Source: www.internalmedicinenews.com
Author: Doug Brunk

Most patients with multiple primary malignancies that are potentially related to human papillomavirus present with cervical cancer, and later develop head and neck squamous cell cancer or anal cancer, results from a long-term, single-center study suggest.

“In head and neck squamous cell cancers, the presence of HPV is correlated with improved patient outcomes,” researchers led by Dr. Heath D. Skinner wrote in an abstract presented in a poster session at the annual meeting of the American Society for Radiation Oncology. “However, it is unknown whether the development of one potentially HPV-related cancer affects the development of another and how the disease factors and outcomes are related.”

Based on the available literature, this patient population has a two- to fourfold increased risk over the general population for the development of a second potentially HPV-related malignancy, said Dr. Skinner of the University of Texas M.D. Anderson Cancer Center in Houston. He and his associates reviewed the charts of 143 patients with multiple cancers who were treated at the center in 1949-2008. Patients with in situ and non–squamous cell carcinoma malignancies were excluded from the analysis, with the exception of cervical adenocarcinoma.

Of the 301 cancers, the most common was head and neck (115), followed by cancer of the cervix (104), anus (49), vulva (21), vagina (8) and penis (4). The median follow-up from diagnosis of the first and second tumor was 16 years and 3 years, respectively.

The median age of patients at first and second diagnosis was 45 and 60 years, respectively, with a median duration between diagnoses of 11 years. Cervical cancer was the most common initial diagnosis (62%); head and neck squamous cell cancer was the most common second diagnosis (58%).

Dr. Skinner and his associates also found that patients with head and neck squamous cell cancer as the first diagnosis were most likely to develop subsequent cervical cancer.

“There is a significant difference in the timeline of the development of a second potentially HPV-related malignancy based on the primary site,” the researchers noted. “Patients with cervix cancer have a much longer latency to a second primary than do patients with head and neck squamous cell cancer, anal [cancer], or other gynecologic malignancies.”

Next, the researchers plan to investigate the actual HPV positivity of these tumors and identify whether a single viral genotype is responsible for multiple tumors in an individual patient.

The researchers stated that they have no relevant financial conflicts to disclose.