Oropharyngeal Cancer

What is oropharyngeal cancer?

Oropharyngeal cancer is cancer in your oropharynx, the middle section of your throat (pharynx) that makes saliva, keeps your mouth and throat moist and helps you digest food. Healthcare providers have different ways to treat oropharyngeal cancer, but the disease may come back (recur) after treatment. Although you may not be able to avoid oropharyngeal cancer, you may reduce your risk of developing it by protecting yourself against human papillomavirus (HPV), not smoking cigarettes and drinking beverages containing alcohol in moderation.

How common is this condition?

Oropharyngeal cancer is a relatively rare kind of cancer. According to the American Cancer Society, about 53,000 people in the U.S. develop oropharyngeal cancer each year. In comparison, the American Cancer Society estimates more than 290,000 people in the U.S. are diagnosed with breast cancer each year.

What are the different types of oropharyngeal cancer?

Tonsil cancer is the most common type of oropharyngeal cancer. People may also develop oropharyngeal cancer in their gums, the floor of their mouths and their oropharynxes.

What are the symptoms of oropharyngeal cancer?

Oropharyngeal cancer symptoms may resemble symptoms of other less serious medical issues. Common oropharyngeal cancer symptoms include:

• A sore throat (pharyngitis) that doesn’t go away.
• Pain or difficulty with swallowing (dysphagia).
• Trouble opening up your mouth fully (trismus) or moving your tongue.
• Unexplained weight loss.
• Voice changes that don’t 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.
• A white patch on your tongue or lining of your mouth that doesn’t go away.

What causes oropharyngeal cancer?

Human papillomavirus (HPV) infection is the most common cause. HPV makes proteins that interfere with genes that manage the cells lining your mouth and throat, including how fast these cells grow. Oropharyngeal cancer happens when genes stop managing cell growth and cells grow uncontrollably and form tumors. Other causes include:

• Tobacco: Tobacco use, including smoking cigarettes and cigars and using chewing tobacco, damages the cells that line your throat. Cells in your throat react to damage by dividing more than usual, which means they’re making more copies of their DNA than usual. The more cells have to divide to compensate for damaged cells, the more likely cells will make mistakes in copying their DNA, which increases the chance cells will become cancerous.
• Alcohol: Drinking beverages containing alcohol may damage cells in your throat, affecting their ability to repair DNA.

What are oropharyngeal cancer risk factors?

The most significant risk factor is being infected with HPV, particularly HPV type 16. Other risk factors include:

• A history of smoking cigarettes and using other forms of tobacco.
• Heavy consumption of beverages that contain alcohol.
• History of head and neck cancer.
• History of radiation therapy to your head and neck.

How do healthcare providers diagnose oropharyngeal cancer?

A provider will ask about your symptoms and your medical history, including whether you have a history of head and neck cancer or if you’ve had radiation therapy to your head and neck. They’ll ask about your lifestyle, including if you use tobacco or used it in the past.

They’ll examine your mouth, throat and neck and feel your neck for lumps that may be signs of masses. Your provider may use a mirror, lights and/or a fiberoptic scope to examine the inside of your mouth and throat.

What tests do healthcare providers use to diagnose this condition?

Providers may do an endoscopic biopsy to obtain tissues. Endoscopes are thin, flexible tubes that have tiny cameras and cutting tools on the tip that providers use to obtain a small sample of tissue. A medical pathologist examines the tissue under a microscope for signs of cancer and/or HPV.

They may do the following imaging tests:

• Computed tomography (CT) scan: Providers may use CT scans to measure tumors’ size and determine whether a tumor has spread. They may combine this scan with positron emission tomography (PET) scans.
• Magnetic resonance imaging (MRI) scan: This test produces detailed images of your body, especially images of soft tissue, such as your tonsils and the base of your tongue. An MRI also helps providers determine tumor size.

Are there stages of oropharyngeal cancer?

Yes, there are. Healthcare providers use cancer staging systems to develop treatment plans and determine prognoses or expected outcomes. There are four oropharyngeal cancer stages (Stage I to Stage IV). Stages may vary depending on whether or not you have oropharyngeal cancer because you have HPV. Other factors in staging include tumor size and if cancer has spread to nearby lymph nodes or distant areas of your body.

How do healthcare providers treat oropharyngeal cancer?

Providers may use surgery, radiation therapy, chemotherapy, targeted drug therapy or immunotherapy to treat oropharyngeal cancer. Their goal is to remove cancer cells without limiting your ability to speak and swallow as normally as possible.

Surgery

Providers may use surgery to treat cancers that are small and haven’t spread. They may use transoral robotic-assisted surgery to remove tumors.

Transoral robotic surgery

Transoral robotic surgery (TORS) is a minimally invasive treatment method to remove difficult-to-reach oropharyngeal cancers through your mouth. By using robotic surgery, your surgeon doesn’t have to make a large incision in your neck or split your lower jaw to remove tumors in your oropharynx. They also don’t need to insert a tracheostomy breathing tube. Other advantages include:

• Less time spent in the hospital after your surgery.
• Faster recovery.
• Less damage to surrounding tissues and the muscles that help you swallow.
• Fewer long-term issues with your speech and ability to swallow.

What are complications/side effects of transoral robotic surgery?

Complications and/or side effects may include:

• Abnormal bleeding (hemorrhage).
• Aspiration, which occurs when food or liquid enters your lungs.
• Respiratory compromise, a condition in which your lungs can’t take in enough oxygen.
• Dysphagia or difficulty swallowing.
• Difficulty chewing food.
• Permanent loss of voice or difficulty talking.
• Difficulty breathing that requires a tracheostomy.
• Changes to your facial appearance.

