Altered presentation of oropharyngeal cancer, a 6‐year review

Abstract

Background Human papilloma virus (HPV)‐associated oropharyngeal squamous cell carcinoma (OPSCC) continues to increase in incidence. Patients are younger, non‐smokers and most commonly present with a neck mass often with no other symptoms. This altered presentation compared with non‐HPV OPSCC may not be recognized by medical practitioners, leading to delayed diagnosis. Methods Patients with histopathological confirmation of OPSCC and known HPV and/or P16 status who presented to our institution between 2012–2017 inclusive were included in the study. Demographic data, tumour characteristics and presenting symptoms were retrospectivxely obtained from both electronic‐ and paper‐based records. Descriptive statistics were used to report demographic data and the two sample t‐test and Fisher's exact test were used to compare groups based on HPV status. Time to diagnosis was also reported. Results A total of 184 patients were included in the study. The majority of patients were male (85.4%) and HPV + (85.3%). The tonsillar complex (53.8%) and tongue base (42.4%) were the most common primary sites. HPV+ patients were less likely to smoke (17.8%) and they commonly presented with a neck mass (39.5% alone or with other symptoms 61.2%). Time to diagnosis in the HPV+ group was longer (15 weeks). Conclusion Our review has highlighted the altered presentation of OPSCC due to the increased incidence of HPV infection. We showed a delayed time to diagnosis in HPV+ OPSCC compared with non‐HPV disease. This confirms the importance of focusing our efforts on educating medical practitioners and creating further awareness to facilitate early detection and treatment.

Protein Translation Dysregulation and Immune Cell Evasion Define Metastatic Clones in HPV-related Cancer of the Oropharynx

“…However, infection with human papillomavirus (HPV) is becoming an increasingly common cause and is now responsible for up to 80% of oropharyngeal cancers 2 . The HPV-positive oropharyngeal cancer (HPV+) patient population differs from HPV-negative (HPV-), with earlier age of onset, smaller primary tumours, and larger lymph node burden but improved survival outcomes 3–5 . The cellular mechanisms underlying these clinical differences in HPV+ and HPV-patients are poorly understood 6,7 , resulting in missed opportunities to understand the defining differences in cancer cell behaviour, metastasis and treatment response.…”

Oncological outcomes post transoral robotic surgery (TORS) for HPV-associated oropharyngeal squamous cell carcinoma, a single-centre retrospective Australian study

“…Human Papillomavirus (HPV) is now recognised as the main risk factor leading to the development of OPSCC [ 1 – 4 ]. At our institution, 85.3% of cases are HPV-associated [ 3 ]. HPV subtypes 16 and 18 are most commonly associated with HPV-associated cancers and in OPSCC, HPV type 16 is the most common HPV subtype, occurring in up to 84% of cases [ 4 – 6 ].…”

Oncological and functional outcomes of transoral surgery compared with non-surgical management in small-volume oropharyngeal cancer: a systematic review protocol

“…2 The incidence of OPSCC is rapidly growing due to the rise in human papillomavirus (HPV) positive cases, 3 accounting for 70% of newly diagnosed cases. 4,5 Of the identified HPV subtypes, HPV 16 subtype has been shown to be linked with the majority (85-96%) of HPV-associated OPSCC. 1,6 P16 is a useful surrogate marker for HPV and is utilized in screening for HPV-associated OPSCC.…”

“…Oropharyngeal squamous cell carcinoma (OPSCC) is a subset of head and neck cancers that includes cancers arising from the tonsils, base of the tongue, soft palate, tonsillar pillars, glossopharyngeal sulci, and the lateral and posterior pharyngeal wall 2 . The incidence of OPSCC is rapidly growing due to the rise in human papillomavirus (HPV) positive cases, 3 accounting for 70% of newly diagnosed cases 4,5 . Of the identified HPV subtypes, HPV 16 subtype has been shown to be linked with the majority (85–96%) of HPV-associated OPSCC 1,6 .…”