Oropharyngeal Cancer: Symptoms, Causes, Diagnosis, Treatment and Prevention

oropharyngeal cancer - symptoms, causes, diagnosis, treatment, prevention

What is Oropharyngeal Cancer?

Oropharyngeal cancer is the one type of head and neck cancer or throat cancer which occurs in oropharynx region. Oropharyngeal carcinoma is also known as throat cancer. In oropharyngeal cancer, malignant transformation occurs in an oropharyngeal region. Oropharyngeal cancer can involve oral cavity, pharynx, and larynx. It is a squamous cell type carcinoma. Medically cancer is termed as Carcinoma. If you find painless swelling or lump in the head and neck region which is one of the oropharyngeal cancer symptoms, so don’t neglect it. Read more oropharyngeal cancer symptoms below in this article.

What is Oropharynx?

Oro- Mouth, pharynx- throat. The oropharyngeal region is the middle part of the throat just behind the mouth. The oropharynx starts where oral cavity ends. It includes the base of the tongue, tonsils, soft palate and walls of the pharynx. The primary function of this area is eating and swallowing.

Oropharyngeal Cancer Symptoms

It is must for you to understand the oropharyngeal cancer symptoms. These symptoms are:

  • Painless swelling or lump in the back of the throat or mouth or neck.
  • A persistent sore throat or tongue.
  • Earache
  • Difficulty in swallowing
  • Difficulty moving your mouth and jaw
  • Changes in the voice
  • A dull pain behind the sternum
  • Bad breath
  • Cough
  • Unexplained weight loss

These kinds of oropharyngeal cancer symptoms can be caused by other conditions as well, but you should always get these symptoms checked by your doctor or dentist. Oropharyngeal cancer can be treated more uneventfully if diagnosed early.

Oropharyngeal Cancer Causes

Oropharyngeal cancer is related to HPV (Human Papilloma Virus) which is a common virus spreading via skin contact. The cases related to human papilloma virus are termed as HPV positive. The mucosal infections are caused by human papilloma virus, generally, our immune system can get rid of the virus but sometimes the virus lies dormant for months and years and hence may cause malignant cell changes.

Some cases are not related to the presence of the virus and are HPV negative; these cancers are usually associated with some risk factors such as smoking and chewing tobacco, heavy alcohol use, a diet low in fruits and vegetables, Chewing betel quid, Plummer-Vinson syndrome, poor nutrition, asbestos exposure, P53 mutation.

Oropharyngeal Cancer Diagnosis

Always, consult a nearby dentist or G.P if you suffer from above-mentioned oropharyngeal cancer symptoms if they find your symptoms associated with cancer they will refer you to the specialist doctor. Generally, only a lump is present in the throat without any symptom, which requires a specialist attention.

The specialist doctor would examine your throat using a small mirror and light. The advanced examination includes:

Endoscopy

For a better view of your throat, they may use nasendoscope. The procedure is somewhat uncomfortable as it requires entry through your nostrils so the procedure requires numbing your nose and throat with a local anesthetic spray. You should not eat or drink for about an hour afterward.

Laryngoscopy

In this procedure, the doctor examines your larynx with a laryngoscope which is a thin, tubes like instrument with a light and lens.

Biopsy

For diagnosis, a small piece of tissue or cells is taken by the pathologist for biopsy. This procedure also requires local or general anesthesia before it.

There are many other tests and investigations you need to undergo for confirmed and specific diagnosis.

FNAC (Fine Needle Aspiration Cytology)

It is a kind of biopsy which is done to check if carcinomatous changes have involved lymph nodes or not.

Ultrasound scan

The test uses sound waves to scan your neck and lymph nodes. It is a painless procedure. Changes in the size or appearance of the lymph nodes in your neck can be examined.

MRI scan

MRI imaging gives a detailed picture of the concerned area. The physics of magnetism is used in MRI machine. Inform your doctor about any metal implants, such as a pacemaker, surgical clips, bone pins, teeth implants etc. or if you’ve ever associated with metal or in the metal industry.

PET scan (Positron Emission Tomography)

It is a procedure to search for malignant cells (cancerous cells). Radioactive glucose is injected into vein since; malignant cells take up more glucose actively. These cells appear brighter in images.

CT (Computerized Tomography) scan

It builds up a three-dimensional picture of the inside of the body, taken from different angles and is painless. It uses a small amount of radiation. You should not eat or drink for at least four hours before the scan. A drink or injection of a dye is given, make a note to your doctor if you are allergic to iodine or have asthma.

PET-CT scan

This procedure combines the pictures from a PET scan and CT scan that are done at the same time with the same machine. It gives more detailed pictures of areas inside. A PET-CT scan may also be used to judge working of the treatment.

