SU20.1-2 | Oropharyngeal Cancer — Summary & Reflection

KEY TAKEAWAYS

Oral and oropharyngeal cancer is overwhelmingly squamous cell carcinoma (>90%) and, especially in India, is driven by smokeless tobacco and areca (betel) nut, with smoking and alcohol (synergistic) and HPV-16 (oropharynx, better prognosis) as further causes. Most cancers arise through premalignant lesions — leukoplakia (white, lower risk), erythroplakia (red, higher risk) and oral submucous fibrosis (areca-nut, fibrosis + trismus). The hallmark presentation is a non-healing ulcer (>3 weeks) with raised edges and an indurated base, with referred otalgia, dysphagia, trismus and a hard cervical node marking spread; lymphatic spread to neck nodes dominates. Investigation is by triple assessment (clinical examination + imaging + biopsy/FNAC) plus panendoscopy to exclude a second primary, assembling a TNM stage that governs treatment. Treatment is stage-directed: early disease (I-II) by single modality (surgery or radiotherapy), advanced disease (III-IV) by combined modality (surgery with neck dissection and reconstruction, plus adjuvant radiotherapy/chemoradiotherapy). Prevention, early detection and palliative care are integral throughout.

REFLECT

Think back to the last time you examined a patient's mouth, or imagine the next patient who chews tobacco. Did you — or would you — inspect the whole oral cavity, palpate any lesion bimanually, and feel the neck for nodes, or did the examination stop at the throat? Reflect on how a single non-healing ulcer or an unremarkable-looking white or red patch might be the only early sign of a curable cancer, and on the responsibility that carries every time you have a patient in the chair. Consider how you would phrase the advice to stop tobacco and areca-nut use so that it actually changes behaviour, and how you would explain to a patient why a lesion needs a biopsy rather than another course of mouthwash.