Oropharyngeal cancer

Oropharyngeal carcinoma is strongly associated with tobacco and alcohol use. 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. Unintentional 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 histologic diagnosis.

Diagnosis is made through biopsy of the primary tumor or ultrasound-guided fine needle aspiration cytology of a metastatic lymph node. Staging is through computed tomography (CT) scan or magnetic resonance imaging of the head and neck with contrast, positron emission tomography (PET) or PET-CT, and triple endoscopy (nasolaryngopharyngoscopy, esophagoscopy, and bronchoscopy).

Treatment regimens vary depending on the stage of the cancer and may involve surgery, radiation, chemotherapy, and/or immunotherapy. Patients should be managed by a multidisciplinary team in specialized head and neck centers to optimize 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.[1]El-Naggar AK, Chan JKC, Grandis JR, et al. eds. WHO classification of head and neck tumours. WHO classification of tumours, 4th ed. Vol 9. IARC Press; 2017.​​ Nonepithelial tumors such as minor salivary gland carcinomas and sarcoma are uncommon. Lymph node involvement is observed in 15% to 75% of patients.[2]National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology: head and neck cancers [internet publication]. https://www.nccn.org/professionals/physician_gls/default.aspx