Cancer of the oropharynx is a disease in which cancer cells are found in the tissues of the oropharynx. The oropharynx is the middle part of the throat (also called the pharynx). The pharynx is a hollow tube about 5 inches long that starts behind the nose and goes down to the neck to become part of the oesophagus (tube that goes to the stomach). Air and food pass through the pharynx on the way to the windpipe (trachea) or the oesophagus. The oropharynx includes the soft palate (the back of the mouth), the base of the tongue, and the tonsils.

Cancer of the oropharynx most commonly starts in the cells that line the oropharynx.  for more information on cancer that started in the lymph cells of the oropharynx.)

A doctor should be seen if a person has a sore throat that does not go away, trouble swallowing, a lump in the back of the mouth or throat, a change in the voice, or pain in the ear.

If there are symptoms, a doctor will examine the throat using a mirror and lights. The doctor will also feel the throat for lumps. If tissue that is not normal is found, the doctor will need to cut out a small piece and look at it under the microscope to see if there are any cancer cells. This is called a biopsy.

The chance of recovery (prognosis) depends on where the cancer is in the throat, whether the cancer is just in the throat or has spread to other tissues (the stage), and the patient’s general state of health. After the treatment, a doctor should be seen regularly because there is a chance of having a second cancer in the head or neck region.

Stages of cancer of the oropharynx

Once cancer of the oropharynx is found, more tests will be done to find out if cancer cells have spread to other parts of the body. This is called staging. A doctor needs to know the stage of the disease to plan treatment. The following stages are used for cancer of the oropharynx.

Stage I

The cancer is no more than 2 centimetres (about 1 inch) and has not spread to lymph nodes in the area (lymph nodes are small bean-shaped structures that are found throughout the body; they produce and store infection-fighting cells).

Stage II

The cancer is more than 2 centimetres, but less than 4 centimetres (less than 2 inches), and has not spread to lymph nodes in the area.

Stage III

Either of the following may be true:

• The cancer is more than 4 centimetres.
• The cancer is any size but has spread to only one lymph node on the same side of the neck as the cancer. The lymph node that contains cancer measures no more than 3 centimetres (just over one inch).

Stage IV

Any of the following may be true:

• The cancer has spread to tissues around the oropharynx. The lymph nodes in the area may or may not contain cancer.
• The cancer is any size and has spread to more than one lymph node on the same side of the neck as the cancer, to lymph nodes on one or both sides of the neck, or to any lymph node that measures more than 6 centimetres (over 2 inches).
• The cancer has spread to other parts of the body.

Recurrent

Recurrent disease means that the cancer has come back (recurred) after it has been treated. It may come back in the oropharynx or in another part of the body.

How cancer of the oropharynx is treated

There are treatments for all patients with cancer of the oropharynx. Three kinds of treatment are used:

• Surgery (taking out the cancer).
• Radiation therapy (using high-dose x-rays or other high-energy rays to kill cancer cells).
• Chemotherapy (using drugs to kill cancer cells).

Hyperthermia (warming the body to kill cancer cells) is being tested in clinical trials.

Surgery is a common treatment of cancer of the oropharynx. A doctor may remove the cancer and some of the healthy tissue around the cancer. If cancer has spread to lymph nodes, the lymph nodes will be removed (lymph node dissection). A new type of surgery called micrographic surgery is being tested in clinical trials for early cancers of the oropharynx. Micrographic surgery removes the cancer and as little normal tissue as possible. During this surgery, the doctor removes the cancer and then uses a microscope to look at the cancerous area to make sure there are no cancer cells remaining.

Radiation therapy uses high-energy x-rays to kill cancer cells and shrink tumours. Radiation may come from a machine outside the body (external radiation therapy) or from putting materials that produce radiation (radioisotopes) through thin plastic tubes in the area where the cancer cells are found (internal radiation therapy). External radiation to the thyroid or the pituitary gland may change the way the thyroid gland works. The doctor may wish to test the thyroid gland before and after therapy to make sure it is working properly. Giving drugs with the radiation therapy to make the cancer cells more sensitive to radiation (radiosensitization) is being tested in clinical trials. If smoking is stopped before radiation therapy is started, there is a better chance of surviving longer.

Chemotherapy uses drugs to kill cancer cells. Chemotherapy may be taken by pill, or it may be put into the body by a needle in the vein or muscle. Chemotherapy is called a systemic treatment because the drug enters the bloodstream, travels through the body, and can kill cancer cells throughout the body.

People with oropharyngeal cancer have a higher risk of getting other cancers in the head and neck area. Clinical trials of chemoprevention therapy are testing whether certain drugs can prevent second cancers from developing in the mouth, throat, windpipe, nose, or oesophagus (the tube that connects the throat to the stomach).

Hyperthermia uses a special machine to heat the body for a certain period of time to kill cancer cells. Because cancer cells are often more sensitive to heat than normal cells, the cancer cells die and the cancer shrinks.

Because the oropharynx helps in breathing, eating, and talking, patients may need special help adjusting to the side effects of the cancer and its treatment. A doctor will consult with several kinds of doctors who can help determine the best treatment. Trained medical staff can also help patients recover from treatment and adjust to new ways of eating and talking. Plastic surgery, or help learning to eat and speak, may be needed if a large part of the oropharynx is taken out.

Stage I Oropharyngeal Cancer

Treatment will be surgery to remove the cancer or radiation therapy

Stage II Oropharyngeal Cancer

Treatment will be surgery to remove the cancer or radiation therapy

Stage III Oropharyngeal Cancer

Treatment may be one of the following:

1. Surgery to remove the cancer followed by radiation therapy.
2. Radiation therapy.
3. A clinical trial of chemotherapy followed by surgery or radiation therapy.
4. A clinical trial of chemotherapy combined with radiation therapy.
5. A clinical trial of new ways of giving radiation therapy.

Stage IV Oropharyngeal Cancer

If the cancer can be removed by surgery, treatment may be one of the following:

1. Surgery to remove the cancer followed by radiation therapy.
2. Radiation therapy.
3. A clinical trial of radiation therapy combined with chemotherapy.
4. A clinical trial of new ways of giving radiation therapy.

If the cancer cannot be removed by surgery, treatment may be one of the following:

1. Radiation therapy. Clinical trials are testing new ways of giving radiation therapy.
2. A clinical trial of chemotherapy followed by surgery or radiation therapy.
3. A clinical trial of radiation therapy given with chemotherapy or with drugs to make the cancer cells more sensitive to radiation therapy (radiosensitizers).
4. A clinical trial of hyperthermia plus radiation therapy.

Recurrent Oropharyngeal Cancer

Treatment may be one of the following:

1. Surgery to remove the cancer.
2. Radiation therapy.
3. A clinical trial of chemotherapy.
4. A clinical trial of hyperthermia plus radiation therapy.

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