Human papilloma virus (HPV) associated oropharyngeal cancers are becoming much more prevalent and, in some geographic areas, have overtaken tobacco as the leading cause of oropharyngeal cancer. HPV-associated cancers are also reported to have better prognosis in general, and research on de-escalating treatments to improve post-treatment functional outcomes is topical. The authors of this study report a prospective analysis of pre-treatment swallowing symptoms in a heterogenous population of HPV-associated oropharyngeal cancers. The aim was to establish baseline incidence of dysphagia and to provide some insight into the nature and severity of swallowing problems for this cohort. All patients with confirmed HPV cancer seen at their institution over a 22-month timeframe were asked to complete the Eating Assessment Tool (EAT-10) at the pre-treatment evaluation. Seventy patients met their criteria, of which 66 were males; overall mean age was 60 years. Almost all (97%) presented with either tongue base or tonsil primary tumours and the majority were early-stage tumours. Nearly three quarters (74.3%) of patients presented with normal EAT-10 scores (score of less than three). Of the remaining patients with abnormal EAT-10 scores, 72% reported pain on swallowing, with three quarters of these patients also presenting with neck mass as part of their symptomatology. Additionally, the authors found that almost 90% of abnormal swallowing was attributed to two key symptoms: sensation of food sticking, and great effort required to swallow. Finally, the authors report a moderate relationship between primary tumour size and overall EAT-10 score. The authors conclude that most patients with HPV-associated oropharyngeal cancer do not experience significant dysphagia at baseline perhaps because they mainly present with small mucosal primary lesions less than 4cm in size. Furthermore, the pattern of invasion may not be as deep into surrounding musculature as Non-HPV associated tumours. However, the absence of early swallowing symptoms may also contribute to this group being missed for early diagnosis until they present with nodal disease which precipitates help-seeking behaviour.
Dysphagia in people with HPV-related oropharyngeal cancer
Reviewed by Roganie Govender
Prospective Evaluation of Swallowing Symptoms in Human Papillomavirus-Associated Oropharynx Cancer.
CONTRIBUTOR
Roganie Govender
University College London, Head & Neck Academic Centre, UK.
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