any recurrence of cancer also in the mouth and throat can be detected at an early stage.

References:
1. M.M. Rietbergen, A.A.J.D van Bokhoven, B.I. Lissenberg-Witte, D.A.M. Heideman, C.R. Leemans R.H. Brakenhoff, E. Bloemena: Epidemiologic associations of HPV-positive oropharyngeal cancer and (pre)cancerous cervical lesions; Cancer Epidemiology; First published: 14. February 2014

2. K Hemminki, C Dong P. Vaittinen: Second Primary Cancer after in Situ and Invasive Cervical Cancer; Epidemiology: July 2000- Volume 11– Issue 4 – p,457 - 461

3. Camille C. Rose Ragin, PhD, MPH, Emanuela Taioli, MD, PhD: Second Primary Head and Neck Tumor risk in Patients with Cervical Cancer - SEER Data Analysis; Wiley Inter Sience DOI: 10.1002/hed20663, published online 26 July 2007

4. Vincett L Biron, MD, PhD, David W./. Côté, MD, MPH, CCFP, and Hadi Seikaly, MD, FRCSC: Oropharyngeal Squamous Cell Carcinoma and Human Papillomavirus-associated Cancers in Women; Journal of Otolaryngology-Head & Neck Surgery, Vol 40, No SI (February), 2011