Oropharyngeal cancer

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 histologic 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 anesthesia. 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, radiation, and monoclonal antibodies (in combination with radiation therapy). 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]Barnes L, Eveson JW, Reichart P, et al. World Health Organization classification of tumours. Pathology and genetics of head and neck tumours. Lyon, France: IARC Press; 2005. Nonepithelial tumors such as minor salivary gland carcinomas and sarcoma are uncommon.