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Diseases & Conditions

Oropharyngeal Cancer Overview

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, and includes the back one-third of the tongue, the soft palate, the side and back walls of the throat, and the tonsils. The pharynx is a hollow tube about 5 inches long that starts behind the nose and ends at the top of the trachea (windpipe) and esophagus (the tube that goes from the throat to the stomach). Air and food pass through the pharynx on the way to the trachea or the esophagus.

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

Use of tobacco products and drinking too much alcohol can increase the risk of developing 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. People who think they may be at risk should discuss this with their doctor. Risk factors include the following:

  • Smoking and chewing tobacco.
  • Heavy alcohol use.
  • A diet low in fruits and vegetables.
  • Drinking maté, a stimulant drink common in South America.
  • Chewing betel quid, a stimulant commonly used in parts of Asia.
  • Being infected with human papillomavirus (HPV).

Possible signs of oropharyngeal cancer include a sore throat and a lump in the neck.

These and other symptoms may be caused by oropharyngeal cancer. Other conditions may cause the same symptoms. A doctor should be consulted if any of the following problems occur:

  • A sore throat that does not go away.
  • A dull pain behind the breastbone.
  • Cough
  • Trouble swallowing.
  • Weight loss for no known reason.
  • Ear pain.
  • A lump in the back of the mouth, throat, or neck.
  • A change in voice.

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 doctor does a complete exam of the mouth and neck and looks down the throat with a small, long-handled mirror to check for abnormal areas. A history of the patient’s health habits and past illnesses and treatments will also be taken.

CT scan (CAT scan):

A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be 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.

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).

X-rays:

An x-ray of the organs and bones. An x-ray is a type of energy beam that can go through the body and onto film, making pictures of areas inside the body.

PET scan (positron emission tomography scan):

A procedure to find malignant tumor cells in the body. A small amount of radionuclide 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.

Endoscopy:

A procedure to look at organs and tissues inside the body to check for abnormal areas. An endoscope is inserted through the patient’s nose or mouth to look at areas in the throat that cannot be seen during a physical exam of the throat. An endoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove tissue or lymph node samples, which are checked under a microscope for signs of disease.

Biopsy:

The removal of cells or tissues so they can be viewed under a microscope by a pathologist to check for signs of cancer.

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

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

  • The stage and grade of the cancer.
  • The location of the tumor.
  • Whether the tumor is associated with HPV infection.

Treatment options depend on the following:

  • The stage and grade of the cancer.
  • The location of the tumor.
  • The patient's general health.

Stages of Oropharyngeal Cancer

After oropharyngeal cancer has been diagnosed, tests are done to find out if cancer cells have spread within the oropharynx or to other parts of the body.

The process used to find out if cancer has spread within the oropharynx or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage in order to plan treatment. The results of some of the tests used to diagnose oropharyngeal cancer are often used to stage the disease.

There are three ways that cancer spreads in the body.

The three ways that cancer spreads in the body are:

  • Through tissue. Cancer invades the surrounding normal tissue.
  • Through the lymph system. Cancer invades the lymph system and travels through the lymph vessels to other places in the body.
  • Through the blood. Cancer invades the veins and capillaries and travels through the blood to other places in the body.

When cancer cells break away from the primary (original) tumor and travel through the lymph or blood to other places in the body, another (secondary) tumor may form. This process is called metastasis. The secondary (metastatic) tumor is the same type of cancer as the primary tumor. For example, if breast cancer spreads to the bones, the cancer cells in the bones are actually breast cancer cells. The disease is metastatic breast cancer, not bone cancer.

The following stages are used for oropharyngeal cancer:

Stage 0 (Carcinoma in Situ)

In stage 0, abnormal cells are found in the lining of the oropharynx. These abnormal cells may become cancer and spread into nearby normal tissue. Stage 0 is also called carcinoma in situ.

Stage I

In stage I, cancer has formed and is 2 centimeters or smaller and has not spread outside the oropharynx.

