Oropharyngeal Cancer

Overview

Oropharyngeal cancer is a type of cancer that develops in the middle part of the throat (oropharynx). It can occur in people of all ages, however, it is more common in older adults. Alcohol, smoking and HPV infection increase the risk of developing the disease. An individual may experience common symptoms such as sore throat, difficulty swallowing, and a persistent cough. While treatment options vary depending on the stage of cancer, they include surgery, radiation therapy, chemotherapy, and immunotherapy. Protection against HPV infection, limiting tobacco and alcohol use, and leading an overall healthy life can improve outcomes.

What is Oropharyngeal Cancer?

Oropharyngeal cancer is the growth of cancerous cells in the oropharynx, the middle section of the throat, which produces saliva. While there are different methods to treat the disease, it can recur even after getting treated. The most common type of oropharyngeal cancer is squamous cell carcinoma (SCC), while less common types include melanoma, salivary gland cancer and lymphoma. An individual cannot avoid the disease. However, the risk of developing it can be reduced by protecting oneself against the HPV infection and quitting smoking and the use of alcohol.

Types of Oropharyngeal Cancer

The following are the different types of oropharyngeal cancer:

Squamous Cell Carcinoma (SCC): This is the most common type of oropharyngeal cancer. It occurs in the squamous cells, which are flat, thin cells that line the mucous membranes of the oropharynx. SCC can be further classified based on its association with human papillomavirus (HPV).

Salivary Gland Cancer: It arises in the salivary glands, which produce saliva. They can affect the major salivary glands (parotid, submandibular, and sublingual) or the minor salivary glands located throughout the oral cavity and upper respiratory tract.

Lymphoma: It affects the lymphatic system, which is part of the immune system. This type of cancer can develop in the lymph nodes of the oropharynx.

Melanoma: This is a type of skin cancer that can develop in the mucous membranes of the oropharynx.

Sarcoma: It is a rare cancer type that affects the connective tissues, such as muscle, bone, cartilage, and fat, in the oropharynx.

Symptoms of Oropharyngeal Cancer

The symptoms of oropharyngeal cancer may be similar to other less serious medical issues. One may experience some common symptoms such as a sore throat (for a long time), unexplained weight loss, voice changes that are persistent, prolonged ear pain, difficulty or pain while swallowing, lump in the back of the mouth or throat or neck, coughing up blood, and a white patch on the lining of the mouth or tongue that doesn't go away.

Causes of Oropharyngeal Cancer

The most common cause of oropharyngeal cancer is human papillomavirus (HPV) infection, which produces proteins interfering with the genes that manage the cells lining the throat and mouth. Cancer occurs when these genes fail to manage cell growth, leading to an abnormal increase in the number of cells and the formation of tumours.

Other causes of cancer include the use of tobacco in the form of smoking cigars or cigarettes and chewing tobacco. It damages the cells lining one's throat, resulting in abnormal division of cells and becoming malignant cells. Additionally, the consumption of beverages containing alcohol can damage the cells in the throat, and impact their ability to repair DNA. Other risk factors include a medical history of neck and head cancer or exposure to radiation to the neck and head.

Diagnosis of Oropharyngeal Cancer

Diagnosis starts with a physical examination where a doctor asks about the symptoms and medical history of radiation therapy to the head and neck or cancer in those areas. They may also ask about one's lifestyle choices including tobacco or alcohol consumption.

A doctor may examine one's throat, mouth and neck to feel lumps or masses. An endoscopic biopsy may then be performed to obtain tissues and examine them under a microscope to determine the signs of HPV or cancer. A healthcare professional may also run other imaging tests including a CT scan, PET scan and MRI scan of the base of the tongues and tonsils.

Oropharyngeal cancer has four stages, and each stage is determined by the tumour size, its spread to the nearby lymph nodes, or different body parts. The following are the stages:

• Stage I: The tumour is 2 cm or smaller and has not spread to adjacent lymph nodes, tissues or other body organs.
• Stage II: The cancer has grown to 2 or 4 cm, but has not spread to nearby lymph nodes, distant sites or tissues.
• Stage III: The tumour is larger than 4 cm, or may have grown into the larynx or epiglottis. It may have also spread to one lymph node on the same side as where the tumour originated.
• Stage IV: The tumour can grow to any size and into nearby structures. However, it has not spread to adjacent lymph nodes, or it may have spread to lymph nodes lying on the same side as the primary tumour.

Besides staging, the cancer can also be graded depending on how much the malignant cells replicate the normal cells. The high-grade cancer cells look very different to normal oropharyngeal cells.

Treatment for Oropharyngeal Cancer

The treatment plan for oropharyngeal cancer is to remove the cancer cells without limiting one's ability to swallow or speak as normally as possible. This may include a surgery such as transoral robotic surgery which is a minimally invasive treatment method to remove tumours through the mouth. Other options include radiation therapy, immunotherapy, chemotherapy and targeted drug therapy.

Prevention of Oropharyngeal Cancer

One cannot prevent oropharyngeal cancer but can alleviate its risk by practising certain measures. These include avoiding HPV infection by limiting sex partners. One must also quit smoking or beverages that contain alcohol. Eating a healthy, balanced diet is crucial besides maintaining weight and exercising regularly. Visiting a dentist can also help them identify any changes in oral health by examination of the mouth and throat.

Myths and Facts Related to Oropharyngeal Cancer

Here are some of the myths and facts about Oropharyngeal Cancer:

Myth 1: One Cannot Prevent Oropharyngeal Cancer
Fact: While not all cases can be prevented, reducing risk factors such as smoking, excessive alcohol consumption, and practising safe sex can help lower the risk of developing oropharyngeal cancer. HPV vaccination is also recommended for adolescents to prevent HPV-related cancers.

Myth 2: Smoking and Alcohol Use are the Main Causes of Oropharyngeal Cancer
Fact: Smoking and excessive alcohol consumption are major risk factors. However, medical experts find human papillomavirus (HPV) infection is a significant cause of cancer.

Myth 3: Only Older Adults are Affected by Oropharyngeal Cancer
Fact: While older adults are at higher risk, oropharyngeal cancer can affect people of all ages, including younger individuals.