History and exam

Your Organizational Guidance

ebpracticenet urges you to prioritize the following organizational guidance:

Kanker van de mondholte: diagnose, behandeling en follow-upPublished by: KCELast published: 2015Cancers de la cavité buccale : diagnostic, traitement et suiviPublished by: KCELast published: 2015

Other diagnostic factors

common

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.

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.

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

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

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.

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.

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

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

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

Risk factors

strong

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]

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]​ 

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]

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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