Some people who have TORS need may need additional treatment, including reconstructive surgery, speech therapy or nutritional therapy to manage surgery side effects.

Chemotherapy

Your provider may use chemotherapy alone or in combination with radiation therapy. They may use combination therapy when you can’t have surgery, including situations when you have tumors that are too large to remove with surgery. Providers may also use combination therapy to:

• Treat cancer that’s spread from your oropharynx to other areas of your body.
• Shrink tumors before surgery.
• Kill any cancer cells that remain after surgery.

What are complications/side effects of chemotherapy and radiation therapy?

Combination therapy may affect your ability to speak. That’s because radiation therapy that targets your throat may damage healthy tissue and make it hard for you to speak or swallow. You may need additional treatment and specialized therapy to manage speech and swallowing issues.

Targeted therapy

Targeted therapies for cancer are lab-made versions of monoclonal antibodies. Monoclonal antibodies are proteins in your immune system. Targeted therapy works by blocking a protein that cancer cells rely on to divide, grow and spread.

What are complications/side effects of targeted therapy?

Targeted therapy side effects vary. Common cetuximab side effects may include:

• Infections that cause fevers and chills.
• Skin rash.
• Itching.
• Dizziness.
• Dry mouth.
• Indigestion.
• Changes in your skin and nails.

Immunotherapy

Immunotherapy is a first-line treatment option for oropharyngeal cancer that has returned or has spread. Immunotherapy helps your immune system find and destroy cancer cells. Immunotherapy for oropharyngeal cancer includes pembrolizumab (Keytruda®) and nivolumab (Opdivo®).

What are complications/side effects of immunotherapy?

Most immunotherapy side effects are mild. The most common side effects include

• Fatigue.
• Itchy rash.
• Diarrhea.
• Nausea and vomiting.

Can oropharyngeal cancer be prevented?

You may not be able to prevent oropharyngeal cancer, but you can take steps to lower your risk. Changes you can make include:

• Avoid human papillomavirus (HPV) infection. Having multiple sex partners and/or having oral sex increases your risk of developing HPV. Ask your doctor about the HPV vaccine.
• Don’t start smoking. If you smoke cigarettes or use tobacco products, quit. Continuing to smoke greatly increases the risk of developing a second cancer in your mouth, throat or voice box or lungs. Ask your healthcare provider for help. They have many resources and can put you in touch with health professionals that can help you quit.
• Don’t drink beverages containing alcohol on a regular basis or in large amounts. Alcohol increases the cancer-causing effects of tobacco, so it’s especially important to avoid this combination.
• 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.

What can I expect if I have this condition?

If you have oropharyngeal cancer, you’ll need regular follow-up examinations so your healthcare provider can check for signs of new or second cancer near your oropharynx. If you drink beverages containing alcohol or you smoke, you should talk to your provider about quitting. Smoking and drinking beverages containing alcohol increase your risk of developing a new or second cancer, or that oropharyngeal cancer will come back.

Is there a cure for oropharyngeal cancer?

Healthcare providers can treat oropharyngeal cancer, but it may come back after successful treatment. According to the American Cancer Society, 70% of people with oropharyngeal cancer were alive five years after diagnosis. Providers have identified some factors that affect prognosis:

• Like most cancers, people who are diagnosed and treated before cancer spreads have better outcomes than people who aren’t.
• People who have HPV tend to have better prognoses than people who don’t have the virus.
• People who don’t use tobacco have better prognoses than people who do.

How do I take care of myself?

The best ways for you to take care of yourself include:

• Avoiding tobacco. If you smoke, try to quit.
• Avoiding beverages that contain alcohol.
• If you have HPV, talk to your provider about being vaccinated against new cases.
• Ask for help. Your treatment may affect your ability to speak and eat normally. But there are special therapies and programs to help you manage treatment side effects.
• Be sure to follow up with your provider so they can monitor your overall health and signs that oropharyngeal cancer has come back.

When should I see my healthcare provider?

It’s very important that you follow up with your provider after treatment. You may need regular checkups for the rest of your life. In general, providers typically do checkups every six to 12 weeks during the first year after treatment. They may do checkups every three months in the second year, every three to four months in the third year and then every six months.

When should I go to the emergency room?

If you had surgery to remove tumors, you should go to the emergency room if you have symptoms that may indicate infection. Symptoms may include:

• Fever.
• Redness or tenderness at the surgery site.
• Discharge from the surgery site.

What questions should I ask my healthcare provider?

• Where exactly 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?

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 or oral cavity and affects the first part of your tongue, the lining of the inside of your cheeks, the first part of the roof of your mouth and the floor of your mouth.
• Oropharyngeal cancer affects your oropharynx, your tonsils, the back part of your tongue and soft palate and the sides and back of your throat. It develops in squamous cells that line the surface of your mouth and throat.

A note from Cleveland Clinic

Oropharyngeal cancer is a relatively rare head and neck cancer. Healthcare providers can treat oropharyngeal cancer, but the condition can come back (recur) after treatment. Nearly all cases of oropharyngeal cancer are caused by exposure to the human papillomavirus (HPV). People who use tobacco and/or drink beverages containing alcohol are also more likely to develop oropharyngeal cancer. If you have oropharyngeal cancer, you can avoid a recurrence by obtaining treatment for HPV or being vaccinated against HPV. You may also help yourself by avoiding tobacco and beverages that contain alcohol. If you have oropharyngeal cancer and want help with tobacco and/or alcohol use, talk to your healthcare provider. They’ll be glad to help.