Oropharyngeal carcinoma : what the dentist should know

Abstract

HPV-related oropharyngeal carcinoma (OPC) is a clinically and molecularly distinct form of squamous cell carcinoma (SCC) which has recently shown a dramatic increase in global incidence. The aetiology, clinical presentation and overall prognosis differ from conventional tobacco and alcohol related SCC of the oral cavity. OPC is seen in a subset of younger predominantly male patients. Acquisition of highrisk HPV subtypes is related to oral sex practices with multiple partners. OPC originates deep within tonsillar crypts which hinders early clinical detection. Patients present with advanced disease and frequent cervical lymph node metastases. Despite its aggressive nature, the overall prognosis remains excellent compared with conventional oral SCC. The increased incidence of OPC is of clinical significance to the general dentist and should always be considered in the clinical differential diagnosis in a young, otherwise healthy, patient with persistent cervical lymph node enlargement. Older patients with a history of tobacco usage and alcohol consumption may also present with conventional SCC of the oropharynx. Potentially malignant disease may precede tumour development at this site in such cases. Clinical examination of the oropharynx should therefore be performed as part of routine dental consultation.