In my institution, no routinely assessment of Human Papillomavirus (HPV) is performed in the histological examination. In relation to recent knowledge within the pathogenic role of HPV in the developing of oral squamous cell carcinoma (OSCC) and even in its prognosis, one should ask if it should be mandatory in all post-op histollogical reports, in order to administer or not complimentary treatment. What is your experience and/or thinking on it?
Dear Dr. Raul,
Yes you are right that HPV have pathogenic role in the development of OSCC of Oro-phyarngeal region. And unfortunately in my country no routine assessment of HPV. As in my Master study i observed that 33.3% patients of OSCC were without any addictive habits and genetic history and most were young patients with majority of them were female. This left me with question mark? Because we are also lacking in HPV routine diagnosis. If we add screening of HPV in our daily routine then with the help of this we will not only improve the prognosis but also the treatment and quality of life of patients
The prognosis of hpv related oral cancer is much better... so the current version of TNM classification to be implemented from 2018 differentiates this class of oral cancer and stating is different ... on the other hand it's costly. To screen for hpv ... a risk benefit analysis and a study involving local cancer characteristics would be beneficial to decide ....
In my practice I see a lot of female patients with SCC without any history of Toombak dipping( local form of smokeless tobacco) or alcohol drinking, which may raise a questions regarding the cause! Screening for HPV definitely will be of value in such cases but unfortunately we don't do such test in our institution.
Dear colleagues, I agree with all comments about routine test for HPV status. We perform p16 test in all oral cavity and oropharyngeal SCC. HPV positive cancers have better prognosis compared to HPV negative SCC, also they respond better to chemoradiotherapy. Most of these patients are younger patients and the discussion about prognosis and risk factors are essential in management of these cancers, and HPV status is helpful in this regard.
In our institute we do routinely perform HPV screening assessment during histological examination for oral cancer. HPV positive tumors are more responsive to radiotherapy, and have better prognosis provided that the patients quit smoking
it is important to not only focus on hpv status in the HN population as Dr Barion states, the importance of Tabaco use is an important determinant of survival in this cohort. If an HPV positive HN SCC patient smokes he/she essentially has the same lower survival rate of a non HPV SCC HN unfortunately.
HPV subtyping should be done. p16 status, while a good surrogate for HPV related disease in the oropharynx is not a reliable surrogate in oral cavity tumours. We subtype all oropharynx also and to date all are HPV 16
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