Oropharyngeal cancer affects the oropharynx of your throat, including the tonsils and soft palate. Early detection is crucial for successful treatment.
What is oropharyngeal cancer?
Oropharyngeal cancer is cancer that develops in the back of the throat, including the base of the tongue, tonsils, and soft palate, which is located in the top of the mouth toward the back. It's primarily caused by human papillomavirus (HPV) infection in many cases, but smoking and alcohol use are also significant risk factors. In the United States, it's estimated to account for more than 16,000 new cases annually, making it a relatively common type of head and neck cancer. The survival rate depends on the stage, but early detection and treatment significantly improve outcomes.
Head and Neck Cancer Center of Excellence
The AHN Cancer Institute has one of the busiest oropharyngeal cancer centers in western Pennsylvania — for good reason. At AHN, we see each patient as the individual they are who needs specific and tailored care. In fact, people come from Ohio, Pennsylvania, and West Virginia to receive care from our highly experienced and compassionate staff.
Our skilled team includes:
- Physicians.
- Endocrinologists.
- ENT (ear, nose, and throat) surgeons.
- General surgeons.
- Physician assistants.
- Nurse practitioners.
Our whole-person approach to care includes robust support services such as support groups, electronic medical records, palliative care, and cancer genetics. Learn more about the Head and Neck Cancer Center of Excellence.
Oropharyngeal cancer symptoms and signs
There is no routine screening for oropharyngeal cancer. Early cancer of the oropharnyxoropharynx (the middle part of the throat, located behind the mouth) often presents with subtle symptoms, making early detection difficult. Regular preventive care and talking with your doctor can be helpful in identifying changes in your health or risk factors that may cause oropharyngeal cancer.
Common signs of oropharyngeal cancer can include:
- Sore throat: Persistent or recurrent sore throat, especially if it doesn't improve with over-the-counter medications.
- Ear pain: Pain radiating to the ear, particularly on one side.
- Difficulty swallowing: Feeling like food gets stuck in the throat or a sensation of choking.
- Lump or mass in the neck: A painless swelling in the neck area, usually on one side.
- Hoarseness: A change in voice, becoming raspy or hoarse.
- Mouth sores: Non-healing sores or ulcers in the mouth, especially on the tongue or tonsils.
- Weight loss: Unexplained weight loss without any dietary changes.
- Bad breath: Persistent bad breath that doesn't improve with oral hygiene.
- Bleeding: Bleeding from the mouth, particularly from the tonsils or back of the throat.
If you experience any of these symptoms, it's crucial to consult with a doctor promptly for diagnosis and treatment.
Oropharyngeal cancer risk factors
Factors that can increase your risk of developing oropharyngeal cancer include:
- HPV Infection: HPV types 16 and 18 are strongly linked to oropharyngeal cancer, especially in non-smokers.
- Tobacco Use: Smoking cigarettes and chewing tobacco increases the risk of oropharyngeal cancer.
- Alcohol Consumption: Excessive alcohol consumption is a risk factor.
- Genetics: Family history of head and neck cancer can increase the risk.
- Diet: A diet low in fruits and vegetables may increase the risk of oropharyngeal cancer.
- Epstein-Barr Virus (EBV): This virus, associated with infectious mononucleosis, is also linked to oropharyngeal cancer.
There is no guarantee that one or more of these factors causes oropharyngeal cancer alone. However, it’s important to know if you are at an increased risk and look out for symptoms and speak to a doctor right away.
Factors that can increase your risk of developing oropharyngeal cancer include:
- Age: Risk increases with age, with most cases diagnosed after the age of 50.
- Sex: Those assigned male at birth are more likely to develop oropharyngeal cancer.
- Race: African Americans have a higher risk than other racial groups.
- Exposure to certain chemicals: Occupational exposure to chemicals like asbestos and nickel can increase the risk.
- Weakened immune system: Conditions like HIV/AIDS can suppress the immune system, making individuals more susceptible to cancer.
