Challenges and Complications in the Management of Advanced Oropharyngeal Carcinoma - Role of Post-Mortem Diagnosis and Future Perspectives

Sep 21, 2026

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Oropharyngeal squamous-cell carcinoma (OPSCC) creates major diagnostic and management difficulties, with significant medico-legal and forensic consequences. In advanced disease, loco-regional tumor spread destroys oral tissues, while radiotherapy can profoundly alter tissue morphology and structure, mimicking neoplastic processes and endovascular effects. These treatment- and disease-related changes elevate the risk of fatal bleeding, as illustrated by hemorrhage from the lingual artery linked to an ulcerative, necrotic lesion on the tongue. Autopsy and histopathology can clarify post-mortem diagnosis, support clinical decision-making, and enable preventive strategies.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages14

Reading Time35 min

AccessFree to download

Introduction

Epidemiology and etiological shift (HPV)

Clinical presentation and diagnostic challenges

Histological subtypes and prognostic indicators

Treatment modalities and management strategy

Article focus: post-mortem diagnosis

Perspective Challenges and Complications in the Management of Advanced Oropharyngeal Carcinoma: Role of Post-Mortem Diagnosis and Future Perspectives Francesca Consalvo 1,2,3, Matteo De Simone 1,2, *, Alfonso Scarpa 1, Alfonso Acerra 1,4, Francesco Antonio Salzano 1,4, Vittorio Fineschi 5 and Alessandro Santurro 1,3 Citation: Consalvo, F.; De Simone, M.; Scarpa, A.; Acerra, A.; Salzano, F.A.; Fineschi, V.; Santurro, A. Challengesand Complications in the Management of Advanced Oropharyngeal Carcinoma: Role of Post-Mortem Diagnosis and Future Perspectives. J. Clin. Med. 2024, 13, 5198. [https://doi.org/10.3390/](https://doi.org/10.3390/)[ ](https://doi.org/10.3390/)jcm13175198 Academic Editor: Maria Lina Tornesello Received: 9 August 2024 Revised: 30 August 2024 Accepted: 31 August 2024 Published: 2 September 2024 Copyright: © 2024 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ([https://](https://)[ ](https://)[creativecommons.org/licenses/by/](creativecommons.org/licenses/by/)[ ](creativecommons.org/licenses/by/)[4.0/](4.0/)) . 1 Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Salerno, Italy; [fconsalvo@unisa.it](fconsalvo@unisa.it) (F.C.); [alfonso.acerra@unisa.it](alfonso.acerra@unisa.it) (A.A.); [frsalzano@unisa.it](frsalzano@unisa.it) (F.A.S.); [asanturro@unisa.it](asanturro@unisa.it) (A.S.) 2 BrainLab s.r.l., Mercato San Severino, 84085 Salerno, Italy 3 Unit of Legal Medicine, University Hospital “San Giovanni di Dio e Ruggi D’Aragona”, 84081 Salerno, Italy 4 Unit of Otolaryngology, University Hospital “San Giovanni di Dio e Ruggi, D’Aragona”, 84081 Salerno, Italy 5 Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, 00161 Rome, Italy; vittorio.fineschi@uniroma1.it * [Correspondence: m.desimone82@studenti.unisa.it](Correspondence: m.desimone82@studenti.unisa.it) Abstract: Oropharyngeal squamous-cell carcinoma (OPSCC) poses significant challenges in diagnosis, treatment, and management and has important medico-legal and forensic implications. In particular, the management of OPSCC and its treatment-related complications can often be challenging. In cases with advanced OPSCC, a loco-regional extension of the tumor can contribute to the destruction of oral cavity tissues, while the radiotherapy treatment can induce profound changes in tissue morphology and structure. These changes, which resemble tumor neoplasms and endovascular effects, are related to a higher risk of fatal bleeding, as reported in the case study illustrated, in which a hemorrhage occurred from a lingual artery, originating from an ulcerative, necrotic, hemorrhagic lesion on the tongue. Bleeding complications in OPSCC and prolonged radiotherapy are associated with high mortality and require comprehensive management strategies to improve survival and quality of life. Autopsy investigations, contributing to the definition of post-mortem diagnosis, can provide valuable insights into the pathogenetic mechanisms underlying bleeding and guide therapeutic decisions and preventive measures. The integration of autopsy and histopathological investigation into clinical practice should be considered as a necessary support to optimize the management of complications in advanced OPSCC patients, emphasizing the importance of a patient-centered approach and continued research. Keywords: head and neck; oropharyngeal carcinoma; squamous-cell cancer; lingual artery bleeding; autopsy investigation; post-mortem diagnosis 1. Introduction Head and neck squamous-cell carcinoma (HNSCC), which includes cancers of the oral cavity and oropharynx, is the world’s sixth most common cancer [1] . Oropharyngeal squamous-cell carcinoma (OPSCC) arises from various sites within the oropharynx, including the soft palate, tonsils, base of the

FAQs

What makes advanced OPSCC management particularly challenging?

Advanced OPSCC can extend loco-regionally, destroying oral cavity tissues, while radiotherapy can cause morphological and structural changes that may mimic tumor processes and increase clinical risk.

How does the article relate bleeding complications to diagnosis and outcomes?

It describes how bleeding complications in OPSCC, including cases of fatal hemorrhage (e.g., from the lingual artery), are linked to high mortality and require comprehensive management.

Why are autopsy investigations important in this context?

Autopsy investigations and histopathological evaluation help define post-mortem diagnosis, clarify pathogenetic mechanisms underlying bleeding, and guide therapeutic decisions and preventive measures.

Sep 21, 2026

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