Stage II

In stage II, the cancer is larger than 2 centimeters, but not larger than 4 centimeters, and has not spread outside the oropharynx.

Stage III

In stage III, the cancer is either:

  • larger than 4 centimeters and has not spread outside the oropharynx; or
  • any size and has spread to only one lymph node on the same side of the neck as the cancer. The lymph node with cancer is 3 centimeters or smaller.
Stage IVA

In stage IVA, the cancer either:

  • has spread to tissues near the oropharynx, including the voice box, roof of the mouth, lower jaw, muscle of the tongue, or central muscles of the jaw, and may have spread to one or more nearby lymph nodes, none larger than 6 centimeters; or
  • is any size and has spread to one lymph node that is larger than 3 centimeters but not larger than 6 centimeters on the same side of the neck as the cancer, or to more than one lymph node, none larger than 6 centimeters, on one of both sides of the neck.
Stage IVB

In stage IVB, the cancer either:

  • surrounds the main artery in the neck or has spread to bones in the jaw or skull, to muscle in the side of the jaw, or to the upper part of the throat behind the nose, and may have spread to nearby lymph nodes; or
  • has spread to a lymph node that is larger than 6 centimeters and may have spread to tissues around the oropharynx.
Stage IVC

In stage IVC, cancer has spread to other parts of the body; the tumor may be any size and may have spread to lymph nodes.

Recurrent Oropharyngeal Cancer

Recurrent oropharyngeal cancer is cancer that has recurred (come back) after it has been treated. The cancer may come back in the oropharynx or in other parts of the body.

Treatment Option Overview

There are different types of treatment for patients with oropharyngeal cancer.

Different types of treatment are available for patients with oropharyngeal cancer. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment. Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.

Patients with oropharyngeal cancer should have their treatment planned by a team of doctors with expertise in treating head and neck cancer.

The patient's treatment will be overseen by a medical oncologist, a doctor who specializes in treating people with cancer. Because the oropharynx helps in breathing, eating, and talking, patients may need special help adjusting to the side effects of the cancer and its treatment. The medical oncologist may refer the patient to other health professionals with special training in the treatment of patients with head and neck cancer. These may include the following specialists:

  • Head and neck surgeon
  • Radiation oncologist
  • Plastic surgeon
  • Dentist
  • Dietitian
  • Psychologist
  • Rehabilitation specialist
  • Speech therapist

Two types of standard treatment are used:

Surgery

Surgery (removing the cancer in an operation) is a common treatment of all stages of oropharyngeal cancer. A doctor may remove the cancer and some of the healthy tissue around the cancer. Even if the doctor removes all the cancer that can be seen at the time of the surgery, some patients may be given chemotherapy or radiation therapy after surgery to kill any cancer cells that are left. Treatment given after the surgery, to lower the risk that the cancer will come back, is called adjuvant therapy.

Radiation therapy

Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated. Fractionated radiation therapy divides the total dose of radiation therapy into several smaller, equal doses given over several days.

Radiation therapy may be more effective in patients who have stopped smoking before beginning treatment.

Radiation therapy to the thyroid or pituitary gland increases the risk of hypothyroidism (too little thyroid hormone). Thyroid function tests should be done before and after treatment.

New types of treatment are being tested in clinical trials.

This section describes treatments that are being studied in clinical trials. It may not mention every new treatment being studied. Information about clinical trials is available from the NCI Web site.

Chemotherapy

Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the spinal column, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). The way the chemotherapy is given depends on the type and stage of the cancer being treated.

Radiosensitizers

Radiosensitizers are drugs that make tumor cells more sensitive to radiation therapy. Combining radiation therapy with radiosensitizers may kill more tumor cells.

Hyperthermia therapy

Hyperthermia therapy is a treatment in which body tissue is exposed to increased temperature to damage and kill cancer cells or to make cancer cells more sensitive to the effects of radiation and certain anticancer drugs.

Patients may want to think about taking part in a clinical trial.

For some patients, taking part in a clinical trial may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment.

Many of today's standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment.

Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward.