Oropharyngeal cancer screening and diagnosis
Your AHN doctor will determine which imaging tests are most appropriate for your individual case based on factors such as the size and location of the tumor, suspected spread, your overall health, and other considerations. AHN specialists take into account your unique needs and health status.
To begin diagnosis, we discuss your symptoms with you and perform a physical exam to feel for any lumps or nodules on the neck. We’re here to answer any questions and take the time so you understand what your care plan will be. That could include the following procedures.
Endoscopy
At AHN, we look for treatment options that will deliver the best results using the least invasive procedure. An endoscopy is a minimally invasive technique that offers a relatively simple and effective way to detect oropharyngeal cancer, often at an early and more treatable stage. A thin, flexible tube with a camera (endoscope) allows the doctor to see the oropharynx in detail. Your AHN doctor can then take a biopsy and will thoroughly review the findings to determine the diagnosis.
Biopsy
A biopsy involves removing a small tissue sample from a suspicious area in the oropharynx. This sample is then examined under a microscope by a highly trained pathologist who can identify cancerous cells. A positive biopsy confirms the presence of oropharyngeal cancer, providing a crucial diagnosis for determining the appropriate treatment plan.
Imaging Tests
Imaging tests play a crucial role in diagnosing and staging oropharyngeal cancer, helping your AHN doctors determine the extent and location of the tumor.
- Computed Tomography (CT) Scan: This scan uses X-rays to create detailed cross-sectional images of your throat and neck. It can reveal the size, shape, and location of the tumor, as well as its spread to nearby lymph nodes.
- Magnetic Resonance Imaging (MRI): Strong magnetic fields and radio waves generate detailed images of soft tissues in your throat and neck. It's particularly useful for evaluating the tumor's invasion into surrounding muscles, nerves, and the base of the skull.
- Positron Emission Tomography (PET) Scan: This scan involves injecting a small amount of radioactive sugar (tracer) into your bloodstream, which is absorbed by metabolically active cells, including cancer cells. It then detects the tracer, highlighting areas of high metabolic activity, which can indicate tumor growth and spread.
- Ultrasound: Using high-frequency sound waves, an ultrasound creates images of the neck, particularly the lymph nodes. It's mainly used to guide fine-needle aspiration biopsies of suspicious lymph nodes.
Types and stages of oropharyngeal cancer
Squamous Cell Carcinoma is the most common type of oropharyngeal cancer, arising from the squamous cells lining the throat. Rare types include adenocarcinoma and lymphoma.
Staging oropharyngeal cancer, like most cancers, is based on tumor size, spread to lymph nodes, and distant metastasis, and helps determine the extent of the disease and guide treatment planning.
- Stage 0: This is also called carcinoma in situ. It means abnormal cells are found in the lining of the oropharynx, but they haven't spread into deeper tissues.
- Stage 1: The cancer is small, and in some types of cancer, it can spread to the lymph nodes.
- Stage 2 and 3: These stages mean the cancer is larger and may have spread to nearby lymph nodes. Higher numbers indicate more advanced disease.
- Stage 4: This is the most advanced stage. It means the cancer has spread to other parts of the body, such as the lungs, liver, or bones.
It's important to remember that staging is complex and depends on several factors. If you'd like to understand the specifics of your own or a loved one's diagnosis, talking to a doctor is crucial. They can provide personalized information and treatment options.
Oropharyngeal cancer treatment
Treatment options for oropharyngeal cancer depend on the stage, location, and other factors. The goal of treatment is to cure the cancer, control its growth, or relieve symptoms. Treatment may involve a combination of different therapies.
Treatment often involves a combination of different approaches to maximize effectiveness and minimize side effects.
Surgery
Surgery aims to physically remove the cancerous tumor and surrounding tissue to prevent its spread. The extent of surgery depends on the cancer's stage and location, ranging from small excisions to more extensive procedures involving removal of lymph nodes. Several surgical approaches can be used, sometimes in combination:
- Transoral surgery: This minimally invasive approach uses specialized instruments inserted through the mouth to remove smaller tumors. It avoids external incisions, leading to faster recovery and less scarring.
