Abstract
Imaging, especially contrast-enhanced computed tomography (CECT) for anatomy and positron emission tomography (PET) with labeled 18F fluorodeoxyglucose for physiologic detail, is critical for staging carcinomas of the oropharynx. As the incidence of human papillomavirus (HPV) infection and related carcinomas of the tonsil and base of tongue (BOT) increases, experience with CECT and PET for staging HPV+ tumors is growing. No imaging modality, however, can determine whether the tumor is HPV+. There are some unique challenges posed by HPV+ oropharyngeal squamous cell carcinoma (SCC). In most locations of the head and neck, a malignancy enhances more than surrounding normal structures, which facilitates tumor mapping. Unfortunately, normal lymphoid tissue of the oropharynx, in the BOT and palatine tonsillar fossa, enhances on CECT and gadolinium enhanced magnetic resonance imaging in a manner similar to SCC. The primary tumor may be small or even occult at presentation, and easily over-looked on CECT. PET coupled with CECT has made a true “unknown primary” very rare, as the metabolically active tumor is almost always detectable on PET. The nodal metastases, so common with HPV+ SCC, can be truly cystic; and as such, can be misdiagnosed as a second branchial cleft cyst, a congenital benign lesion. These pitfalls, coupled with the complex anatomy of the upper aerodigestive tract, make staging these tumors difficult. In this monograph we describe the anatomy of the oropharynx and review the imaging modalities available for staging. Figures highlight the points raised in the text.
Similar content being viewed by others
References
Osborne RG, Brown JJ. Carcinoma of the oral pharynx: an analysis of subsite treatment heterogeneity. Surg Oncol Clin N Am. 2004;13:71–80.
Filion E, Le Q-T. Oropharynx: epidemiology and treatment outcome. In: Harari PM, Connor NP, Grau C, editors. Functional preservation and quality of life in head and neck radiotherapy. Berlin: Springer; 2009.
Simard EP, Ward EM, Siegel R, Jemal A. Cancers with increasing incidence trends in the United States: 1999–2008. CA Cancer J Clin. 2012 (epub ahead of print). doi:10.3322/caac.20141.
Saba NF, Goodman M, Ward K, et al. Gender and ethnic disparities in incidence and survival of squamous cell carcinoma of the oral tongue, base of tongue and tonsils: a surveillance, epidemiology and end results program-based analysis. Oncology. 2011;81:12–20.
D’Souza F, Kreimer AR, Viscidi R, et al. Case-control study of human papillomavirus and oropharyngeal cancer. N Engl J Med. 2007;356:1944–56.
Chaturverdi AK, Engels EA, Pfeiffer RM, et al. Human papillomavirus and rising oropharyngeal cancer incidence in the United States. J Clin Oncol. 2011;29:4294–301.
Lin DT, Cohen SM, Coppit GL, et al. Squamous cell carcinoma of the oropharynx and hypopharynx. Otolaryngol Clinc N Am. 2005;38:59–74.
Trotta BM, Pease CS, Rasamny JJ, et al. Oral cavity and oropharyngeal squamous cell cancer: key imaging findings for staging and treatment planning. Radiographics. 2011;31:339–54.
Cohan DM, Popat S, Kaplan SE, et al. Oropharyngeal cancer: current understanding and management. Curr Opin Otolaryngol Head Neck Surg. 2009;17:88–94.
Stambuk HE, Karimi S, Lee N, et al. Oral cavity and oropharynx tumors. Radiol Clin N Am. 2007;45:1–20.
Wesolowski JR, Mukherji S. Pathology of the pharynx. In: Som PM, Curtin HD, editors. Head and neck imaging. 5th ed. Amsterdam: Elsevier; 2011.
Edge S, Byrd D, Compton C, et al. AJCC7 cancer staging manual. New York: Springer; 2010.
Syms MJ, Birkmire-Peters DP, Holtel MR. Incidence of carcinoma in incidental tonsil asymmetry. Laryngoscope. 2000;11:1807–10.
Yoon DY, Hwang HS, Chang SK, et al. CT, MR, US, 18F-FDG PET/CT, and their combined use for the assessment of cervical lymph node metastases in squamous cell carcinoma of the head and neck. Eur Radiol. 2009;19:634–43.
Xu G-Z, Zhu X-D, Li M-Y. Accuracy of whole-body PET and PET-CT in initial M staging of head and neck cancer: a meta-analysis. Head Neck. 2011;33:87–94.
Bannas P, Habermann CR, Jung C, et al. Diagnostic accuracy of state-of-the-art MDCT scanners without gantry tilt in patient with oral and oropharyngeal cancer. Eur J Radiol. 2011;. doi:10.1016/j.ejrad.2011.07.009.
Bhargava P, Rahman S, Wendt J. Atlas of confounding factors in head and neck PET/CT imaging. Clin Nucl Med. 2011;36:e20–9.
Blodgett TM, Fukui MB, Snyderman CH, et al. Combined PET-CT in the head and neck. Part 1. Physiologic, altered physiologic and artifactual FDG uptake. Radiographics. 2005;25:897–912.
Schmalbach CE, Miller FR. Occult primary head and neck cancer. Curr Oncol Rep. 2007;9:139–46.
Wong WL, Sonoda LI, Gharpurhy, et al. 18F-fluorodeoxyglucose positron emission tomography/computed tomography in the assessment of occult primary head and neck cancers—an audit and review of published studies. Clin Oncol. Available on-line 17 Dec 2011.
Fakhry C, Westra WH, Li S, et al. Improved survival of patients with human papillomavirus-positive head and neck squamous cell carcinoma in a prospective clinical trial. J Natl Cancer Inst. 2008;100:261–9.
Westra WH. The changing face of head and neck cancer in the 21st century: the impact of HPV on the epidemiology and pathology of oral cancer. Head Neck Pathol. 2009;3:78–81.
Goldenberg D, Begu S, Westra WH, et al. Cystic lymph node metastatsis in patients with head and neck cancer: an HPV-associated phenomenon. Head Neck. 2008;30(7):898–903.
Morani A, Shah G, Eisbruch A, et al. Intranodal cystic changes: a potential radiological signature/biomarker to assess the human papilloma virus status of patients with oropharyngeal carcinoma. AJR 2011;196:A47. Abstract presented in scientific session 14—neuroradiology: head and neck on 4 May 2011 at the ARRS meeting.
Hudgins PA, Gillison M. Editorial: second branchial cleft cyst: NOT!! AJNR. 2009;30:1628–9.
Ahuga AT, Ying M. Sonographic evaluation of cervical lymph nodes. AJR. 2005;184:1691–9.
King KG, Kositwattanarerk A, Genden E, et al. Cancers of the oral cavity and oropharynx: FDG-PET with contrast enhanced CT in the posttreatment setting. Radiographics. 2011;31:355–73.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Corey, A.S., Hudgins, P.A. Radiographic Imaging of Human Papillomavirus Related Carcinomas of the Oropharynx. Head and Neck Pathol 6 (Suppl 1), 25–40 (2012). https://doi.org/10.1007/s12105-012-0374-3
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12105-012-0374-3