Differences Seen in HPV Positive, Negative in Squamous Cell Head, Neck Cancer

Bottom Line: Neck mass and sore throat appear to be the initial symptoms in patients with oropharyngeal (mouth and throat) squamous cell carcinoma (OPSCC), and the symptoms appear to be associated with the human papillomavirus (HPV) status of the tumors.

Authors: Wesley R. McIlwain, B.S., of the Medical University of South Carolina, Charleston, and colleagues.

Background: The incidence of OPSCC has been on the rise, unlike other head and neck cancers that have been on the decline. The trend has been associated with an increased incidence of HPV-positive OPSCC (which comprised 40.5 percent of OPSCC cases before 2000 and up to 70 percent of cases since 2009). HPV-positive OPSCC tends to affect younger, nonsmoking men and patients with more extensive sexual history. HPV-negative OPSCC typically affects older patients with heavy tobacco and alcohol use.

How the Study Was Conducted: The authors sought to determine common initial symptoms in patients with OPSCC and the association with HPV status. They reviewed the medical records of patients evaluated by senior author, Terry A. Day, M.D., of the Medical University of South Carolina, from January 2008 to May 2013 and included 88 patients in their study.

Results: The most common initial symptoms of OPSCC were neck mass in 39 patients and sore throat in 29 patients. More HPV-positive patients noticed a neck mass as an initial sign, while HPV-negative patients had pain symptoms related to the primary tumor site, including sore throat and uncomfortable or painful swallowing.

Discussion: “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.”

(JAMA Otolaryngol Head Neck Surg. Published online March 20, 2014. doi:10.1001/jamaoto.2014.141