According to a recent article in the Journal of the American Board of Family Medicine, the prevalence of oropharynx cancer has increased because of HPV. Three of the 4 newly diagnosed carcinomas are HPV positive.
From 1988 to 2004 there has been a 225% increase in prevalence which has been exclusively attributed to HPV (and more specifically to HPV-16).
By 2020 it is projected that HPV will cause more oropharyngeal carcinoma than its cervical counterpart.
HPV positive carcinoma is associated with the younger patient, oral sex, and improved treatment outcomes when compared to HPV negative carcinomas. The estimated overall survival rate for patients with HPV positive oropharyngeal carcinoma was 95%.
It is considered to be a completely different entity than HPV negative oral cancer with its own epidemiology, tumor biology, presentation, response to treatment, and prognosis.
It has a very non specific presentation, therefore a high clinical index of suspicion is needed for early diagnosis and treatment. The patient is more likely to be white, college educated, and on average be 54 years of age. Typical risk factors such as tobacco aren’t present.
HPV positive carcinoma most commonly arises from the lymphoid tissues of the palatine tonsils or base of tongue. The most common initial presentation is a neck mass because there is a high rate of cervical metastasis. Other symptoms include sore throat, globus sensation, dysphagia, and otalgia.
If a unilateral neck mass is found refer to an otolaryngologist for possible FNA and CT scan. Sensitivity and specificity of FNA to diagnose cancer is considered to be 88% and 100% respectively.
Because of the increasing rate of HPV positive carcinoma, vaccination has never been more important. Remember to vaccinate all patients 9-26. It is especially important to counsel the parents about cancer prevention, as a lot will be reluctant in allowing the administration of the vaccine.