Changing paradigms for oropharynx cancer: Swinging of pendulum back towards surgery

The oropharynx, extending from the soft palate to the level of the epiglottis, and containing the palatine tonsils and base of tongue (BOT), is a common site for Head and Neck cancer. Squamous cell carcinoma (SCC) comprises the overwhelming majority of cases. Traditional aetiological factors for oropharynx SCC (OPSCC) are smoking and alcohol consumption. In recent years, human papilloma virus (HPV) type 16 has emerged as the major cause of an ever increasing number of cases . Over the last two decades, there has been a dramatic surge in the incidence of OPSCC. Figures obtained by the Irish National Cancer Registry show an increase from 50 cases per year in 1994 to over 100 cases per year in 2012. This recent rise in OPSCC incidence is almost exclusively related to an increase in HPV related cancers. In the United States, between 1988 and 2004, HPV related OPSCC showed a 225% increase, while HPV-negative OP SCC showed a 50% decline, attributed to decreased prevalence of smoking.