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What Is Oropharyngeal Cancer? Symptoms, Causes, Diagnosis, Treatment, and Prevention

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Oropharyngeal cancer is a type of head and neck cancer that develops in the oropharynx, which is the middle area of the throat. The oropharynx produces saliva, helps you digest food, and keeps your throat and mouth lubricated. It can be seen when you open your mouth wide and includes: The back part of the tongue The soft palate (the back part of the roof of your mouth) The tonsils The side and back walls of the throat Though oropharyngeal cancer is a relatively rare type of cancer, new cases are rising at an alarming pace, according to Stat Pearls . Researchers believe that this surge is related to an increase in cases of human papillomavirus (HPV) infection, a sexually transmitted infection. Doctors can successfully treat oropharyngeal cancer, but a person’s outcome will depend on the type of oropharyngeal cancer, the stage of their disease, the treatments they receive, and other factors, says the Cleveland Clinic .
Causes and Risk Factors for Oropharyngeal Cancer Causes HPV is the most common cause of oropharyngeal cancer. About 70 percent of all oropharyngeal cancers in the United States are linked to HPV, notes Yale Medicine . You can contract HPV by engaging in sexual activity (including oral sex) with someone who has the virus, explains Cancer.Net . Additionally, tobacco use (including cigarettes, cigars, and chewing tobacco) and alcohol consumption significantly increase a person’s chances of developing oropharyngeal cancer. Using tobacco and drinking alcohol together amplifies the risk. In some parts of the world, such as in Southeast Asia and South Asia, people frequently chew betel quid (a mix of areca nut, spices, lime, and other ingredients) and gutka (a mix of betel quid and tobacco). According to the American Cancer Society , these products can also increase the odds of developing oropharyngeal cancer. Other risk factors for oropharyngeal cancer include: Male sex An unhealthy diet low in fruits and vegetables Excess weight A weakened immune system A history of head and neck cancer A history of radiation to the head and neck Prolonged sun exposure A genetic syndrome like Fanconi anemia or dyskeratosis congenita
Types of Oropharyngeal Cancer Types There are many types of oropharyngeal cancer. According to Stat Pearls, more than 90 percent of oropharyngeal cancer is squamous cell cancer, which develops in the thin, flat cells that line the oropharynx. Squamous cell oropharyngeal cancer is further divided into two categories: HPV Related These tumors are caused by HPV. The majority are linked to the subtype HPV 16. HPV Unrelated They are commonly caused by tobacco, alcohol, or other causes. HPV-related oropharyngeal cancer typically responds better to treatment, says Yale Medicine. Though rare, lymphoma (cancer that affects cells in the lymphatic system) is another type that can affect the base of the tongue and tonsils.
Signs and Symptoms of Oropharyngeal Cancer Symptoms Some symptoms of oropharyngeal cancer may include: A sore throat that doesn’t go away Difficult swallowing, opening the mouth, or moving the tongue Ear pain A lump in the back of the mouth, neck, or throat Unexplained weight loss A white patch in the mouth or on the tongue that doesn’t go away Coughing up blood Hoarseness or voice changes
How Is Oropharyngeal Cancer Diagnosed? Diagnosis To diagnose oropharyngeal cancer, doctors may first perform a physical exam of the mouth and throat area. They may also ask about your lifestyle habits and medical history. A dentist is frequently the first person to identify an oropharyngeal cancer during a routine exam. Other tests that health providers might order to help diagnose this disease include: Biopsy Doctors remove a small piece of tissue to examine in the lab for cancer. They might also test the sample for HPV. Fine Needle Aspiration A small needle is used to withdraw a sample of cells to examine under a microscope to check for cancer. HPV testing can also be performed on this sample. Imaging Procedures These tests can help doctors see the cancer and determine if it has spread in the body. Some examples of imaging exams include computed tomography, magnetic resonance imaging, and positron emission tomography.
Stages of Oropharyngeal Cancer Stages Once doctors diagnose oropharyngeal cancer, they will assign it a stage, which describes the extent of the cancer. The presence of HPV is also taken into account. Staging helps health professionals develop an appropriate treatment plan and provide an accurate prognosis. The TNM (tumor, node, metastasis) staging system is most often used for oropharyngeal cancer, according to the American Cancer Society . TNM considers the extent of the tumor, whether it has spread to lymph nodes, and if it has metastasized, or spread, to other areas of the body. Health providers also assign oropharyngeal cancer with a numeric stage, ranging from 1 to 4. The higher the number, the more advanced the cancer.
