Screening and Presentation
Unlike cervical cancer, which uses Papanicolaou cytology screening to assess precancerous lesions of the cervix, there are currently no practical screening tools available for HPV-positive OPSCC screening. Several techniques are under investigation, but each has limitations that preclude its use for population-level screening (Table 1). Furthermore, validated sexual history screening questionnaires have not been developed to capture patients most at risk.
Without a validated screening test or questionnaire to detect patients with or most at risk for HPV-positive OPSCC, it is imperative that first-line health care providers (PCPs and dentists) remain cognizant of the current epidemiologic factors discussed above. This information, coupled with knowledge and awareness of common clinical presentations, can be greatly beneficial to patients. A recent retrospective analysis of 207 patients with OPSCC found that patients with HPV-positive OPSCC were most likely to present with a neck mass (56%), sore throat (11%), or oral mass (11%). Furthermore most HPV-positive patients in this study presented at a tumor, node, metastasis stage of IVa (57%), with the tonsil (60%) and base of tongue (40%) being the most common primary tumor site.
If a patient presents to the office with a history suspicious for OPSCC, it is recommended that providers conduct a formal head and neck examination that includes inspection of the oral cavity, palatine tonsils, base of tongue, and cervical lymph nodes. An external light source and tongue blade are important for optimum visualization of the oral cavity and oropharynx for asymmetries or lesions. A mirror may be used to inspect the vallecula. Thorough palpation of the tonsillar fossae and tongue base can identify induration, ulceration, or swelling.
J Am Board Fam Med. 2021;34(4):832-837. © 2021 American Board of Family Medicine