HPV test

A further test is carried out if cancer is detected, that is HPV test. HPV test is used to detect if the cancer cells are associated with HPV virus or not.

Staging, Grading for Oropharyngeal Cancer

The stage of cancer describes its size and spread. Knowledge of staging helps to decide suitable treatment.

Stage 1 – the tumor is 2cm or less and only in the oropharynx. This is called T1 N0 M0 in the TNM system.

Stage 2 – the tumor is between 2cm and 4cm and only in the oropharynx. Not involving the lymph node.

Stage 3 – the tumor is larger than 4 cm and only in the oropharynx or there is cancer in the oropharynx and in the lymph node is involvement.

Stage 4 – the tumor has spread to larger areas around the oropharynx and has spread into the nearby lymph nodes or has spread to distant organs.

Oropharyngeal Cancer Treatment

The treatment will depend on the stage and grade of cancer as well as general health. The goal is to treat cancer with as little damage as possible to throat and appearance as.

Treatments can be used for oropharyngeal cancer are surgery, radiotherapy, chemotherapy and targeted therapy.

Early stage oropharyngeal cancer can be treated with either surgery or radiotherapy. Late stages of cancer or cancer spread to the lymph nodes usually can be treated with a combination of treatments: chemotherapy and radiotherapy known as Chemoradiation. Surgery may be followed by radiotherapy or chemoradiation.

Oropharyngeal Cancer Surgery

It is used to remove early stage oropharyngeal cancer. It may also be used for advanced stages of oropharyngeal cancer. For small oropharyngeal carcinoma, transoral surgery is carried out that is, operation through the open mouth. The endoscope is used in surgery; the advantages are that it doesn’t leave any scars on neck or face. Faster recovery and fewer problems with speech difficulties.

For cancer involving larger area or in a difficult position, the operation is done through a cut on the neck. It may also require removing part of the jawbone or tongue. Reconstruction is further carried out. Involved lymph nodes are also resected.

Radiotherapy and Chemoradiation

High-energy rays are used to destroy the cancer cells, with as little harm as possible to normal tissue. Radiotherapy can be given alone or as an adjunct to surgery, chemotherapy or targeted therapy to treat advanced stages of cancer. This combination treatment also prevents possibility recurrence after surgery. Chemoradiation, as mentioned earlier, is used for advanced oropharyngeal cancer. This combination of therapy is more beneficial than a single treatment alone but the side effects are usually worse. Radiotherapy is given in series of short, daily sessions (called fractions) over 4–7 week.

In advanced cancer; radiotherapy is used to control symptoms, like pain, only a few days of treatment or even just a single dose is enough for it. A new radiotherapy modality called Intensity-modulated Radiotherapy Treatment (IMRT) is also available. With IMRT, the radiotherapy beams are shaped very precisely to the area of cancer. It ensures that a higher dose radiation is given to the tumor, while healthy areas nearby get a lower dose of radiation. It has fewer side effects.

Side effects are very much associated with radiotherapy such as erythema and rashes of the skin, irritation in eyes, skin, and mucosa, loss of hair, xerostomia (dryness of mouth). The side effects reduce after cessation of therapy.

Chemotherapy

It includes the usage of anti-cancer (cytotoxic) drugs to destroy cancer cells. For oropharyngeal cancer, it’s usually given in combination with radiotherapy. The chemotherapy drugs most often used to treat oropharyngeal cancer are cisplatin, fluorouracil (5FU), carboplatin, usually given into a vein (intravenously).

Chemotherapy drugs reduce the number of white blood cells in blood during treatment. Side effects of Chemotherapy are feeling tired, a sore mouth, nausea or vomiting, diarrhea, and hair loss.

Targeted therapy

Cetuximab is commonly used targeted therapy to treat oropharyngeal cancer. Cetuximab may stop the cancer cells growing and dividing. Cancer becomes more sensitive to the effects of radiotherapy.

Follow-up after treatment

After treatment is completed, regular check-ups are held and possibly scan or x-rays continuing for several years.

Oropharyngeal Cancer Prognosis

Cases associated with HPV-mediated oropharyngeal cancer have higher survival rates. The prognosis oropharyngeal carcinoma depends on the age, the health of the person and the stage of the disease.

Oropharyngeal Cancer Prevention

It is important for patients with oropharyngeal cancer to have follow-up exams for the rest of their lives, to prevent any further recurrence. Elimination of risk factors such as smoking and drinking alcohol is a must for prevention.

Conclusion

Oropharyngeal cancer although may cause severe life-threatening complications but with newer treatment modalities and knowledge, it can be treated well if diagnosed early. So, continuous monitoring your health plays a key role in early diagnosis of oropharyngeal cancer symptoms and hence better treatment outcome. In any case, Elimination of risk factors such as smoking and drinking alcohol is the must.