This is Episode sixteen: Oropharynx Foundations, H.P.V. Biology, and A.J.C.C. Eighth Edition Staging.Today we begin a new block, and I want to set the stage with something fundamental: oropharynx cancer is not one disease. It is two biologically distinct diseases that share an anatomic region.H.P.V. positive oropharynx cancer is virally driven, occurs in a different patient population, and has dramatically better outcomes. H.P.V. negative oropharynx cancer is the traditional tobacco and alcohol-related disease with worse prognosis and different behavior.This distinction is so important that A.J.C.C. eighth edition created separate staging systems for these two entities. That's unprecedented in head and neck oncology.By the end of today, you'll understand why a patient with a large cystic neck node can still have early-stage H.P.V. positive disease — and why that is actually biologically coherent.
