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  Table of Contents  
Year : 2022  |  Volume : 59  |  Issue : 1  |  Page : 107-109

MCQs on “Human papillomavirus and head and neck squamous cell carcinoma in a UK population: Is there an association?”

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

Date of Submission15-Mar-2022
Date of Decision15-Mar-2022
Date of Acceptance22-Mar-2022
Date of Web Publication19-May-2022

Correspondence Address:
H S Darling
Department of Medical Oncology and Hemato-Oncology, Command Hospital Air Force, Bengaluru, Karnataka
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijc.ijc_330_22

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How to cite this article:
Darling H S, Jaiswal P, Lohia N, Tiwari NR. MCQs on “Human papillomavirus and head and neck squamous cell carcinoma in a UK population: Is there an association?”. Indian J Cancer 2022;59:107-9

How to cite this URL:
Darling H S, Jaiswal P, Lohia N, Tiwari NR. MCQs on “Human papillomavirus and head and neck squamous cell carcinoma in a UK population: Is there an association?”. Indian J Cancer [serial online] 2022 [cited 2022 Jun 27];59:107-9. Available from:

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?

  1. Statement 1 is true
  2. Statement 2 is true
  3. Both statements are true
  4. Both statements are false

Q2. Which of the following statements is true regarding the pathological role of HPV in HNSCC?

  1. Oncoprotiens E6 and E7 are expressed
  2. P53 and pRb are inactivated
  3. Both of the above
  4. None of the above

Q3. Which of the following statements is not true regarding HPV-related head and neck cancers?

  1. Are usually well differentiated
  2. Basaloid SCC
  3. Occur in non-smokers and non-drinkers
  4. Most common subsites are the base of the tongue/tonsillar region

Q4. The surrogate marker for HPV status is

  1. p18INK4A
  2. p16INK4A
  3. p20INK4A
  4. PCR of HPV DNA

Q5. The most common site of HPV-mediated cancer in the oropharynx is

  1. Base of the tongue
  2. Soft palate
  3. Palatine and lingual tonsil
  4. Posterior pharyngeal wall

Q6. Based on the published data, which of the following is the indicator of bad prognosis in HPV (+) HNSCC?

  1. p16 negativity
  2. p16 positivity
  3. Female gender
  4. EGFR (-) status

Q7. Which of the following gender is associated with a higher prevalence of HPV (+) HNSCC?

  1. Males
  2. Females
  3. It is gender-neutral
  4. Epidemiology differs with the geographical area

Q8. In the study by Al-Dabbagh et al., which of the following was the most common primary tumor site?

  1. Pharynx
  2. Larynx
  3. Palate
  4. Tongue

Q9. Find the incorrect statement

  1. HNSCC accounts for 90% of squamous cell carcinomas in humans
  2. 60% of HNSCC are associated with tobacco and alcohol
  3. 90% of cervical cancers are associated with HPV infection
  4. None of the above

Q10. In the study by Al-Dabbagh et al., as compared to HPV-negative cases, HPV-positive cases were associated with

  1. Indolent behavior
  2. Better prognosis
  3. Longer survival rates
  4. None of the above

Answers 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 Top

Al-Dabbagh R, Al-Hazmi N, Alhazzazi TY, Barrett AW, Speight PM. Human papillomavirus and head and neck squamous cell carcinoma in a UK population: Is there an association? Indian J Cancer 2021;59:65-72.  Back to cited text no. 1
Salama JK, Brizel DM. Chapter 48: Oropharynx. In: Halperin EC, Brady LW, Wazer DE, Perez CA, editors. Perez and Brady's Principles and Practice of Radiation Oncology. 7th ed. Philadelphia: Wolters Kluwer; 2018.  Back to cited text no. 2
Sullivan BO, Lydiatt WM, Haughey BH, Gensler MB, Glastonbury CM, Shah JP. Chapter 10: HPV-mediated (p16+) oropharyngeal cáncer. AJCC Cancer Staging Manual. 8th ed. New York: Springer; 2017.  Back to cited text no. 3
Sabatini ME, Chiocca S. Human papillomavirus as a driver of head and neck cancers. Br J Cancer 2020;122:306-14.  Back to cited text no. 4


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