Oropharyngeal Cancer

Oropharyngeal cancer starts in the oropharynx, the middle part of the throat. This area includes the tonsils, the base of the tongue (the back part), the soft palate (the back of the roof of the mouth) and the sides and back walls of the throat.

Like other cancers, oropharyngeal cancer can grow into nearby tissue and, in some cases, spread to other parts of the body.

Types & Stages

Tonsil cancer is the most common type of oropharyngeal cancer. Most of these cancers are squamous cell carcinomas, which begin in the thin, flat cells that line the throat.

Less often, cancer can start in the lymph tissue of the tonsil. This type is called lymphoma.

Doctors also test many of these tumors for HPV (human papillomavirus), often by checking what is called p16 status. This matters because HPV-related cancers tend to respond better to treatment and are staged differently from HPV-negative cancers.

Oropharyngeal cancer is not described with a single simple number. Instead, doctors look at:

• Where in the oropharynx the cancer started
• The size of the tumor
• Whether it has reached nearby lymph nodes
• Whether it has spread to other parts of the body
• Whether the cancer is linked to HPV

This helps your care team plan the best treatment.

Signs & Symptoms

Many oropharyngeal cancer symptoms can look like other, less serious problems at first. The difference is that these symptoms tend to stick around.

Visit a doctor if you are experiencing any of these symptoms:

• A sore throat that does not go away
• Trouble or pain when swallowing
• Trouble opening the mouth fully or moving the tongue
• Unexplained weight loss
• Ongoing voice changes
• Ear pain
• A lump in the throat, mouth or neck
• Coughing up blood
• A white patch in the mouth that does not go away

Many of these symptoms can be caused by conditions that are not cancer. Still, if a symptom is new, lasting or worries you, talk with a healthcare provider.

Diagnosis

Tests and procedures used to diagnose oropharyngeal cancer may include:

• Exam of the mouth and throat. Your doctor reviews your symptoms and looks closely at your mouth, throat and neck.
   
• Fiberoptic scope exam. A thin, lighted tube with a small camera is passed through the nose to look at the throat and voice box.
   
• Biopsy. A small sample of tissue is removed and examined under a microscope by a pathologist. This is the only way to confirm cancer.
   
• Fine-needle aspiration. If there is a lump in the neck, a thin needle can be used to take a small sample of cells, often guided by ultrasound.
   
• Imaging tests. A CT scan, MRI, PET scan or ultrasound may be used to find the tumor and show whether it has spread.
   
• Swallowing tests. In some cases, these tests check how well your throat is working.

Treatment

Treatment depends on where the cancer started, the size of the tumor, whether it has spread, the HPV status and your overall health. Your care team can help explain the benefits and risks of each option.

Treatment may include:

• Surgery. This is often a first treatment. Many smaller or well-positioned tumors can be removed with minimally invasive techniques, such as transoral robotic surgery or other approaches through the mouth. These methods may shorten recovery and avoid external incisions. Larger or harder-to-reach tumors may need open surgery.
   
• Radiation therapy. Radiation uses high-energy beams to kill cancer cells. It may be used alone for some early cancers, combined with chemotherapy, given before surgery to shrink a tumor, or given after surgery to lower the chance the cancer comes back.
   
• Chemotherapy. Chemotherapy may be used with radiation, after surgery, or before surgery in select cases.

Clinical trials may also be an option. These studies test new treatments or new ways to use current ones.

Ask your care team whether a clinical trial may be right for you.

Causes & Risk Factors

The exact cause of oropharyngeal cancer is not always known. Some factors may raise the risk, including:

• Tobacco use. Smoking or using other tobacco products raises the risk.
   
• Alcohol use. Drinking alcohol raises the risk, especially when combined with tobacco.
   
• HPV. Human papillomavirus (HPV) is a common virus passed through sexual contact and is linked to many oropharyngeal cancers.
   
• Being male. This cancer is more common in men than in women.
   
• Excess body weight. Carrying extra weight may raise the risk.
   
• Older age. Most cases are found in people older than 55, though HPV-related cancers may occur in younger people.
   
• Poor nutrition. A diet low in fruits and vegetables may increase risk.
   
• A weakened immune system. A weaker immune system, due to certain medicines or conditions such as HIV, can raise the risk.
   
• Prior radiation. Past radiation to the head and neck may play a role.
   
• Rare inherited syndromes. Some genetic conditions, such as Fanconi anemia and dyskeratosis congenita, can raise the risk.

Having a risk factor does not mean you will develop oropharyngeal cancer, and some people with the disease have no clear risk factors. Talk with your healthcare provider about your personal risk.

Screening

There is no standard oropharyngeal cancer screening program for everyone.

Even so, ENT (ear, nose, and throat) specialists and dentists may look for abnormalities in the mouth and throat during routine exams. This can sometimes help find early cancers or precancers.

If you have symptoms that are new, lasting, or unusual for you, talk with a healthcare provider about whether further evaluation is needed.

This information is for general education only and is not a substitute for medical advice. Please consult a qualified healthcare provider for diagnosis, treatment recommendations, and guidance based on your personal health history.