History and exam

Other diagnostic factors

common

sore throat

Persistent sore throat is common in human papillomavirus (HPV)-independent oropharyngeal cancer, occurring in up to 33% of patients at presentation.[56]​ Sore throat is less commonly seen in HPV-associated oropharyngeal cancer.

neck lump

Present in up to 49% of patients because of neck metastases at diagnosis.[56]​ Present in an even higher percentage of patients (>90% in some series) with HPV-associated oropharyngeal cancer.

indurated or ulcerated mass

Most patients present with advanced tumor stage (≥T2) because of the insidious presentation of tumor.[57]

dysphagia

Present in up to 10% of patients secondary to tumor infiltration of muscles critical for swallowing.[58]

oral pain

Present in up to 32% of patients, particularly those with HPV-independent disease, due to ulceration of the mucosa.[59] Oral pain and weight loss in a person ages >40 years with a strong smoking and drinking history signals possible oropharyngeal cancer.

weight loss

Up to 50% of patients present with severe weight loss (10% over 6 months).[60] Oral pain and weight loss in a person ages >40 years with a strong smoking and drinking history signals possible oropharyngeal cancer.

otalgia

Due to referred pain through stimulation of tympanic branches of cranial nerves IX and X, occurring in 3% to 6% of patients.[56][61]

uncommon

trismus

Usually a late symptom from tumor invasion of pterygoid space; limits opening of mouth. Occurs in about 2% of patients at diagnosis.[62]

white plaques (leukoplakia) and red plaques (erythroplakia)

Should be noted, as they may indicate field cancerization, distinct from the primary lesion.

Risk factors

strong

human papillomavirus (HPV) infection

Incidence of HPV-associated oropharyngeal cancer is rising in the developed world, linked to oral sex practices.[11][17]​​​[27][28]​​​ White, non-Hispanic men have the highest incidence of HPV-associated oropharyngeal cancers.​[12]

smoking tobacco cigarettes

Tobacco cigarette smoke contains multiple carcinogens and procarcinogens that induce cancer of the oral cavity and oropharynx.[22][29]​​​​ People who smoke have higher odds of developing oropharyngeal cancer, compared with nonsmokers.[13]​ 

alcohol

One meta-analysis reported that the relative risk of oropharyngeal cancer in people who consume ≥4 alcoholic drinks per day was 7.76 (95% confidence interval 4.77 to 12.62), compared with people who consume fewer than 4 alcoholic drinks per day.[14]​ People who smoke cigarettes as well as drink alcohol are at higher risk of oropharyngeal cancer, compared with nonsmokers. Another meta-analysis reported a 2.54-fold increase in oropharyngeal cancer risk in nonsmokers who consume ≥4 alcoholic drinks per day, and a 6.32-fold increase in oropharyngeal cancer risk among smokers who consume ≥4 alcoholic drinks per day. Beer, wine, and spirits were associated with similar increases in risk.[15]

tobacco and betel nut chewing

Chewing betel nuts and tobacco, known risk factors for oral and oropharyngeal squamous cell carcinoma, is popular in some countries such as India because of its nervous-system stimulatory effect.[29] Betel nut chewing is also associated with a poorer prognosis after cancer treatment. Patients with heavy consumption of betel nuts (30 quids a day for >30 years) have a 31.4-fold risk of death as compared with moderate users (10 quids a day for <10 years).[30]

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