Tobacco and alcohol abuse are the strongest predictors of developing oropharyngeal carcinoma. Human papillomavirus infection is strongly implicated in people not exposed to smoking or alcohol. Betel nut chewing in developing countries is also a risk factor.
Signs include sore throat, referred oral pain, dysphagia, and trismus. Weight loss and neck mass can be the first signs of otherwise asymptomatic oropharyngeal cancer.
Patients should be referred to an ear, nose, and throat surgeon for histological diagnosis.
Staging is through computed tomography (CT) scan or magnetic resonance imaging of the head and neck with contrast and ultrasound-guided fine needle aspiration cytology. This is traditionally followed by triple endoscopy under general anaesthesia. However, positron emission tomography (PET) scan either alone or combined with CT scan has become an acceptable method for detecting primary disease if there is a solitary neck node or there are distant metastases.
Treatment regimens vary depending on the stage of the cancer and involve surgery, chemotherapy, radiotherapy, and monoclonal antibodies (in combination with radiotherapy). Patients should be managed by a multidisciplinary team in specialised head and neck centres to optimise outcome.
Oropharyngeal cancer is predominantly (90%) a squamous cell carcinoma arising from the subsites of the oropharynx: the base of the tongue, soft palate, palatine tonsillar fossa and pillars, and lateral and posterior pharyngeal wall. Non-epithelial tumours, such as minor salivary gland carcinomas and sarcoma, are uncommon.
History and exam
Key diagnostic factors
- oral pain
- weight loss
Other diagnostic factors
- sore throat
- neck lump
- indurated or ulcerated mass
- neck lymphadenopathy
- white (leukoplakia) and red plaques (erythroplakia)
- presence of risk factors
- smoking cigarettes
- human papillomavirus (HPV)-16 infection
- tobacco and betel nut chewing
1st investigations to order
- biopsy of the primary site
- PET-CT of the head and neck
- fine needle aspiration cytology (FNAC) of neck nodes
- excision biopsy of neck nodes
Investigations to consider
- CT scan of the head and neck
- MRI of the head and neck
- panendoscopy or triple endoscopy
- modified barium swallow
- in situ hybridisation for HPV-16, p16 immunohistochemistry, or PCR in biopsy specimen
- blood urea/nitrogen
- serum creatinine
- total protein
stage I or II (early stage disease)
stage III or IVA (locally advanced and resectable)
stage IVB (locally advanced and unresectable)
stage IVC (distant metastases at presentation)
Nam P. Nguyen, MD
Professor and Chair
Radiation Oncology Department
NPN is an author of a number of references cited in this topic.
Fabio Almeida, MD
Assistant Professor of Radiology
University of Arizona
FA declares that he has no competing interests.
Dr Nam P. Nguyen and Dr Fabio Almeida would like to gratefully acknowledge Dr Linda Garland, a previous contributor to this topic.
LG is on the speakers' bureau for Sanofi-Aventis, maker of Taxotere.
AJ Balm, MD, PhD, FACS, FRCS
Head and Neck Multidisciplinary Cooperative Group
Department of Head & Neck Oncology and Surgery
The Netherlands Cancer Institute
AJB declares that he has no competing interests.
Andy Trotti, MD
Specializing in Head & Neck Cancer
Director of Clinical Trials
H. Lee Moffitt Cancer Center & Research Institute
AT is an author of a reference cited in this topic.
Hari Deshpande, MD
Assistant Professor of Medicine
Yale Cancer Center
HD is on the speakers' bureau for Sanofi-Aventis and has received reimbursement for talks given about their product Taxotere.
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