Oropharyngeal Cancer Treatment

General Information About Oropharyngeal Cancer

KEY POINTS

  • Oropharyngeal cancer is a disease in which malignant (cancer) cells form in the tissues of the oropharynx.
  • Smoking or being infected with human papillomavirus can increase the risk of oropharyngeal cancer.
  • Signs and symptoms of oropharyngeal cancer include a lump in the neck and a sore throat.
  • Tests that examine the mouth and throat are used to help detect (find), diagnose, and stage oropharyngeal cancer.
  • Certain factors affect prognosis (chance of recovery) and treatment options.

Oropharyngeal cancer is a disease in which malignant (cancer) cells form in the tissues of the oropharynx.

The oropharynx is the middle part of the pharynx (throat), behind the mouth. The pharynx is a hollow tube about 5 inches long that starts behind the nose and ends where the trachea (windpipe) and esophagus (tube from the throat to the stomach) begin. Air and food pass through the pharynx on the way to the trachea or the esophagus.

ENLARGEAnatomy of the pharynx; drawing shows the nasopharynx, oropharynx, and hypopharynx. Also shown are the nasal cavity, oral cavity, hyoid bone, larynx, esophagus, and trachea.
Anatomy of the pharynx (throat). The pharynx is a hollow tube that starts behind the nose, goes down the neck, and ends at the top of the trachea and esophagus. The three parts of the pharynx are the nasopharynx, oropharynx, and hypopharynx.

The oropharynx includes the following:

  • Soft palate.
  • Side and back walls of the throat.
  • Tonsils.
  • Back one-third of the tongue.
ENLARGEParts of the oropharynx; drawing shows the soft palate, side and back wall of the throat, tonsil, and the back third of the tongue.
Parts of the oropharynx. The oropharynx includes the soft palate, side and back wall of the throat, tonsils, and the back third of the tongue.

Oropharyngeal cancer is a type of head and neck cancer. Sometimes more than one cancercan occur in the oropharynx and in other parts of the oral cavity, nose, pharynx, larynx(voice box), trachea, or esophagus at the same time.

Most oropharyngeal cancers are squamous cell carcinomas. Squamous cells are the thin, flat cells that line the inside of the oropharynx.

See the following PDQ summaries for more information about other types of head and neck cancers:

Smoking or being infected with human papillomavirus can increase the risk of oropharyngeal cancer.

Anything that increases your risk of getting a disease is called a risk factor. Having a risk factor does not mean that you will get cancer; not having risk factors doesn’t mean that you will not get cancer. Talk with your doctor if you think you may be at risk.

The most common risk factors for oropharyngeal cancer include the following:

  • A history of smoking cigarettes for more than 10 pack years and other tobacco use.
  • Personal history of head and neck cancer.
  • Heavy alcohol use.
  • Being infected with human papillomavirus (HPV), especially HPV type 16. The number of cases of oropharyngeal cancers linked to HPV infection is increasing.
  • Chewing betel quid, a stimulant commonly used in parts of Asia.

Signs and symptoms of oropharyngeal cancer include a lump in the neck and a sore throat.

These and other signs and symptoms may be caused by oropharyngeal cancer or by other conditions. Check with your doctor if you have any of the following:

  • A sore throat that does not go away.
  • Trouble swallowing.
  • Trouble opening the mouth fully.
  • Trouble moving the tongue.
  • Weight loss for no known reason.
  • Ear pain.
  • A lump in the back of the mouth, throat, or neck.
  • A white patch on the tongue or lining of the mouth that does not go away.
  • Coughing up blood.

Sometimes oropharyngeal cancer does not cause early signs or symptoms.

Tests that examine the mouth and throat are used to help detect (find), diagnose, and stage oropharyngeal cancer.

The following tests and procedures may be used:

  • Physical exam and history : An exam of the body to check general signs of health, including checking for signs of disease, such as swollen lymph nodes in the neck or anything else that seems unusual. The medical doctor or dentist does a complete exam of the mouth and neck and looks under the tongue and down the throat with a small, long-handled mirror to check for abnormal areas. An exam of the eyes may be done to check for vision problems that are caused by nerves in the head and neck. A history of the patient’s health habits and past illnesses and treatments will also be taken.
  • PET-CT scan : A procedure that combines the pictures from a positron emission tomography (PET) scan and a computed tomography (CT) scan. The PET and CT scans are done at the same time with the same machine. The combined scans give more detailed pictures of areas inside the body than either scan gives by itself. A PET-CT scan may be used to help diagnose disease, such as cancer, plan treatment, or find out how well treatment is working.
    • CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, such as the head and neck, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye is injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.
    • PET scan (positron emission tomography scan): A procedure to find malignanttumor cells in the body. A small amount of radioactive glucose (sugar) is injected into a vein. The PET scanner rotates around the body and makes a picture of where glucose is being used in the body. Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells do.
  • MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI).
  • Biopsy : The removal of cells or tissues so they can be viewed under a microscope by a pathologist to check for signs of cancer. A fine-needle biopsy is usually done to remove a sample of tissue using a thin needle.

    The following procedures may be used to remove samples of cells or tissue:

    • Endoscopy : A procedure to look at organs and tissues inside the body to check for abnormal areas. An endoscope is inserted through an incision (cut) in the skin or opening in the body, such as the mouth or nose. An endoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove abnormal tissue or lymph node samples, which are checked under a microscope for signs of disease. The nose, throat, back of the tongue, esophagus, stomach, larynx, windpipe, and large airways will be checked. The type of endoscopy is named for the part of the body that is being examined. For example, pharyngoscopy is an exam to check the pharynx.
    • Laryngoscopy : A procedure in which the doctor checks the larynx with a mirror or with a laryngoscope. A laryngoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove abnormal tissue or lymph node samples, which are checked under a microscope for signs of disease.

    If cancer is found, the following test may be done to study the cancer cells:

    • HPV test (human papillomavirus test): A laboratory test used to check the sample of tissue for certain types of HPV infection. This test is done because oropharyngeal cancer can be caused by HPV.

Certain factors affect prognosis (chance of recovery) and treatment options.

The prognosis (chance of recovery) depends on the following:

  • Whether the patient has HPV infection of the oropharynx.
  • Whether the patient has a history of smoking cigarettes for ten or more pack years.
  • The stage of the cancer.
  • The number and size of lymph nodes with cancer.

Oropharyngeal tumors related to HPV infection have a better prognosis and are less likely to recur than tumors not linked to HPV infection.

Treatment options depend on the following:

  • The stage of the cancer.
  • Keeping the patient’s ability to speak and swallow as normal as possible.
  • The patient’s general health.

Patients with oropharyngeal cancer have an increased risk of another cancer in the head or neck. This risk is increased in patients who continue to smoke or drink alcohol after treatment.