MCQs on “Human papillomavirus and head and neck squamous cell carcinoma in a UK population: Is there an association?”
HS Darling1, Pradeep Jaiswal2, Nishant Lohia3, Nishant R Tiwari4
1 Department of Medical Oncology and Hemato-Oncology, Command Hospital Air Force, Bengaluru, Karnataka, India
2 Department of Surgical Oncology, Command Hospital Air Force, Bengaluru, Karnataka, India
3 Department of Radiation Oncology, Command Hospital, Lucknow, Uttar Pradesh, India
4 Department of Internal Medicine, B.J. Govt. Medical College, Pune, Maharashtra, India
Correspondence Address:
H S Darling
Department of Medical Oncology and Hemato-Oncology, Command Hospital Air Force, Bengaluru, Karnataka
India
Source of Support: None, Conflict of Interest: None
CheckDOI: 10.4103/ijc.ijc_330_22
Q1. Statement 1 – Detection of HPV DNA in biopsy/resection specimen is diagnostic for HPV HNSCC
Statement 2 – HPV-positive HNSCC show a 2–5-fold increase in mutations
Which of the following is true for the above statements?
Statement 1 is trueStatement 2 is trueBoth statements are trueBoth statements are falseQ2. Which of the following statements is true regarding the pathological role of HPV in HNSCC?
Oncoprotiens E6 and E7 are expressedP53 and pRb are inactivatedBoth of the aboveNone of the aboveQ3. Which of the following statements is not true regarding HPV-related head and neck cancers?
Are usually well differentiatedBasaloid SCCOccur in non-smokers and non-drinkersMost common subsites are the base of the tongue/tonsillar regionQ4. The surrogate marker for HPV status is
p18INK4Ap16INK4Ap20INK4APCR of HPV DNAQ5. The most common site of HPV-mediated cancer in the oropharynx is
Base of the tongueSoft palatePalatine and lingual tonsilPosterior pharyngeal wallQ6. Based on the published data, which of the following is the indicator of bad prognosis in HPV (+) HNSCC?
p16 negativityp16 positivityFemale genderEGFR (-) statusQ7. Which of the following gender is associated with a higher prevalence of HPV (+) HNSCC?
MalesFemalesIt is gender-neutralEpidemiology differs with the geographical areaQ8. In the study by Al-Dabbagh et al., which of the following was the most common primary tumor site?
PharynxLarynxPalateTongueQ9. Find the incorrect statement
HNSCC accounts for 90% of squamous cell carcinomas in humans60% of HNSCC are associated with tobacco and alcohol90% of cervical cancers are associated with HPV infectionNone of the aboveQ10. In the study by Al-Dabbagh et al., as compared to HPV-negative cases, HPV-positive cases were associated with
Indolent behaviorBetter prognosisLonger survival ratesNone of the aboveAnswers and explanations:
1 (b). Statement 2 is true
”However, the detection of viral 2 DNA in either biopsy or resection samples is not sufficient for the definitive implication of an etiologic role in the pathogenesis of HNSCC.” “Some studies have suggested genetic subclasses of HNSCC based on HPV infection and activity within the host cell nucleus. Further, studies have shown that HPV-positive HNSCC showed a 2–5-fold increase in mutations, making HPV a serious etiologic factor.”[1]
2 (c). Both of the above
Viral expression of E6 and E7 of HPV16 were detected more often in oropharyngeal tumors and less often in oral squamous cell carcinomas (OSCC). The HPV16 E6 and proteins inactivate p53 and pRb, respectively, with an associated lack of p53 mutations, a reduction in pRb expression, and overexpression of p16 proteins.[1]
3 (a). Are usually well differentiated
Recent literature clearly supports the theory that oropharyngeal and tonsillar cancers are more likely to be associated with HPV than other head and neck tumors. Hence, they are phenotypically a different entity—usually poorly differentiated, basaloid SCC, and occur in patients who don't smoke and don't consume alcohol.
4 (b). p16INK4A
A number of different techniques are used to detect HPV in oropharyngeal cancer biopsy specimens. The gold standard is the demonstration of HPV E6/E7 in clinical specimens. However, this approach is clinically impractical because it is very difficult to detect viral RNA from cytologic fluid and paraffin-embedded tissues. Polymerase chain reaction (PCR) of HPV DNA is a technique with high sensitivity but low specificity. Immunohistochemistry staining for p16INK4A is frequently used as a surrogate for HPV status.[2]
5 (c). Palatine and lingual tonsil
HPV-mediated cancers most commonly arise in the lymphatic tissue of the palatine and lingual tonsil but may arise in any of the regions of the oropharynx.[3]
6 (a). p16, a protein coded by a tumor suppressor gene, CDKN2A, normally functions by slowing the progression of cells from the G1 to S phase of the cell cycle. Deletion of the CDKN2A gene causes p16 negativity and is associated with poor prognosis in HNSCC. In general, the female gender is associated with better overall survival in HNSCC. EGFR (+) status is associated with poor prognosis.[4]
7 (c). In general, males have a higher prevalence of HPV (+) HNSCC in any geographical area of the world. However, based on recent trends, the prevalence of HPV-associated HNSCC is increasing in females at a rate higher than in males.[4]
8 (d). Tongue
In the study by Al-Dabbagh et al.,[1] tongue was the most common primary tumor site, comprising 34.68% (N = 43) cases of the sample size (n = 124), as noted in [Table 1].
9(b). 60% of HNSCC are associated with tobacco and alcohol
Globally, HNSCC accounts for more than 90% of squamous cell carcinomas. HNSCC has been associated with environmental risk factors such as tobacco and alcohol. However, there is a small population (15%–20%) of HNSCC that occur in people who do not smoke and consume alcohol, suggesting that other factors such as human papillomavirus (HPV) may play a role.
HPV's role in the etiology of carcinogenesis was first identified in cervical cancer where more than 90% of these cancers can be associated with HPV infection.[1]
10 (d). None of the above
HPV-positive cases were found to be associated with more aggressive behavior, poor prognosis, and lower survival rates compared to HPV-negative cases despite aggressive treatment approaches and radiation-based adjuvant therapy.[1]
References
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