- Partial or total pharyngectomy: These procedures involve the removal of part or all the pharynx (throat), depending on the extent of the cancer's spread. This might involve resection of the tonsils, base of tongue, or other structures within the oropharynx.
- Neck dissection: If the cancer has spread to the lymph nodes in the neck, a neck dissection may be necessary. This surgery involves removing lymph nodes to check for cancer and prevent further spread. Different types of neck dissections exist, ranging in the extent of lymph node removal.
- Reconstructive surgery: Often, after removing cancerous tissue, reconstructive surgery is required to restore swallowing, speaking, and breathing function. This might involve using tissue from other parts of the body (such as a muscle flap from the leg or forearm) to rebuild the removed portion of the throat.
Radiation therapy
Radiation therapy uses high-energy X-ray beams to kill cancer. It can be used alone or in combination with other treatments. It can be used to preserve critical organs in the head and neck that might otherwise require removal with surgery, or it can be used to eliminate microscopic cancer cells that may remain after surgery.
Chemotherapy
Chemotherapy to treat oropharyngeal cancer uses powerful drugs to kill cancer cells throughout the body. It's rarely used alone and is frequently employed in combination with other therapies, most commonly radiation therapy (chemoradiation). The specific chemotherapy regimen depends on factors like the stage of cancer, your overall health, and whether it's used with radiation or as a subsequent treatment for recurrent or metastatic disease. Your AHN Care Team will work in tandem to develop the right treatment for you and will be with you to answer any questions or concerns.
Targeted therapy
Targeted therapy for oropharyngeal cancer focuses on specific molecules or pathways involved in cancer cell growth and survival, aiming to disrupt these processes while minimizing harm to healthy cells. The most common targets are related to the human papillomavirus (HPV) status of the tumor. While not all oropharyngeal cancers are HPV-positive, HPV status significantly influences treatment choices.
For HPV-positive oropharyngeal cancers, treatments that target the effects of HPV infection are sometimes used. However, there isn't a single, universally effective targeted therapy for oropharyngeal cancer. That’s why you have your AHN Care Team. AHN reviews the ongoing research that can identify and develop drugs targeting specific molecular abnormalities within the cancer cells to help our patient population find the therapy that will work for their specific needs.
Immunotherapy
Immunotherapy harnesses the power of the body's own immune system to fight cancer. In oropharyngeal cancer, immunotherapy is primarily used to enhance the immune system's ability to recognize and attack cancer cells, especially those expressing specific proteins or markers. AHN uses several immunotherapy approaches, depending on the patient, when it comes to treatment. Some examples include:
- Checkpoint inhibitors: These drugs target checkpoints on immune cells that normally keep the immune response in check. By blocking these checkpoints, the immunotherapy unleashes the immune system to attack cancer cells more effectively. Pembrolizumab and nivolumab are examples of checkpoint inhibitors used for oropharyngeal cancer, often in patients with recurrent or metastatic disease after other treatments have failed.
- Adoptive cell transfer: This is a more complex approach that involves removing immune cells (like T cells) from the patient, modifying them in the lab to better target cancer cells, and then infusing them back into the patient to fight the tumor. This is less commonly used in oropharyngeal cancer than checkpoint inhibitors.
- Cancer vaccines: Though still under development for widespread use in oropharyngeal cancer, research explores the use of vaccines to stimulate the immune system and target specific cancer antigens.
Immunotherapy may be used alone or in combination with other treatments like chemotherapy or radiation, depending on the stage of cancer, patient's overall health, and other factors. It's crucial to note that immunotherapy's effectiveness varies among patients, and side effects can occur.
Contact us
Call the AHN Cancer Help Line anytime at (412) NURSE-4-U (412) 687-7348 to schedule a cancer-related appointment or to just talk with our nurses about diagnoses, treatments, and side effects.