Oropharyngeal cancer: What to know

Oropharyngeal cancer is a type of head and neck cancer.

It may develop in the following areas:

• the back of the tongue
• tonsils
• oropharynx (middle part of the throat)
• the floor of the mouth
• side and back walls of the throat

The American Cancer Society (ACS) estimates that doctors diagnose about 54,000 new cases of oropharyngeal cancer or oral cancer yearly.

It occurs most often in older adults, with the average age of diagnosis being 63 years old. However, about 20% of cases occur in people under age 55 years.

Symptoms of oropharyngeal cancer may start with a sore that does not heal on the part of the oropharynx.

Cancer cells can directly invade the tissue in the area where the first tumor may occur, known as the primary tumor. Cells can also spread through the lymphatic system or from other areas in the body. These are known as secondary tumors.

According to the ACS, additional signs and symptoms of oropharyngeal cancer may include:

• pain in the mouth that does not go away
• a lump in the mouth or back of the throat
• red or white patches on the tonsils or tongue
• trouble swallowing
• a sore throat that does not go away
• difficulty moving the tongue or jaw
• numbness of the tongue
• pain in the ear
• voice changes
• pain around the teeth

The above symptoms can develop for reasons other than oropharyngeal cancer. However, if any of the above symptoms last for more than 2 weeks, it is important to contact a doctor.

Certain factors increase a person’s risk of developing oropharyngeal cancer.

Research suggests that there has been an increase in the incidence of human papillomavirus (HPV)-positive oropharyngeal squamous cell carcinoma. There is also a link between HPV and other forms of cancer, including cervical cancer.

Several types of HPV viruses exist, though most forms of HPV do not cause cancer. However, there is an association between HPV 16 and oral cancers.

HPV can infect the throat and mouth. In some cases, the infection from HPV causes cells to mutate or change into precancerous and possibly cancer cells. According to the Centers for Disease Control and Prevention (CDC), HPV causes about 70% of oropharyngeal cancers in the United States.

HPV is not the only cause of oropharyngeal cancer. According to the National Cancer Institute, other risk factors for oropharyngeal cancer include cigarette smoking for 10 years or more and heavy alcohol use.

Doctors will typically conduct a physical exam of the mouth, throat, and neck to diagnose oropharyngeal cancer.

They may take a biopsy, which involves removing a small amount of tissue or cells to examine under a microscope for cancerous cells.

Imaging tests also help confirm a diagnosis, and may include:

• MRI: This procedure uses radio waves and magnets to produce detailed pictures of areas inside the body.
• PET: A PET scan helps doctors to detect malignant (cancerous) tumor cells in the body.
• CT: CT scans create images of the body from different angles.

The classifications (stages) of oropharyngeal cancer range from stage 1 to stage 4. Stage 1 involves smaller tumors with minimal or no spread to nearby lymph nodes. Stage 4 involves spread to distant organs, such as the lungs.

A doctor will also assign a stage to a person’s primary tumor, depending on its size. The stages are as follows:

• T0: Doctors cannot assess a primary tumor.
• T1: The tumor is smaller than 2 centimeters (cm).
• T2: The tumor is between 2–4 cm.
• T3: The tumor is larger than 4 cm or has extended to the surface of the epiglottis (cartilage that seals off the windpipe).
• T4: This is for advanced local disease, and the tumor may spread to other areas of the throat and mouth.

Learn more about cancer stages here.

Treatment for oropharyngeal cancer varies based on a person’s general health and stage of cancer.

Some treatments may affect a person’s ability to speak and swallow. Doctors will try to recommend treatments that preserve a person’s ability to do these.

Surgery is the most common treatment for all stages of oropharyngeal cancer. The surgeon will likely remove as much of the tumor as possible while trying to avoid affecting swallowing and speaking ability.

Additional treatments by stage may include:

Stages 1 and 2

Treatment options include surgery and radiation therapy. Radiation therapy uses specific types of high energy X-rays to destroy cancer cells.

Stages 3 and 4

These stages involve the same treatment options as stages 1 and 2. However, treatment may also include chemotherapy and targeted therapy.

Targeted treatment involves drugs that attack specific cancer cells. Targeted drugs may not harm noncancerous cells as much as chemotherapy drugs.

It may not always be possible to prevent all cases of oropharyngeal cancer. However, a person can take steps to reduce certain risk factors.

The HPV vaccine helps reduce the risk of cervical cancer. According to the CDC, it may also help prevent oropharyngeal cancers.

Avoiding smoking and limiting alcohol use may also help reduce a person’s risk of developing oropharyngeal cancer.

The outlook for someone with oropharyngeal cancer varies based on a few factors. It often depends on whether a person has HPV-associated oropharyngeal cancer. Research indicates that HPV-positive oropharyngeal cancer typically has a better treatment response and outlook.

Other factors that affect outlook include:

• the stage of disease
• the number of lymph nodes with cancer
• spread to distant sites

The 5-year survival rates for oropharyngeal cancer vary from 28–59%, depending on the extent of the disease.

The 5-year survival rate for people with local or regional oropharyngeal cancer is 59%. The localized disease involves no evidence or spread of cancer beyond where it started. Regional cancer involves spread only to nearby structures or lymph nodes.

The 5-year survival rate for oropharyngeal cancer spread to distant body parts, such as the lungs, is 28%.

Oropharyngeal cancer involves cancer of the tonsils, back of the throat, tongue, or roof of the mouth. It can develop due to contracting HPV. Other risk factors include long-term cigarette smoking and heavy alcohol use.

Treatment typically includes surgery, depending on the stage of cancer. Additional treatment includes radiation and chemotherapy.