Oropharyngeal Cancer

Oropharyngeal cancer is a type of head and neck cancer where malignant cells form in the tissues of the middle part of the throat, behind the mouth.

The oropharynx is the middle part of the pharynx, which is the hollow tube about 5 inches long that starts behind the nose and ends where the windpipe and esophagus begin.  It includes the soft palate (rear roof of the mouth), side and rear walls of the throat, tonsils, and the rear ¹⁄₃ of the tongue.  Air and food pass through the pharynx on the way to the windpipe and the esophagus respectively.

Causes and Development; Contributing Risk Factors

Most cases of oropharyngeal cancer involve squamous cell carcinomas, which affect the thin, flat cells lining the inside of the oropharynx.

The main risk factors for developing oropharyngeal cancer are smoking (more than 10 pack-years), being infected with HPV (human papillomavirus), other tobacco use, heavy alcohol consumption, and a past history of head or neck cancer.

Signs and Symptoms

Signs and symptoms are not always present but, when they are, can include:

• a lump in the neck, throat, or back of the mouth
• a sore throat that does not go away
• difficulty swallowing
• difficulty opening mouth fully
• difficulty moving the tongue
• swollen lymph nodes in the neck
• unexplained weight loss
• ear pain
• a permanent white patch on the tongue or inside of the mouth
• coughing up blood

Diagnosis and Tests

An oral and throat examination is used to detect, diagnose, and stage oropharyngeal cancer.  A PET scan and CT scan are used together in order to provide more detail; an MRI can also be used, as well as a biopsy (using an endoscope or laryngoscope) to remove a tissue sample for testing.

If cancer is present, an HPV test can be used to determine whether HPV is the cause.

Treatment and Prevention

Treatment options depend on the stage of the cancer, overall health of the patient, and whether speaking and swallowing ability is to be preserved.

Prognosis; Complications

Prognosis depends on various factors.  There is a better chance of recovery – and less chance of recurrence – if the oropharyngeal tumors were caused by HPV infection.  Smoking history, stage and size of the cancer, and the number of lymph nodes affected are also determining factors.

Patients with oropharyngeal cancer are at increased risk of developing another head or neck cancer, especially if they continue to use alcohol or tobacco.