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Early symptoms of OPSCC may be tied to HPV status
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Neck masses and sore throats were the most common initial symptoms among patients with oropharyngeal squamous cell carcinoma, but the symptoms appeared to correlate with the HPV status of the tumors, according to recent study data.
HPV-positive patients were more likely to report a neck mass as the initial symptom, whereas HPV-negative patients more commonly exhibited symptoms associated with the primary tumor site, such sore throat, dysphagia and odynophagia.
Contrary to the declining incidence of other head and neck cancers, the incidence of oropharyngeal squamous cell carcinoma (OPSCC) has continued to rise in recent years, a trend often associated with an increased incidence of HPV-positive OPSCC. HPV-positive oropharyngeal tumors tend to affect younger, nonsmoking men and those with a more extensive sexual history, whereas HPV-negative tumors are more commonly observed among older patients with a history of heavy tobacco and alcohol use.
“With the rapidly increasing incidence in OPSCC, it may be important to consider education of the general public about the early symptoms of OPSCC and to encourage primary care providers and dental health care professionals to have a high index of suspicion in patients with symptoms suggestive of OPSCC,” the researchers wrote.
Terry A. Day
To examine the most common initial symptoms in patients with OPSCC — and ascertain if any differences existed in initial symptoms between HPV-positive and HPV-negative tumors — Terry A. Day, MD, and colleagues from the department of otolaryngology — head and neck surgery at the Medical University of South Carolina retrospectively reviewed the medical records of 88 patients with untreated OPSCC diagnosed from 2008 to May 2013.
Inclusion criteria consisted of newly diagnosed, previously untreated OPSCC with documented HPV tumor status via p16 immunohistochemical analysis. Patients were excluded if they exhibited recurrence or persistence of previously treated oropharyngeal tumors, unknown HPV status, nonsquamous cell carcinoma of the oropharynx or insufficient medical records.
Study results showed the most commonly reported initial symptoms among patients were neck mass (44%) and sore throat (33%).
The researchers observed that patients who were HPV-positive were more likely to primarily notice a neck mass than HPV-negative patients (51% vs. 18%; P=.02), whereas HPV-negative patients were more likely to report sore throat (53% vs. 28%; P=.09), dysphagia (41% vs. 10%; P=.05) or odynophagia (24% vs. 6%; P=.04).
“The differences in clinical presentation between HPV-positive and HPV-negative OPSCC may better support the ongoing theory of how HPV-positive OPSCC tends to originate in the tonsillar crypts, resulting in early cervical metastasis, and that HPV-negative OPSCC is more likely to be locally invasive correlating with initial symptoms at the primary tumor site,” Day and colleagues wrote.
Disclosure: The researchers report no relevant financial disclosures.
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