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Advisor(s)
Abstract(s)
Introdução: O Carcinoma de Células Escamosas da Orofaringe (CCEO) é o tumor da
cabeça e pescoço mais comum atualmente e aquele com maior aumento de incidência
nos últimos 30 anos, apesar da redução na prevalência dos hábitos tabágicos. A infeção
pelo Papiloma Vírus Humano (HPV), em particular pelos tipos de alto risco (HPV 16 e
18), é hoje reconhecida como fator etiológico dos CCEO HPV positivos (+). O aumento
deste tipo de tumor parece relacionar-se com mudanças nos comportamentos sexuais ao
longo dos anos, destacando-se a prática de sexo oral. Os CCEO HPV (+) apresentam
características que divergem dos CCEO HPV negativos (-) e que podem ter impacto a
nível de tratamento, prevenção e terapêutica dirigida.
Objetivo: Analisar a evidência científica atual acerca dos CCEO HPV (+),
diferenciando-os dos CCEO HPV (-) em termos epidemiológicos, clínicos, biológicos, de
tratamento e prognóstico. Pretende-se também, avaliar os fatores de risco que levam à
infeção e à carcinogénese pelo HPV, os principais métodos de deteção do HPV nos CCEO
e possíveis métodos de rastreio e prevenção da doença.
Métodos: Para a realização desta dissertação foi realizada pesquisa bibliográfica e
efetuada revisão de literatura científica através da utilização das plataformas PubMed,
UpToDate, bem como a utilização de outras plataformas de interesse como o CDC, NCCN
e DGS.
Resultados: Dos fatores de risco que contribuem para a carcinogénese causada
pelo HPV na orofaringe, destacam-se: o sexo masculino, o maior número de parceiros
sexuais e o tabagismo. Os CCEO HPV (+), geralmente, respondem melhor ao tratamento
do que os CCEO HPV (-), tendo assim melhor prognóstico. O teste para deteção do HPV
deve ser feito em todos os CCEO. Este permitirá tratamentos menos agressivos em CCEO
HPV (+). As principais técnicas de rastreio analisadas têm como premissa ser pouco
invasivas e algumas mostram-se promissoras.
Discussão/Conclusão: Tendo em conta os dados obtidos, é extremamente importante
conhecer o status HPV dos doentes com CCEO de forma a realizar o estadiamento
adequado, perceber o seu prognóstico e adequar o tratamento. Entende-se a necessidade
de encontrar uma técnica adequada de rastreio, não só devido ao grande aumento dos
CCEO atualmente, mas também para prevenir o diagnóstico em estadios avançados do
tumor. Apesar de ser importante a introdução da vacina HPV no sexo masculino, esta
não terá efeitos imediatos.
Introduction: Oropharyngeal Squamous Cell Carcinoma (CCEO) is the most common head and neck cancer nowadays and the one with the highest incidence rates in the last 30 years, despite the reduction in the prevalence of smoking habits. Human Papilloma Virus (HPV) infection, in particular by high-risk HPV types 16 and 18, is now recognized as an etiological factor of HPV positive (+) CCEO. The increase in this type of tumour seems to be related to the change in sexual behaviours over the years, with emphasis on the practice of oral sex. HPV positive (+) CCEO have characteristics that differ from HPV negative (-) CCEO and which can have an impact in terms of treatment, prevention and targeted therapy. Goals: Analyse the current scientific evidence about CCEO HPV (+), differentiating them from CCEO HPV (-) in epidemiological, clinical, biological, treatment and prognostic terms. It is also intended to assess the risk factors that lead to HPV infection and carcinogenesis, the main methods of detecting HPV in the CCEO and possible methods of screening and preventing the disease. Methods: A bibliographic search and a review of the scientific literature were carried out using the PubMed, UpToDate platforms, as well as the use of other platforms of interest such as the CDC, NCCN and DGS. Results: Among the risk factors that contribute to the HPV carcinogenesis in the oropharynx, the following stand out: the male sex, the largest number of sexual partners, and smoking. CCEO HPV (+) generally respond better to treatment than CCEO HPV (-), thus having a better prognosis. The HPV detection test should be done at all CCEO. This HPV detection will allow de-escalation in treatments of CCEO HPV (+). The main screening techniques analysed are premised on being less invasive and some show promise. Discussion/Conclusion: Considering the collected data, it is extremely important to know the HPV status of patients with CCEO in order to perform the proper staging, understand their prognosis and adapt the treatment according to the result. It is understood the need to find an appropriate screening technique, not only due to the large increase in CCEO currently, but also to prevent the diagnosis in advanced stages of the tumour. Although it is important to introduce the HPV vaccine in men, it will not have immediate effects.
Introduction: Oropharyngeal Squamous Cell Carcinoma (CCEO) is the most common head and neck cancer nowadays and the one with the highest incidence rates in the last 30 years, despite the reduction in the prevalence of smoking habits. Human Papilloma Virus (HPV) infection, in particular by high-risk HPV types 16 and 18, is now recognized as an etiological factor of HPV positive (+) CCEO. The increase in this type of tumour seems to be related to the change in sexual behaviours over the years, with emphasis on the practice of oral sex. HPV positive (+) CCEO have characteristics that differ from HPV negative (-) CCEO and which can have an impact in terms of treatment, prevention and targeted therapy. Goals: Analyse the current scientific evidence about CCEO HPV (+), differentiating them from CCEO HPV (-) in epidemiological, clinical, biological, treatment and prognostic terms. It is also intended to assess the risk factors that lead to HPV infection and carcinogenesis, the main methods of detecting HPV in the CCEO and possible methods of screening and preventing the disease. Methods: A bibliographic search and a review of the scientific literature were carried out using the PubMed, UpToDate platforms, as well as the use of other platforms of interest such as the CDC, NCCN and DGS. Results: Among the risk factors that contribute to the HPV carcinogenesis in the oropharynx, the following stand out: the male sex, the largest number of sexual partners, and smoking. CCEO HPV (+) generally respond better to treatment than CCEO HPV (-), thus having a better prognosis. The HPV detection test should be done at all CCEO. This HPV detection will allow de-escalation in treatments of CCEO HPV (+). The main screening techniques analysed are premised on being less invasive and some show promise. Discussion/Conclusion: Considering the collected data, it is extremely important to know the HPV status of patients with CCEO in order to perform the proper staging, understand their prognosis and adapt the treatment according to the result. It is understood the need to find an appropriate screening technique, not only due to the large increase in CCEO currently, but also to prevent the diagnosis in advanced stages of the tumour. Although it is important to introduce the HPV vaccine in men, it will not have immediate effects.
Description
Keywords
Epidemiologia Fatores de
Risco Infeção Oral Por Hpv Rastreio Hpv Na Orofaringe Tumor da Orofaringe