Which sign requires urgent referral for suspected HPV-associated oropharyngeal cancer?

• A. Persistent unilateral throat mass
• B. Intermittent sore throat
• C. Nasal congestion
• D. Hearing loss with ear fullness

Answer: (A)

A persistent unilateral throat mass is the red flag that most strongly suggests a potential HPV-associated oropharyngeal cancer and warrants urgent referral for evaluation and biopsy. This mass points to a localized lesion in the oropharynx (such as the tonsillar area or base of tongue) and, unlike more common benign symptoms, persists and may grow despite usual care. Early, dedicated assessment by ENT with appropriate imaging and tissue sampling is crucial because HPV-related OPSCC can present subtly but has better outcomes when caught early.

Intermittent sore throat is common and nonspecific, often due to infections or irritation. Nasal congestion likewise tends to reflect benign conditions like allergies or sinusitis. Hearing loss with ear fullness can arise from middle-ear or eustachian tube issues and is not itself a definitive cancer sign, though it can occur secondarily. The key distinguishing feature is a persistent, unilateral throat mass, which rightly triggers urgent cancer evaluation.