What is oropharyngeal cancer?
Oropharyngeal cancer is a type of head and neck cancer in which cancer cells are found within an area of your throat called your oropharynx.
More than 90% of oropharyngeal cancers are squamous cell carcinomas, which are cancers arising from the flat surface cells lining your mouth and throat.
What is the oropharynx?
Your oropharynx is the middle part of your throat (pharynx) just beyond your mouth. Your oropharynx includes the back part of your tongue (base of tongue), your tonsils, your soft palate (back part of the roof of your mouth), and the sides and walls of your throat. Your oropharynx makes saliva, keeps your mouth and throat moist and starts to help digest the food you eat.
How common is oropharynx cancer?
According to the American Cancer Society, about 53,000 people in the U.S. develop oropharyngeal cancer each year. This cancer occurs in twice the number of men than women. It occurs in equal amounts in African Americans and Caucasians.
The average age at diagnosis is 62. About 25% of oropharyngeal cancers occur in people under age 55. This cancer is rare in children.
What factors increase my risk of oropharyngeal cancer?
Factors that increase your chance of getting oropharyngeal cancer include:
- History of smoking.
- Heavy alcohol use.
- History of head and neck cancer.
- History of radiation therapy to the head and neck.
- Being infected with human papillomavirus (HPV), especially HPV type 16.
Symptoms and Causes
What causes oropharyngeal cancer?
Cancer is an uncontrolled multiplication and buildup of abnormal cells. Abnormal cells happen because of changes to our DNA – the “building blocks” of who we are. Many different things can cause cancer. In the case of oropharyngeal cancer, use of tobacco products and alcohol have been shown to damage the cells lining your mouth and throat. The virus that cause HPV infection makes proteins that interfere with the genes that normally keep cell growth under control. Uncontrolled cell growth can lead to cancer. Currently, HPV infection is the most frequent cause of oropharyngeal cancer and is on the rise. Some cases of oropharyngeal cancer have no known cause.
What are the symptoms of oropharyngeal cancer?
The following may be signs of oropharyngeal cancer or of other conditions. See a doctor if any of the following symptoms are present:
- A sore throat that doesn’t go away.
- Pain or difficulty with swallowing.
- Trouble opening up your mouth fully or moving your tongue.
- Unexplained weight loss.
- Voice changes that do not go away.
- Ear pain that doesn’t go away.
- A lump in the back of your throat or mouth.
- A lump in your neck.
- Coughing up blood.
- White patch on your tongue or lining of your mouth that doesn’t go away.
Diagnosis and Tests
How is oropharyngeal cancer diagnosed?
First, your healthcare provider will take your medical history, ask about your smoking history (if you use tobacco products), review current and past illnesses and medications and ask about your symptoms. Next, your provider will examine your mouth, throat and neck, using a mirror and lights and/or a fiberoptic scope to look for abnormal areas in your mouth and throat and will feel your neck for masses. If any abnormal tissue is found, a biopsy will be taken to check for cancer cells and the presence of HPV infection. Imaging tests of your throat area, such as a PET, CT scan or MRI, may be ordered. These tests provide greater detail of your throat and any masses found.
What are the stages of oropharyngeal cancer?
Staging is the process of determining if cancer is present and, if so, how far it has spread. It helps your healthcare team develop your treatment plan. The stages of oropharyngeal cancer span from Stage I (best prognosis) to Stage IV (worst prognosis). The system developed by the American Joint Committee on Cancer for staging cancer is complex and contains specific information based on the extent of the tumor, its spread to nearby lymph nodes and spread to distant organs, and whether or not the cancer is associated with the HPV virus. Be sure to ask your healthcare provider to explain your stage in a way you understand.
Management and Treatment
How is oropharyngeal cancer treated?
The stage of cancer, where the oropharyngeal cancer is located, your age and general health determines your treatment plan. The goal is to treat cancer cells while retaining your ability to speak and swallow as normally as possible.
Treatment can involve one method or combination of methods that may include surgery (usually transoral robotic-assisted surgery), radiation therapy, chemotherapy, targeted drug therapy and immunotherapy.
Surgery and/or radiation therapy are usually tried first for early stage cancer that are small and haven’t spread.
Chemotherapy is used in several ways:
- Combined with radiation therapy in place of surgery.
- Usually combined with radiation therapy to kill any cancer cells that remain after surgery.
- Alone or combined with radiation therapy to shrink larger cancers before surgery.
- Alone or combined with radiation therapy to treat larger cancers and cancers that have spread that can’t be treated with surgery.
