Oropharyngeal Cancer

Oropharyngeal (oar-oh-fuh-RIN-jee-uhl) cancer is a rare type of head and neck squamous cell carcinoma. It starts in the squamous cells that line your oropharynx, which is the middle part of your throat. It includes the:

• Base of your tongue
• Back part of the roof of your mouth
• Sides and back walls of your throat
• Tonsils

Symptoms of oropharyngeal cancer

Oropharyngeal cancer symptoms may feel or look like those that other, less serious conditions cause. Those symptoms include:

• Sore throat that doesn’t get better
• Pain when you swallow, or it’s hard to swallow
• Trouble when you open your mouth wide or move your tongue
• Losing weight without trying
• Ear pain or voice changes that don’t go away
• A lump in the back of your throat or mouth
• A lump in your neck
• Coughing up blood
• A white patch on your tongue or the lining of your mouth that doesn’t go away

Oropharyngeal cancer causes

Human papillomavirus (HPV) infection is the most common cause. HPV makes proteins that cause changes in certain genes. These genes manage how fast cells divide.

Oropharyngeal cancer develops when the genes stop managing cell growth. Cells then keep dividing and form cancerous tumors. That process takes many years. For example, a teenager with HPV may develop oropharyngeal cancer 30 to 40 years later.

Other causes include:

• Tobacco use: Smoking cigarettes, cigars or chewing tobacco damages the DNA in cells lining your mouth and throat. These cells react to damage by dividing more often. That means they make more copies of their DNA. The more cells divide, the more likely it is that they’ll make a mistake. Mistakes in DNA increase the chance that cells will become cancerous.
• Alcohol: Drinking beverages containing alcohol may help chemicals that damage DNA get into the cells lining your throat. Alcohol also affects cells’ ability to repair DNA.

Risk factors

Other issues may increase your risk, including:

• Having a history of head and neck cancer
• Having radiation therapy on your head and neck

How to lower your risk

Making some lifestyle changes may help reduce your risk. Changes you can make include:

• Avoid HPV infections: Practice safe sex and get the shot that protects you from the virus. This reduces the chance you’ll get an infection that may lead to oropharyngeal cancer.
• Avoid tobacco: Ask your healthcare provider for help with quitting tobacco, especially if you have oropharyngeal cancer. Continuing to smoke increases your risk of a second cancer in your mouth, throat or voice box.
• Avoid alcohol: If you drink beverages that contain alcohol, try to limit how often and how much you consume. Alcohol use increases the ways that tobacco causes cancer. Combining the two raises your risk of oropharyngeal cancer and other head and neck cancers.
• Eat well: Build meals around natural and plant-based foods. The Mediterranean diet is an example of a healthy way to get nutrition.
• Have regular checkups: Your healthcare provider and dentist may spot changes in your throat that could be oropharyngeal cancer.

How doctors diagnose oropharyngeal cancer

A provider will ask about your symptoms. They’ll ask about your medical history, including whether you’ve had medical issues that increase your risk, like:

• HPV virus
• Head and neck cancer
• Radiation therapy to your head and neck

They’ll also ask about your personal habits. For example, they’ll ask if you use tobacco now or have in the past. They may ask how often you drink beverages that contain alcohol, and how much you drink.

Your provider may check the inside of your mouth and throat. They’ll gently feel your neck for lumps.

Tests to diagnose this condition

Your provider may use a thin, flexible tube with small tools to get tumor tissue samples. A medical pathologist will check the samples under a microscope for signs of cancer and HPV.

If tests show you have a cancerous tumor, your provider may do other tests to learn more about it. These include:

• CT scan: This test helps providers measure tumor size and check whether it’s spread. They may combine this test with a positron emission tomography (PET) scan.
• MRI scan: This test produces detailed images of your tonsils and the base of your tongue. An MRI also helps providers determine tumor size.

Cancer staging

Your provider uses test results to stage the cancer. Staging cancer helps them plan treatment and develop a prognosis (outlook).

There are two oropharyngeal cancer staging systems. Both systems set cancer stages based on:

• Tumor size and location
• Signs of cancer in your lymph nodes
• The tumor spreading to other areas of your body

Both systems involve four stages, from Stage I to Stage IV. The difference is whether tests show you have HPV. If you do, your provider may say you have HPV-positive oropharyngeal cancer.

How is oropharyngeal cancer treated?

Treatment focuses on ways to remove the tumor so you can speak and swallow as normally as possible. Your treatment may involve:

• Surgery: Your surgeon may use special surgical tools to remove a small tumor that hasn’t spread. They may do other surgeries if cancer spreads to nearby lymph nodes and tissues.
• Combination therapy: You may have chemotherapy and radiation therapy if you can’t have surgery. Or you may have this treatment before surgery to shrink a large tumor. It’s also a way to treat cancer that’s spread from your oropharynx to other areas of your body.
• Targeted therapy: This treatment blocks a protein that cancer cells rely on to divide, grow and spread.
• Immunotherapy: This is a treatment for oropharyngeal cancer that comes back or spreads. Immunotherapy helps your immune system find and destroy cancer cells.

When should I seek care?

Go to the emergency room or talk to your healthcare provider if you have surgical wound infection symptoms, like:

• Fever that’s greater than 101 degrees Fahrenheit or 38.4 degrees Celsius
• Redness, skin discoloration or tenderness at the surgery site
• Thick, cloudy discharge from the surgery site

Oropharyngeal cancer can come back, so you may need regular checkups for the rest of your life. Your provider may do checkups every six to 12 weeks during the first year after treatment. You’ll have fewer regular checkups over time.

Is there a cure for oropharyngeal cancer?

Sometimes, surgery to remove small tumors cures this disease. Survival rates for oropharyngeal cancer vary depending on the tumor location. According to the National Cancer Institute (U.S.), overall, 7 out of 10 people with this disease are alive five years after their diagnoses. Survival rates by tumor location are:

• Localized: This is when you receive treatment before a tumor spreads. In this case, 8 out of 10 people are alive five years after their diagnoses.
• Regional: In this case, a tumor spreads outside the oropharynx to nearby lymph nodes or your voice box, soft palate or muscles in your jaw. More than 7 out of 10 people with regional oropharyngeal cancer are alive five years after their diagnoses.
• Distant: The five-year survival rate drops to 4 out of 10 people if oropharyngeal cancer spreads to your bones, liver or lungs.

It’s important to remember that cancer survival rates are estimates based on other people’s experiences with specific kinds of cancer. Your experience may be very different. Ask your healthcare provider to explain what survival rate estimates mean in your situation.

Is there anything I can do to feel better?

Cancer surgery and treatment can be physically and emotionally challenging. If you have oropharyngeal cancer, the following programs may help you manage those challenges:

• Cancer rehabilitation: This is specialized care to help you get ready for surgery and support you afterward. For example, you may need reconstructive surgery, speech therapy or nutrition support.
• Palliative care: Your palliative care team may offer treatment to help manage cancer treatment side effects. They can also connect you with mental health support and support groups.
• Cancer survivorship: You’re a cancer survivor regardless of your personal situation. Cancer survivorship programs focus on your care plan after treatment.

Is oropharyngeal cancer the same as oral cancer?

No. They’re different forms of head and neck cancer. Oral cancer is cancer in your mouth. This includes the:

• First part of your tongue
• Lining inside of your cheeks
• First part of the roof of your mouth
• Floor of your mouth

Oropharyngeal cancer affects the middle of your throat, the back of your tongue and soft palate, and the sides and back of your throat.