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. 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, followed by triple endoscopy (nasolaryngopharyngoscopy, oesophagoscopy, and bronchoscopy), positron emission tomography (PET), or CT-PET.
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 tobacco 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)
- Aphthous ulcer
- Oral syphilis
- NCCN clinical practice guidelines in oncology: head and neck cancers
- Nivolumab for treating recurrent or metastatic squamous cell carcinoma of the head and neck after platinum-based chemotherapy
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