**2. Epidemiology**

Oropharyngeal carcinoma represents 0.9% of all cancers and its incidence is increasing with an estimate of 173,495 new cases in 2018 [1]. Epidemiological studies have demonstrated that there has been a reduction in the incidence of laryngeal, hypopharyngeal, and oral cavity cancers since 1980, following a reduction in tobacco use in developed countries [2]. Oropharyngeal cancer incidence initially remained constant, then started rising [2, 3]. Later it was correlated to HPV-associated cancers in the tonsillar region and base of the tongue. There is a geographical variation in the incidence of oropharyngeal carcinoma with the increasing incidence of HPV associated cancers in the developed countries [4]. Among men the rising incidence of HPV associated oropharyngeal cancer was noticed in the United States, Australia, Canada, Japan and Slovakia and among women it was noticed in Denmark, Estonia, France, Netherlands, Poland, Slovakia and United Kingdom [4]. These patients tend to be younger and follow a biphasic distribution, which peaks around 30 and 55 years [5]. Male gender preponderance has been noted in many studies. In the ICON-S database median age of the HPV positive cases was 57 years and 84% of patients were male [5].
