Oropharyngeal cancer

Last reviewed: June 2019

Last updated: May 2019

Summary

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.

Definition

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] Nonepithelial tumors such as minor salivary gland carcinomas and sarcoma are uncommon.

History and exam

Key diagnostic factors

oral pain
weight loss

Full details

Other diagnostic factors

sore throat
neck lump
indurated or ulcerated mass
dysphagia
neck lymphadenopathy
otalgia
trismus
white plaques (leukoplakia) and red plaques (erythroplakia)

Full details

Risk factors

smoking cigarettes
alcohol
human papillomavirus (HPV)-16 infection
tobacco and betel nut chewing

Full details

Diagnostic investigations

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

Full details

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 hybridization for HPV-16, p16 immunohistochemistry, or PCR in biopsy specimen
CBC
electrolytes
BUN
serum creatinine
total protein
albumin
prealbumin
LFTs

Full details

Treatment algorithm

ACUTE

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)

ONGOING

recurrent disease

Contributors

Authors VIEW ALL 

Nam P. Nguyen, MD

Professor and Chair

Radiation Oncology Department

Howard University

Washington

Disclosures

NPN is an author of a number of references cited in this topic.

Fabio Almeida, MD

Assistant Professor of Radiology

University of Arizona

Tucson

Disclosures

FA declares that he has no competing interests.

Acknowledgements

Dr Nam P. Nguyen and Dr Fabio Almeida would like to gratefully acknowledge Dr Linda Garland, a previous contributor to this topic.

Peer reviewers VIEW ALL 

AJ Balm, MD, PhD, FACS, FRCS

Chair Emeritus

Head and Neck Multidisciplinary Cooperative Group

Department of Head & Neck Oncology and Surgery

The Netherlands Cancer Institute

Amsterdam

The Netherlands

Disclosures

AJB declares that he has no competing interests.

Andy Trotti, MD

Specializing in Head & Neck Cancer

Director of Clinical Trials

Radiation Oncology

H. Lee Moffitt Cancer Center & Research Institute

Tampa

Disclosures

AT is an author of a reference cited in this topic.

Hari Deshpande, MD

Assistant Professor of Medicine

Yale Cancer Center

Yale University

New Haven

Disclosures

HD is on the speakers' bureau for Sanofi-Aventis and has received reimbursement for talks given about their product Taxotere.

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Oropharyngeal cancer

Summary

Definition

History and exam

Key diagnostic factors

Other diagnostic factors

Risk factors

Diagnostic investigations

1st investigations to order

Investigations to consider

Treatment algorithm

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)

recurrent disease

Contributors

Authors VIEW ALL 

Nam P. Nguyen, MD

Disclosures

Fabio Almeida, MD

Disclosures

Acknowledgements

Peer reviewers VIEW ALL 

AJ Balm, MD, PhD, FACS, FRCS

Disclosures

Andy Trotti, MD

Disclosures

Hari Deshpande, MD

Disclosures

Differentials

Guidelines

Patient leaflets

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