Targeted drug therapies are man-made versions of a protein in your immune system called a monoclonal antibody. These drugs slow or stop cancer by blocking a protein the cancer cells need to divide, grow and spread. Cetuximab (Erbitux®) is a commonly used target drug used to treat oropharyngeal cancer. It’s used alone, in combination with radiation therapy or with other traditional chemotherapy drugs.
Immunotherapy are drugs used to help your body’s own immune system find and destroy cancer cells. Cancer is smart and cancer cells want to be blend in with other cells and not be recognized and attacked by your body’s immune system. Immunotherapies turn off or on certain proteins in your body’s own immune system so it can recognize cancer cells and boost the body’s attack response against them. Immunotherapy is used as a first-treatment option, for cancer that has returned or cancer that has spread. Immunotherapy for oropharyngeal cancer includes pembrolizumab (Keytruda®) and nivolumab (Opdivo®)
A final option for treating oropharyngeal cancer, when no other options are available, is to enroll in a clinical trial. To be enrolled in a clinical trial, strict entry criteria must be meet. Medications in clinical trials are in various stages of development toward Food and Drug Administration approval – some drugs may be proven safe and effective, other drugs will not. You and your healthcare team will discuss if enrollment in a clinical trial is an option to consider.
Your healthcare team will work closely with you to devise a treatment plan that is specific for your cancer that will involve some of the therapies described above. Never hesitate to ask your team about any aspect of your treatment plan.
What is transoral robotic surgery?
Transoral robotic surgery is a minimally invasive treatment method to remove difficult-to-reach oropharyngeal cancers through your mouth. With robotic surgery, your surgeon operates while seated at a console unit, while you are on a nearby operating table. Your surgeon operates using hand and foot controls to position a 3D, high-definition camera and to precisely direct surgical instruments, which are attached to robotic arms. Robotic surgery avoids the larger neck incision and lower jaw splitting required with traditional surgery. Advantages of transoral robotic surgery include a shorter hospital stay, faster recovery, less damage to surrounding tissues and swallowing muscles, avoidance of a tracheostomy breathing tube and less long-term problems with speech and swallowing.
Can I do anything to prevent the development of oropharyngeal cancer?
You may not be able to prevent oropharyngeal cancer, but you can take steps to lower your risk. Changes you can make include:
- Don’t start smoking. If you smoke or use tobacco products, quit. Continuing to smoke greatly increased the risk of developing a second cancer in the mouth, throat or voice box or lung. Ask your healthcare provider for help. They have many resources and can put you in touch with the information need or other health professionals that can help you quit.
- Don’t drink alcohol regularly or heavily. Alcohol increases the cancer-causing effects of tobacco, so it’s especially important to avoid this combination.
- Avoid human papilloma virus (HPV) infection. Ask your doctor about the HPV vaccine. Multiple sex partners and oral sex increases your risk of HPV.
- Eat a healthy, well-balanced diet and exercise regularly.
- See your healthcare provider and dentist on a regular schedule. They can check your mouth and throat and catch any changes early in their development.
Outlook / Prognosis
What is the prognosis (chance of recovery) for people with oropharyngeal cancers?
The prognosis for people with oropharyngeal cancer depends on your age and overall health, the HPV status of the tumor, history of smoking, and stage of cancer. Tumors that are HPV-associated have a dramatically improved cure rate, compared to tumors that are not associated with HPV. It is important for people with oral cancer or oropharyngeal cancer to have follow-up exams for the rest of their lives as cancer can occur in nearby areas. In addition, it is important to eliminate risk factors like smoking and drinking, which increase the risk for second cancers, or recurrent cancer.
According to the American Cancer Society, the five year relative survival rate is 70%. This means that if you have cancer, you are 70% as likely to live for at least five years after being diagnosed as people who don’t have cancer. Keep in mind that this number does not take into account your age, general health, treatment response and HPV 16 status. The survival rate does not apply if your cancer stage changes. Also keep in mind that the survival rates are based on statistics collected five years earlier and newer treatments and management strategies are becoming available all the time.
What questions should I ask my healthcare provider if I have been diagnosed with oropharyngeal cancer?
- Exactly where is my cancer?
- Has my cancer spread? What stage is it? What does that mean?
- What tests will I undergo?
- What healthcare providers will be on my care team?
- Is my cancer related to the human papillomavirus (HPV)?
- What lifestyle changes should I make?
- What’s my treatment plan? What are all my options?
- What’s my chance of being cured?
- What are the side effects of treatment?
- What will happen if the cancer comes back? What are my options?
These are just a few questions. Be sure to write down others as you think of them. Your healthcare team wants to help you understand everything concerning your cancer and care.