Oropharyngeal cancer

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at May 29, 2016
StartDiseasesOropharyngeal cancer

Oropharyngeal cancers occur when malignant cells form in any tissue of the oropharynx which is one of three parts of the pharynx (throat) and includes the middle area of the throat: tonsils, soft palate, back of the tongue. There are two main types of oropharyngeal cancer: those linked to the human papilloma virus (HPV) and non-HPV oropharyngeal cancers associated with the use of tobacco and alcohol products. Oropharyngeal cancers are a type of head and neck cancer

Contents

Definition & Facts

In 2016, the American Cancer Society estimates there will be approximately 48,300 new cases of oropharyngeal cancer diagnosed in the United States. They also estimate approximately 9,500 deaths from these cancers this year.

Men are twice as likely as women to get this type of cancer, and the incidence is approximately the same for both African-American and Caucasian people. The incidence of head and neck cancer in males has not increased in recent years, and diagnosis of this cancer in women has gone down slightly in the same time period.

The aforementioned statistics refer to incidences of oropharyngeal cancers linked to alcohol and tobacco use. However, oropharyngeal cancers linked to HPV infection (HPV-positive oropharyngeal cancer) have increased slightly in Caucasian men and women during the same time period. Overall, death rates from oropharyngeal cancers have dropped steadily for the past 30 years. 

Symptoms & Complaints

A wide range of symptoms can indicate the presence of oropharyngeal cancer. For some people, symptoms are mild and are not noticed by the person themselves, and a doctor or dentist is the first to notices the indicators during a routine check-up. When symptoms do occur they can include:

Causes

There are two known causes of oropharyngeal cancer: human papillomavirus (HPV) and use of alcohol and tobacco products. Tobacco use is the single biggest cause of this disease. As much as 85 percent of all oropharyngeal cancer diagnoses are associated with tobacco use including smoking cigarettes, pipes, cigars, use of snuff, and chewing tobacco.

Exposure to secondhand smoke is also linked to development of this disease. Next to tobacco use, alcohol is the second biggest causal factor associated with development of head and neck cancers. Use of alcohol and tobacco together increases the risk. Other causative and risk factors associated with the development of this form of cancer are:

Diagnosis & Tests

Diagnosis of this form of cancer often happens during regular dental and physical health screenings. Doctors and dentists routinely look for symptoms of oropharyngeal cancer by examining the throat, mouth, tongue, and neck of patients. Symptoms indicating oropharyngeal cancer can also be indicators of many other health conditions, so if these symptoms are present, the doctor will order follow-up tests.

Doctors will also initially take an extensive medical history of the patient looking for risk factors, such as the use of tobacco and alcohol. Follow-up tests can include a more extensive physical examination using an endoscope to look more deeply into the mouth and throat. A detailed physical examination of the area behind the nose, on the larynx, and in the lymph nodes in the neck is usually performed because metastasis or spread of this cancer to those areas is common.

Other diagnostic tests for this cancer include a tissue biopsy in which a small skin sample is removed from the affected area and examined under a microscope. Dentists also use an oral brush biopsy which gathers a sample of cells from the lining of the mouth which is then sent to a laboratory for analysis. X-rays, barium swallow tests, CT scans, PET scans, and ultrasound examinations are also used for detecting and diagnosing this cancer. 

Treatment & Therapy

The most appropriate treatment depends on where the tumor is located, whether or not it has spread to other areas of the body, the age and general health of the patient, and the stage of the cancer. Cancers in the early stage have not spread from the original site. Treatment in this case usually involves surgical removal of the affected tissue. Regular follow-up screenings are then used to check for recurrence. Most cancers which are treated at this stage can be cured completely without further treatment, especially if the person ceases smoking.

Stage I and II oropharyngeal cancers are most often treated with surgery, radiation therapy, chemotherapy, or a combination of these treatments. Stage III and IVA oropharyngeal cancers are those which have already extended into adjacent tissues. Surgery followed by radiation is most often used in these cases. Removal of lymph nodes in the neck is also common for oropharyngeal cancers in these stages.

Stage IVB cancers are those which have already metastasized to other parts of the body. Radiation treatment is most commonly used for treating cancers in stage IVB. Another treatment option is use of Cetuximab, an antibody which inhibits the growth of malignant epidermal tissue.

Prevention & Prophylaxis

Research into how people can reduce their chances of developing oropharyngeal cancers is ongoing. So far, the most effective way of lowering risk is by completely avoiding use of tobacco products and drinking alcohol in moderation, if at all. The HPV vaccine may help prevent oropharyngeal cancers caused by HPV infections.

Having regular dental appointments and health screenings to detect head and neck cancers also provides the best chances of catching the disease at an early stage when it is most easily treated and survival rates are highest.