Treatment Options for Oropharyngeal Cancer Treatment Treatment for oropharyngeal cancer depends on the stage, a person’s overall health, their age, and other factors. Surgery Surgery to remove the cancer is the preferred treatment option for people with oropharyngeal cancer, especially for smaller tumors that haven’t spread. NYU Langone Health explains that there are several surgical procedures for oropharyngeal cancer, including traditional techniques and minimally invasive approaches. Transoral robotic-assisted surgery (TORS) is a common minimally invasive surgery for oropharyngeal cancer. This method involves using surgical tools and a camera mounted on robotic arms to remove tumors through a patient’s mouth. Sometimes, reconstructive surgery is also needed to restore the appearance and function of the mouth or throat. Radiation Therapy Radiation therapy uses beams of energy to kill cancer cells in the body. It may be used as a standalone treatment for oropharyngeal cancer. It can be combined with chemotherapy, which is a technique referred to as chemoradiation. Radiation is sometimes given after surgery. Typically, the radiation is delivered via an external machine that rotates around the patient. Doctors might alternatively recommend brachytherapy, which is a type of radiation that involves placing radioactive materials directly into a tumor. Chemotherapy Chemotherapy involves using drugs to kill cancer cells in the body. The treatment can be given on its own, before or after surgery, or along with radiation therapy. Targeted Therapy Targeted treatments focus on specific proteins that help cancer cells grow and divide. Cetuximab (Erbitux) is a targeted therapy that’s approved by the U.S. Food and Drug Administration in combination with radiation therapy to treat head and neck cancers. Immunotherapy Immunotherapy is a treatment that helps a person’s own immune system find and destroy cancer cells. It’s sometimes recommended for people with oropharyngeal cancer that has metastasized or recurred (come back). Immunotherapy medicines approved for oropharyngeal cancer include: Pembrolizumab (Keytruda) Nivolumab (Opdivo) Clinical Trials Clinical trials are studies that test the safety and effectiveness of novel treatments. Some people with oropharyngeal cancer choose to participate in a clinical trial in hopes of receiving a therapy that isn’t available otherwise.
Complications of Oropharyngeal Cancer Complications The Oral Cancer Foundation says that the procedures and medicines used to treat oropharyngeal cancer can lead to complications: Disfigurement of the mouth or throat area Mucositis (inflammation of the mucous membranes in the mouth) Infection, pain, or bleeding Difficulty swallowing, which can lead to malnutrition or dehydration Injury to the glands that produce saliva Damage to muscles and joints in the neck or jaw Reduction of blood vessels and blood supply to the mouth Dental issues Nausea, vomiting, or fatigue Anemia (low red blood cell counts) Problems with speech
Prognosis of Oropharyngeal Cancer Prognosis The outlook for oropharyngeal cancer will depend on the type of disease, when it was diagnosed, and the treatments an individual receives. According to the American Cancer Society , the five-year survival rate for oropharyngeal cancer is: 59 percent for localized cancer that has not spread beyond the oropharynx. 62 percent for regional cancer that has spread to nearby structures or lymph nodes. 29 percent for distant cancer that has spread to distant areas of the body. Researchers aren’t sure exactly why the outlook is slightly better for oropharyngeal cancer in the regional stage compared with the localized stage. According to Stat Pearls, people with oropharyngeal cancer that is HPV related generally have a better prognosis than those with oropharyngeal cancer that’s not related to HPV. This could be due to the tumor makeup or because many HPV-related cases are diagnosed in a younger, healthier population.
Research and Statistics: Who Has Oropharyngeal Cancer? Research and Statistics The American Cancer Society reports that roughly 54,540 people in the United States are diagnosed with oral cavity or oropharyngeal cancer each year. The Cleveland Clinic notes that tonsil cancer is the most common form of oropharyngeal cancer. Over the past 10 years, there’s been at least a four- to fivefold increase in the number of oropharyngeal cancer cases in the United States, says Mount Sinai . Researchers believe that this surge correlates to a rise in HPV cases. Yale Medicine reports that HPV-related oropharyngeal cancer has increased more than 200 percent since the 1980s. The average age of diagnosis is 64, but the American Cancer Society says that oropharyngeal cancer can occur in young people. The disease is more than twice as common in men as it is in women.
Screening and Prevention for Oropharyngeal Cancer Prevention The American Cancer Society notes that there’s no routine screening test for oropharyngeal cancer. However, adopting the following lifestyle habits may help you reduce your risk of developing this disease: Avoid HPV . Having multiple sex partners and having oral sex can increase your risk of developing HPV. Vaccines for the infection are available, but they must be given before a person is infected, so they are usually recommended at a younger age, before an individual is sexually active. Don’t smoke or use tobacco products . If you smoke, quit as soon as possible. Avoiding tobacco greatly reduces the risk of oropharyngeal cancer. Limit alcohol consumption . The Centers for Disease Control and Prevention says that men should limit alcoholic intake to two drinks a day or fewer. For women, the recommendation is one drink or fewer a day. Eat a healthy diet . Include plenty of fruits and vegetables. See your dentist regularly . Your dentist may be able to spot signs of cancer in your mouth or throat.

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