Ear, nose & throat · UKMLA & AKT
Oropharyngeal cancer
A free high-yield preview for the UKMLA Applied Knowledge Test. Below are the key points to recognise oropharyngeal cancer — the full SA Note notes add investigations, management, complications and 10 practice questions.
Key high-yield points
- Vast majority are squamous cell carcinomas (SCC) - two distinct pathways:
- HPV-related SCC - HPV-16 dominant; oncoproteins E6/E7 inactivate p53 and Rb respectively; loss of Rb causes compensatory p16 overexpression (used as surrogate marker); better prognosis, more radiosensitive
- Tobacco/alcohol-related SCC - carcinogen-driven mucosal field change; HPV-negative; worse prognosis; tobacco and alcohol act synergistically (multiplicative risk)
- In Western Europe, up to 93% of newly diagnosed oropharyngeal cancers are HPV-positive; HPV-positive disease affects younger, non-smoking patients
Tonsils and tonsillar fossae drain to the jugulodigastric (level II) anterior triangle nodes. The nasopharynx drains to the posterior triangle - a posterior triangle SCC node in an Asian patient points to nasopharyngeal primary.
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