Abstract

Oropharyngeal cancer is a disease in which cancer form in the tissues of the throat (oropharynx). The oropharynx is the middle part of the throat that includes the base of the tongue, the tonsils, the soft palate, and the walls of the pharynx. Oropharyngeal cancers can be divided into two types, HPV-positive, which are related to human papillomavirus infection, and HPV-negative cancers, which are usually linked to alcohol or tobacco use.

Signs and symptoms

The possible signs of oropharyngeal cancer are:

- A sore throat that persists

- Pain or difficulty with swallowing

- Unexplained weight loss

- Voice changes

- Ear pain

- A lump in the back of the throat or mouth

- A lump in the neck

- A dull pain behind the sternum

- Cough

Risk factors

The risk factors that can increase the risk of developing oropharyngeal cancer are:

- Smoking and chewing tobacco

- Heavy alcohol use

- A diet low in fruits and vegetables

- Chewing betel quid, a stimulant commonly used in parts of Asia

- Mucosal infection with human papilloma virus (HPV) (HPV-mediated oropharyngeal cancer)

- HPV infection

- Plummer-Vinson syndrome

- Poor nutrition

- Asbestos exposure

Certain genetic changes including: P53 mutation and CDKN2A (p16) mutations.

High-risk lesions:

- Erythroplakia

- Speckled erythroplakia

- Chronic hyperplastic candidiasis

Medium-risk lesions:

- Oral submucosal fibrosis

- Syphilitic glossitis

- Sideropenic dysphagia (or Paterson-Kelly-Brown syndrome)

Low-risk lesions:

- Oral lichen planus

- Discoid lupus erythematosus

- Discoid keratosis congenita

Pathophysiology

The cancer can spread three ways:

- Cancer invades the surrounding normal tissues.

- Cancer invades the lymph system and travels through the lymph vessels to other places in the body.

- Cancer invades the veins and capillaries and travels through the blood to other places in the body.

Diagnosis | Squamous cell carcinomas

Oropharyngeal squamous cell carcinomas is a type of head and neck cancer that begins in the oropharynx, the middle part of the throat that includes the soft palate, the base of the tongue, the tonsils, and the side and back wall of the throat. Squamous cell cancers of the tonsils are more strongly associated with human papillomavirus infection than are cancers of other regions of the head and neck.

Diagnosis | Stages

The National Cancer Institute (2016) provides the following definition:

Diagnosis | Stages | Stage 0 carcinoma "in situ"

Abnormal cells are found in the lining of the oropharynx. These may become cancer and spread into nearby normal tissue.

Diagnosis | Stages | Stage 1

Cancer has formed and is 20 mm or smaller and has not spread outside the oropharynx.

Diagnosis | Stages | Stage 2

Cancer has formed and is larger than 20 mm, but not larger than 40 mm. Also, it has not yet spread outside the oropharynx.

Diagnosis | Stages | Stage 4C

Cancer has spread to other parts of the body; the tumor may be any size and may have spread to lymph nodes.

Prognosis

People with HPV-mediated oropharyngeal cancer tend to have higher survival rates. The prognosis for people with oropharyngeal cancer depends on the age and health of the person and the stage of the disease. It is important for people with oropharyngeal cancer to have follow-up exams for the rest of their lives, as cancer can occur in nearby areas. In addition, it is important to eliminate risk factors such as smoking and drinking alcohol, which increase the risk for second cancers.