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# Head and neck squamous cell carcinoma (oral cavity and oropharynx, HPV)

A cancer of the lining of the mouth and throat, linked to tobacco, alcohol and HPV. A mouth sore or neck lump that lasts over 3 weeks needs checking.

Updated 2026-11-01

## Structures involved

Tap one to see what it is and open it in 3D.

- [Tongue](https://durgical.com/en/anatomy/tongue/)
- [Palatine tonsils](https://durgical.com/en/anatomy/palatine-tonsil/)
- [Pharynx](https://durgical.com/en/anatomy/pharynx/)
- [Neck lymph nodes](https://durgical.com/en/anatomy/lymph-nodes-of-neck/)
- [Soft palate](https://durgical.com/en/anatomy/soft-palate/)
- [Gums (gingiva)](https://durgical.com/en/anatomy/gums/)
- [Mandible](https://durgical.com/en/anatomy/mandible/)
- [Pharyngeal constrictors](https://durgical.com/en/anatomy/superior-pharyngeal-constrictor/)
- [Hypoglossal nerve (XII)](https://durgical.com/en/anatomy/hypoglossal-nerve/)
- [Epiglottis](https://durgical.com/en/anatomy/epiglottis/)
- [Submandibular gland](https://durgical.com/en/anatomy/submandibular-gland/)

## In embryology

- [Branchial cleft cysts, sinuses and fistulas](https://durgical.com/en/embryology/branchial-cleft-cysts-sinuses-and-fistulas/)

## In the clinical exam

- [Mouth and pharynx examination](https://durgical.com/en/clinical-exam/mouth-and-pharynx-examination/)

## Why it happens

- [Chemical carcinogens: initiation, promotion and the table to know](https://durgical.com/en/general-pathology/chemical-carcinogens-initiation-promotion-and-the-table-to-know/)
- [Tumour suppressor genes: RB, TP53, APC, BRCA and the two-hit hypothesis](https://durgical.com/en/general-pathology/tumour-suppressor-genes-rb-tp53-apc-brca-and-the-two-hit-hypothesis/)
- [Oncogenic viruses and H. pylori: the table to know](https://durgical.com/en/general-pathology/oncogenic-viruses-and-h-pylori-the-table-to-know/)
- [Tobacco: how smoking injures tissue](https://durgical.com/en/general-pathology/tobacco-how-smoking-injures-tissue/)
- [Differentiation and anaplasia: how a tumour cell looks under the microscope](https://durgical.com/en/general-pathology/differentiation-and-anaplasia-how-a-tumour-cell-looks-under-the-microscope/)
- [Oral cavity, tongue and teeth](https://durgical.com/en/histology/oral-cavity-tongue-and-teeth/)

## What it is

A malignant tumour of the squamous lining of the upper aerodigestive tract; this page covers the oral cavity (tongue, floor of mouth, gums, lips) and the oropharynx (tonsils, base of tongue, [soft palate](https://durgical.com/en/anatomy/soft-palate/)). Tobacco- and alcohol-related tumours and HPV-related oropharyngeal tumours behave as different diseases.

## Who gets it

Squamous cell carcinoma is by far the most common cancer of the mouth and throat and is more frequent in men over 50. HPV-positive oropharyngeal cancer is rising worldwide in younger non-smokers. In Latin America, tobacco and alcohol remain the main causes; many patients are diagnosed at advanced stages.

## Causes

- Tobacco in any form (smoked or chewed)
- Heavy alcohol use, which multiplies the effect of tobacco
- High-risk human papillomavirus (mainly HPV-16) in oropharyngeal cancer
- Chewing betel quid (areca nut) in some regions
- Sun exposure for cancer of the lower lip

## Risk factors

- Smoking and alcohol, especially combined
- Oral HPV infection; higher number of oral sex partners
- Male sex and age over 50
- Poor oral hygiene and chronic irritation, immunosuppression (including HIV)
- Premalignant lesions: leukoplakia, and especially erythroplakia

## Pathophysiology

Carcinogens from tobacco and alcohol cause accumulating mutations (often of TP53) across the whole mucosa, a field effect that explains second primary tumours. In HPV-driven tumours, viral oncoproteins E6 and E7 inactivate p53 and Rb; the tumour cells overexpress p16, a marker used in diagnosis. Lesions progress from dysplasia (white leukoplakia or red erythroplakia) to invasive carcinoma, which spreads first to the cervical lymph nodes.

## Classification

- By site: oral cavity (lip, oral tongue, floor of mouth, gums, hard palate) or oropharynx (tonsils, base of tongue, soft palate)
- HPV-associated (p16-positive) or HPV-negative oropharyngeal cancer
- TNM staging (AJCC/UICC), with a separate system for p16-positive oropharyngeal cancer

## Symptoms and signs

- A sore, ulcer or lump in the mouth that does not heal within about 2–3 weeks
- White (leukoplakia) or red (erythroplakia) patches in the mouth
- Pain or difficulty swallowing; sore throat that does not go away
- Painless lump in the neck (often the first sign in HPV-related cancer)
- Pain referred to the ear, loose teeth, bleeding, numbness or a change in voice

## Red flags

- Mouth ulcer or patch lasting more than 3 weeks, especially in smokers or drinkers
- Hard, fixed or growing neck mass in an adult
- Red patch in the mouth (erythroplakia), with a high risk of malignancy
- One-sided ear pain with a normal ear examination
- Weight loss, trouble breathing or swallowing

## Diagnosis

**Clinical**
Full examination of the mouth, palpation of the [tongue](https://durgical.com/en/anatomy/tongue/) and floor of mouth, inspection of the oropharynx, flexible endoscopy of the upper aerodigestive tract and palpation of the neck levels.