Patients can enter clinical trials before, during, or after starting their cancer treatment.

Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from recurring (coming back) or reduce the side effects of cancer treatment.

Clinical trials are taking place in many parts of the country.

Follow-up tests may be needed.

Some of the tests that were done to diagnose the cancer or to find out the stage of the cancer may be repeated. Some tests will be repeated in order to see how well the treatment is working. Decisions about whether to continue, change, or stop treatment may be based on the results of these tests. This is sometimes called re-staging.

Some of the tests will continue to be done from time to time after treatment has ended. The results of these tests can show if your condition has changed or if the cancer has recurred (come back). These tests are sometimes called follow-up tests or check-ups.

After treatment for oropharyngeal cancer, frequent and careful follow-up is important because of the risk of developing a second cancer in the head or neck.

Treatment Options by Stage

Stage I Oropharyngeal Cancer

Treatment of stage I oropharyngeal cancer may include the following:

  • Radiation therapy
  • Surgery
  • A clinical trial of fractionated radiation therapy
Stage II Oropharyngeal Cancer

Treatment of stage II oropharyngeal cancer may include the following:

  • Radiation therapy (external radiation therapy and/or internal radiation therapy).
  • Surgery
Stage III Oropharyngeal Cancer

Treatment of stage III oropharyngeal cancer may include the following:

Surgery followed by radiation therapy or by chemotherapy given at the same time as radiation therapy.

  • Radiation therapy (for patients with tongue or tonsil cancer).
  • Chemotherapy given at the same time as radiation therapy.
  • A clinical trial of chemotherapy followed by surgery or radiation therapy.
  • A clinical trial of chemotherapy given at the same time as radiation therapy.
  • A clinical trial of fractionated and/or internal radiation therapy.
Stage IV Oropharyngeal Cancer

Treatment of stage IV oropharyngeal cancer that can be treated by surgery may include the following:

  • Surgery followed by radiation therapy and chemotherapy.
  • Radiation therapy (for tonsil cancer).
  • A clinical trial of chemotherapy given at the same time as radiation therapy.
  • A clinical trial of fractionated and/or internal radiation therapy.

Treatment of stage IV oropharyngeal cancer that cannot be treated by surgery may include the following:

  • Radiation therapy with or without chemotherapy.
  • A clinical trial of chemotherapy with radiation therapy and/or radiosensitization.
  • A clinical trial of fractionated and/or internal radiation therapy.
  • A clinical trial of radiation therapy with or without chemotherapy.
  • A clinical trial of hyperthermia therapy with radiation therapy.

Following treatment, it is important to have careful head and neck examinations to look for recurrence. Check-ups will be done monthly in the first year, every 2 months in the second year, every 3 months in the third year, and every 6 months thereafter.

Treatment Options for Recurrent Oropharyngeal Cancer

Treatment of recurrent oropharyngeal cancer may include the following:

  • Surgery if radiation therapy did not remove all the cancer.
  • Radiation therapy (if not previously used) or additional surgery if the first surgery did not remove all the cancer.
  • A clinical trial of chemotherapy.
  • A clinical trial of hyperthermia therapy with radiation therapy.

Following treatment, it is important to have careful head and neck examinations to look for recurrence. Check-ups will be done monthly in the first year, every 2 months in the second year, every 3 months in the third year, and every 6 months thereafter.

Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with oropharyngeal cancer. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug.

For more information from the NCI, please write to this address:

NCI Public Inquiries Office
Suite 3036A
6116 Executive Boulevard, MSC8322
Bethesda, MD 20892-8322

U.S. residents may call the National Cancer Institute's (NCI's) Cancer Information Service toll-free at 1.800.4.CANCER (1.800.422.6237) Monday through Friday from 9:00 a.m. to 4:30 p.m. Deaf and hard-of-hearing callers with TTY equipment may call 1-800-332-8615.

Information about ongoing clinical trials is available from the NCI website.

Source: National Institutes of Health; National Cancer Institute

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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. This document was last reviewed on: 11/6/2008...#6188