Neck Mass, Persistent Sore Throat Could Mean Throat Cancer

Fran Lowry

March 20, 2014

A prolonged sore throat and a neck mass are the most common initial symptoms of oropharyngeal squamous cell carcinoma, and primary care clinicians whose patients report such symptoms should refer them immediately for screening.

These symptoms are usually the first signs of human papillomavirus (HPV)-positive throat cancer, which is increasingly occurring in young healthy people, researchers report. Other early symptoms of throat cancer are pain or difficulty swallowing and difficulty opening the mouth; these are usually indications of HPV-negative oropharyngeal cancer.

These findings come from a retrospective study 88 patients with known HPV status, published online today in JAMA Otolaryngology – Head & Neck Surgery.

Dr. Terry Day

"We want clinicians to tell their patients about the possibility of throat cancer, and make them aware that patients with a sore throat lasting 2 weeks or more, trouble swallowing, or a lump in the neck should be referred to a specialist for exam and biopsy," said senior author Terry A. Day, MD, from the Medical University of South Carolina in Charleston.

Dr. Day said he began to notice an "alarming" trend about 7 or 8 years ago, when young, healthy, and predominantly male patients were coming to him with HPV-related throat cancer.

"In the past, head and neck cancers occurred mostly in people who smoke and drank excessively, but there have been so many people exposed to HPV now, more people are getting this at a younger age, and they are generally white and generally male," Dr. Day told Medscape Medical News.

The fact that his patients did not even know that this cancer existed prompted Dr. Day to do his retrospective study.

The patients were diagnosed by Dr. Day from January 2008 to May 2013. This was before all the publicity last year over comments made by Oscar-winning actor Michael Douglas about his throat cancer being HPV-positive and supposedly resulting from oral sex.

"Their physicians and dentists didn't know that the sore throat or neck lump was cancer, and these folks ended up going to 2 or 3 physicians or dentists before being sent a for a biopsy," he said.

"When I looked at the literature and Web sites from the American Cancer Society, National Cancer Institute, and all these other places, they didn't mention what we were seeing. I decided to look back at my last 100 or so patients to see what their symptoms were when they came to the office. This was a retrospective study, and that is one of its weaknesses, but we have a prospective study ongoing now. The important thing is that we want to get the word out that this is real, this cancer exists," Dr. Day said.

Getting the Message Out

Dr. Day and his colleagues are keen to get the word out to the general public before Oral, Head and Neck Cancer Awareness Week, April 20 to 26, 2014.

During that week, people can get free screenings from their doctor or dentist at various centers across the United States.

The Head and Neck Cancer Alliance Web site provides information about screening, and allows doctors and dentists who wish to take part in the Oral, Head and Neck Cancer Awareness Week screening program to register their services, Dr. Day said. The week and the free screenings are supported by Bristol-Myers Squibb.

"People need to be proactive about screening. Educating the public is the first step in prevention and, hopefully, an early diagnosis. We don't have a blood test or a Pap test," said Dr. Day. However, most of the symptoms can be seen on physical examination.

"People can go to the Web site to find a place in their home town where they can get a free screening for throat cancer. We want people to be diagnosed earlier and be aware that this cancer exists," he said.

Retrospective Study

In their study, Dr. Day and his colleagues reviewed the records of 88 patients diagnosed with newly diagnosed oropharyngeal squamous cell carcinoma and known HPV status.

The most common initial symptoms for oropharyngeal squamous cell carcinoma were neck mass — in 39 patients (44%) — and sore throat in 29 patients (33%).

HPV-positive patients were more likely than HPV-negative patients to notice a neck mass (51% vs 18%; P = .02). In contrast, HPV-negative patients were more likely to notice a sore throat (53% vs 28%; P = .09), dysphagia (41% vs 10%; P = .05), or odynophagia (24% vs 6%; P = .04).

HPV Vaccine for Adults?

Dr. Day agrees that vaccinating adults against HPV is a good idea. However, the vaccine is currently approved by the US Food and Drug Administration only for use in children and young adults.

"I would recommend it to prevent HPV cancers, but I'm not a pediatrician or vaccine expert. We'll know in another couple of decades if the vaccine works" to prevent oropharyngeal squamous cell carcinoma, he noted.

In the meantime, it is important to educate adults about the importance of screening and early diagnosis.

"HPV-related oropharyngeal cancer tends to have a good cure rate, even when it has spread to the lymph nodes," Dr. Day explained. Unfortunately, the HPV-negative cancers do not. Still, an early diagnosis is always best, he said.

Dr. Day has disclosed no relevant financial relationships. Bristol-Myers Squibb is providing funding for free screening as part of its support of Oral, Head and Neck Cancer Awareness Week.

JAMA Otolaryngol Head Neck Surg. Published online March 20, 2104. Abstract

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