Altered presentation of oropharyngeal cancer, a 6-year review

ANZ J Surg. 2021 Jun;91(6):1240-1245. doi: 10.1111/ans.16537. Epub 2021 Jan 12.

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.

Keywords: human papilloma virus; neck mass; oropharyngeal squamous cell carcinoma; presenting symptom.

MeSH terms

  • Carcinoma, Squamous Cell* / diagnosis
  • Carcinoma, Squamous Cell* / epidemiology
  • Female
  • Head and Neck Neoplasms*
  • Humans
  • Male
  • Oropharyngeal Neoplasms* / diagnosis
  • Oropharyngeal Neoplasms* / epidemiology
  • Papillomaviridae
  • Papillomavirus Infections* / complications
  • Papillomavirus Infections* / diagnosis
  • Papillomavirus Infections* / epidemiology