**Tests**
Biopsy of the lesion is mandatory; fine-needle aspiration of a neck node. p16 immunohistochemistry or HPV testing in oropharyngeal tumours.

**Imaging**
CT or MRI of the [head and neck](https://durgical.com/en/anatomy/region/head-and-neck/) for local extent and nodes; [chest](https://durgical.com/en/anatomy/region/chest/) CT or PET-CT to look for distant spread and a second primary tumour.

## Differential diagnosis

- Aphthous ulcer, traumatic ulcer from teeth or dentures
- Oral candidiasis or lichen planus
- Tuberculosis, syphilis or deep fungal infection of the mouth
- Reactive or infectious cervical lymphadenopathy
- Lymphoma of the tonsil, salivary gland or thyroid tumours, branchial cleft cyst

## Goal of treatment

Cure the cancer when possible while preserving speech, swallowing and appearance, through multidisciplinary planning by stage and site, and support nutrition, airway and quality of life.

## Treatment

**Surgical**
Resection with clear margins is the main treatment for oral cavity cancer, often with neck dissection and reconstruction; transoral surgery is used in selected oropharyngeal tumours.

**Procedure**
Radiotherapy, alone in early disease or after surgery, and as the main treatment in many oropharyngeal cancers.

**Medical**
Platinum-based chemotherapy given with radiotherapy in advanced disease; anti-EGFR antibodies or immunotherapy (checkpoint inhibitors) in recurrent or metastatic disease.

**Rehabilitation**
Speech and swallowing therapy, nutritional support (sometimes a feeding tube) and dental care before radiotherapy.

**Follow-up**
Regular follow-up with examination and imaging to detect recurrence and second primary tumours; nursing focus on airway, oral care, nutrition and tobacco cessation.

## Drugs for this condition

- [Cisplatin](https://durgical.com/en/pharmacology/cisplatin/)
- [Bleomycin](https://durgical.com/en/pharmacology/bleomycin/)
- [Docetaxel](https://durgical.com/en/pharmacology/docetaxel/)
- [Amifostine](https://durgical.com/en/pharmacology/amifostine/)

## Complications

- Airway obstruction and difficulty swallowing with aspiration
- Malnutrition and weight loss
- Effects of treatment: dry mouth, mucositis, osteoradionecrosis of the [mandible](https://durgical.com/en/anatomy/mandible/), fibrosis
- Recurrence and second primary tumours of the head and neck, oesophagus or lung

## Prognosis

Early tumours have a good chance of cure; outcome worsens with nodal and distant spread. HPV-positive oropharyngeal cancer responds better to treatment and has clearly better survival than HPV-negative disease, especially in non-smokers.

## Prevention

- Avoiding tobacco in all forms and limiting alcohol
- HPV vaccination
- Regular oral examination, especially in smokers and drinkers, and biopsy of persistent lesions
- Sun protection of the lips

## Test yourself

Think of the answer, then tap the question to see it.

## What are the two main risk factors for HPV-negative oral cavity squamous cell carcinoma?

Tobacco and alcohol, with a multiplied risk when combined.

## Which HPV type causes most HPV-related oropharyngeal cancers?

HPV-16.

## Which immunohistochemical marker is used as a surrogate for HPV in oropharyngeal cancer?

p16 overexpression.

## Which oral premalignant lesion has the highest risk of malignant change?

Erythroplakia (red patch), more than leukoplakia (white patch).

## What is a common first sign of HPV-positive oropharyngeal cancer?

A painless lump in the neck from a metastatic cervical lymph node, sometimes with a small primary tumour in the tonsil or base of tongue.

[Add to my cards (5)](https://durgical.app/estudiar/?add=/en/conditions/head-and-neck-squamous-cell-carcinoma/)

## Related conditions

- [Laryngeal cancer](https://durgical.com/en/conditions/laryngeal-cancer/)
- [Human papillomavirus (HPV) infection](https://durgical.com/en/conditions/human-papillomavirus-infection/)
- [Cervical lymphadenopathy](https://durgical.com/en/conditions/cervical-lymphadenopathy/)
- [Oesophageal cancer](https://durgical.com/en/conditions/oesophageal-cancer/)
- [Lung cancer](https://durgical.com/en/conditions/lung-cancer/)
- [HIV infection and AIDS](https://durgical.com/en/conditions/hiv-infection-and-aids/)

Educational information, not medical advice. For any symptom, see a health professional.

Sources: [Oral cancer: MedlinePlus Medical Encyclopedia](https://medlineplus.gov/ency/article/001035.htm) (MedlinePlus, US National Library of Medicine, 2026); [HPV and Oropharyngeal Cancer](https://www.cdc.gov/cancer/hpv/oropharyngeal-cancer.html) (Centers for Disease Control and Prevention (CDC), 2025).

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Representative model, for educational purposes only.

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Source: https://durgical.com/en/conditions/head-and-neck-squamous-cell-carcinoma/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/conditions/head-and-neck-squamous-cell-carcinoma/