Oropharyngeal Cancer

The oropharynx is the part of the pharynx (throat) that lies directly behind the mouth; it includes the tonsils, the base of the tongue, the soft palate and the back wall of the throat. Cancers that develop in this area are called oropharyngeal cancer. In recent years it has become clear that a proportion of these tumours are linked to the human papillomavirus (HPV), and this has changed the approach to diagnosis and treatment.

What is oropharyngeal cancer?

The great majority of oropharyngeal cancers are squamous cell carcinomas arising from the flat cells that line the area. The tumour most often develops in the tonsil or the base of the tongue; the soft palate and the back wall of the throat are affected less often. Oropharyngeal cancers are broadly considered in two groups:

• HPV-related tumours: These may also occur at younger ages and in people who do not use tobacco. The first sign is often a painless lump in the neck; these tumours generally respond well to treatment.
• Tumours not related to HPV: These are usually linked to long-term tobacco and alcohol use and appear at older ages.

Symptoms

• A long-lasting sore throat on one side
• Pain on swallowing or a feeling of something stuck in the throat
• Pain radiating to the ear on the same side
• Enlargement of one tonsil or an ulcer on it
• A painless, gradually enlarging lump in the neck
• Bad breath or blood in the saliva
• A muffled, “hot potato” quality to the voice

Diagnosis

At the examination, the inside of the mouth and the tonsils are inspected directly; the base of the tongue and the lower parts of the throat are assessed with a flexible endoscope. A biopsy is taken from the suspicious tissue, and the sample is also tested for markers that indicate a link with HPV; this result is decisive in planning treatment. If there is a lump in the neck, a fine-needle sample can be taken under ultrasound guidance. The extent of the tumour is determined with computed tomography, magnetic resonance imaging or a PET scan, and the stage (stage I–IV) is established.

Treatment

The aim of treatment is to remove the tumour completely while preserving swallowing and speech as far as possible. For early-stage tumours, surgery through the mouth (transoral surgery) or radiotherapy alone may be an option. In more advanced stages, radiotherapy is given together with chemotherapy, or additional treatment is planned after surgery. If the lymph nodes in the neck are involved, they are removed surgically or included in the radiotherapy field. Because HPV-related tumours respond better to treatment, approaches aimed at reducing side effects are being investigated.

What to expect after treatment

For a while after treatment is completed, you may experience difficulty swallowing, a dry mouth and changes in taste. Speech and swallowing therapy helps these functions recover. Regular follow-up is needed both to monitor recovery and to detect any recurrence early.

When should you see a doctor?

If you notice a sore throat on one side lasting more than a few weeks, pain radiating to the ear, enlargement of a tonsil or a lump in the neck, you are advised to see an ear, nose and throat specialist. Most of these complaints have benign causes, but timely assessment allows a possible tumour to be detected at an early stage.