Is oropharyngeal cancer being misdiagnosed as acute tonsillitis?

Abstract

Oropharyngeal carcinoma (OPC) is an uncommon cancer of the head and neck region but with a growing incidence. Patients usually present after the fourth decade of life with chronic, persistent symptoms including non-tender cervical lymphadenopathy, chronic sore throat, ear pain, difficulty swallowing, pain on swallowing, and a change in voice quality. However, in our region, we have noticed that a significant number of patients with OPC have presented to their GPs and been diagnosed and treated as having acute tonsillitis. In this article, we review these cases, contrast the clinical features of OPC and acute tonsillitis, and alert other doctors to this issue. The NHS Grampian database of head and neck cancer referrals was reviewed between October 2008 and August 2013 to assess the number of patients diagnosed with OPC, the stage of the disease on presentation, and their referral pathway to otolaryngology. Patients’ electronic referral letters were reviewed, which assessed for the number of tonsillitis diagnoses made shortly before referral. Patients’ hospital medical notes were reviewed to assess the treatment provided and outcome. Thirty-eight patients were diagnosed …