Pathology · patient case question
In the United States, HPV is now most strongly associated with cancer at which site?
Patient case: A lump behind the tonsil
demo: 56-year-old male
chief: A painless lump in the right side of the neck that he first noticed two months ago.
history: Never smoked. Modest alcohol intake. Reports multiple lifetime sexual partners.
meds: None.
findings: A firm, non-tender 3 cm level II cervical node on the right. Examination of the oropharynx shows an ulcerated, slightly raised lesion of the right tonsil. Elsewhere the mucosa is unremarkable.
Show answer and explanation
Correct answer: C. Oropharynx
- A. Floor of mouth carcinoma is strongly linked to tobacco and alcohol. It sits in the oral cavity proper rather than the oropharynx.
- B. The hard palate is an uncommon site for squamous cell carcinoma and is more associated with salivary gland tumours and with reverse smoking practices.
- C. Correct. HPV-associated oropharyngeal cancer has overtaken cervical cancer as the most common HPV-related malignancy in the United States. Incidence has risen in men in particular, while tobacco-driven oral cavity cancer has been falling. The prognosis is notably better than for HPV-negative disease.
- D. Lower lip cancer is driven by ultraviolet exposure, which is why it affects outdoor workers and is preceded by actinic cheilitis.