Oropharyngeal Cancer
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Description
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What is cancer of the oropharynx?
Cancer of the oropharynx is a disease in which cancer cells are found in the
tissues of the oropharynx. The oropharynx is the middle part of the throat
(also called the pharynx). The pharynx is a hollow tube about 5 inches long
that starts behind the nose and goes down to the neck to become part of the
esophagus (tube that goes to the stomach). Air and food pass through the
pharynx on the way to the windpipe (trachea) or the esophagus. The oropharynx
includes the base of the tongue, the tonsils, the soft palate (the back of the mouth), and the walls of the pharynx.
Cancer of the oropharynx most commonly starts in the cells that line the
oropharynx. (Refer to the PDQ summaries on Adult Non-Hodgkin’s Lymphoma
Treatment and Childhood Non-Hodgkin’s Lymphoma Treatment for more information
on cancer that started in the lymph cells of the oropharynx.)
A doctor should be seen if a person has a sore throat that does not go away, trouble swallowing, weight loss, a lump in the back of the mouth or throat, a change in the
voice, or pain in the ear.
If there are symptoms, a doctor will examine the throat using a mirror and
lights. The doctor will also feel the throat for lumps. If tissue that is not
normal is found, the doctor will need to cut out a small piece and look at it
under the microscope to see if there are any cancer cells. This is called a
biopsy.
The chance of recovery (prognosis) depends on where the cancer is in the
throat, whether the cancer is just in the throat or has spread to other tissues
(the stage), and the patient’s general state of health. After the treatment, a
doctor should be seen regularly because there is a chance of having a second
primary cancer in the head or neck region.
Smoking or drinking alcohol after treatment increases the chance of developing a second primary cancer.
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Stage Explanation
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Stages of cancer of the oropharynx
Once cancer of the oropharynx is found, more tests will be done to find out if
cancer cells have spread to other parts of the body. This is called staging.
A doctor needs to know the stage of the disease to plan treatment. Imaging tests may be done, including special x-rays and an MRI (magnetic resonance imaging) scan, which uses a magnet, radio waves, and a computer to make a picture of the inside of the body. The
following stages are used for cancer of the oropharynx.
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Stage 0
Cancer is found only in cells lining the oropharynx. Stage 0 cancer is also called carcinoma in situ.
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Stage I
The cancer is 2 centimeters (about ¾ inch) or smaller and has not spread outside the
oropharynx.
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Stage II
The cancer is larger than 2 centimeters, but not larger than 4 centimeters (about 1½
inches), and has not spread outside the
oropharynx.
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Stage III
Stage III is either of the following:
- The cancer is larger than 4 centimeters and has not spread outside the
oropharynx.
- The cancer is any size and has spread to only one lymph node on the same
side of the neck as the cancer. (Lymph nodes are small, bean-shaped structures found throughout the body. They help fight infection and disease.) The lymph node that contains cancer
is 3 centimeters (just over one inch) or smaller.
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Stage IVA
Stage IVA is either of the following:
- The cancer has spread to tissues near the oropharynx, including the voice box, roof of the mouth, lower jaw, muscle of the tongue, or central muscles of the jaw. Cancer may have spread to one or more nearby lymph nodes, none larger than 6 centimeters (almost 2½ inches).
- The cancer is any size, is only in the oropharynx, and has spread to one lymph node that is larger than 3 centimeters but no larger than 6 centimeters, or to more than one lymph node, none larger than 6 centimeters.
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Stage IVB
Stage IVB is either of the following:
- The cancer is found in a lymph node that is larger than 6 centimeters and may have spread to other tissues around the oropharynx.
- Cancer surrounds the main artery in the neck or has spread to bones in the jaw or skull, to muscle in the side of the jaw, or to the upper part of the throat behind the nose; the cancer may have spread to nearby lymph nodes.
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Stage IVC
In stage IVC, cancer has spread to other parts of the body; the tumor may be any size and may have spread to lymph nodes.
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Recurrent
Recurrent disease means that the cancer has come back (recurred) after it has
been treated. It may come back in the oropharynx or in another part of the
body.
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Treatment Option Overview
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How cancer of the oropharynx is treated
There are treatments for all patients with cancer of the oropharynx. Three
kinds of treatment are used:
- Surgery (taking out the cancer).
- Radiation therapy (using high-dose x-rays or other high-energy rays to kill
cancer cells).
- Chemotherapy (using drugs to kill cancer cells).
Hyperthermia therapy (warming the body to kill cancer cells) is being tested in
clinical trials.
Surgery is a common treatment of cancer of the oropharynx. A doctor may remove
the cancer and some of the healthy tissue around the cancer. If cancer has
spread to lymph nodes, the lymph nodes will be removed (lymph node dissection).
A new type of surgery called micrographic surgery is being tested in clinical
trials for early cancers of the oropharynx. Micrographic surgery removes the
cancer and as little normal tissue as possible. During this surgery, the
doctor removes the cancer and then uses a microscope to look at the cancerous
area to make sure there are no cancer cells remaining.
Radiation therapy uses high-energy x-rays to kill cancer cells and shrink
tumors. Radiation may come from a machine outside the body (external radiation
therapy) or from putting materials that produce radiation (radioisotopes)
through thin plastic tubes in the area where the cancer cells are found
(internal radiation therapy). External radiation to the thyroid or the
pituitary gland may change the way the thyroid gland works. The doctor may
wish to test the thyroid gland before and after therapy to make sure it is
working properly. Giving drugs with the radiation therapy to make the cancer
cells more sensitive to radiation (radiosensitization) is being tested in
clinical trials. If smoking is stopped before radiation therapy is started,
there is a better chance of surviving longer.
Chemotherapy uses drugs to kill cancer cells. Chemotherapy may be taken by
pill, or it may be put into the body by a needle in the vein or muscle.
Chemotherapy is called a systemic treatment because the drug enters the
bloodstream, travels through the body, and can kill cancer cells throughout the
body.
People with oropharyngeal cancer have a higher risk of getting other cancers in
the head and neck area. Clinical trials of chemoprevention therapy are testing
whether certain drugs can prevent second cancers from developing in the mouth,
throat, windpipe, nose, or esophagus (the tube that connects the throat to the
stomach).
Hyperthermia therapy uses a special machine to heat the body for a certain period of
time to kill cancer cells. Because cancer cells are often more sensitive to
heat than normal cells, the cancer cells die and the cancer shrinks.
Because the oropharynx helps in breathing, eating, and talking, patients may
need special help adjusting to the side effects of the cancer and its
treatment. A doctor will consult with several kinds of doctors who can help
determine the best treatment. Trained medical staff can also help patients
recover from treatment and adjust to new ways of eating and talking. Plastic
surgery, or help learning to eat and speak, may be needed if a large part of
the oropharynx is taken out.
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Treatment by stage
Treatment of cancer of the oropharynx depends on where the cancer is in the
oropharynx; the stage of the disease; the effect of treatment on the patient's ability to talk, eat, and breathe normally; and the patient’s age and overall health.
Standard treatment may be considered because of its effectiveness in patients
in past studies, or participation in a clinical trial may be considered. Not
all patients are cured with standard therapy and some standard treatments may
have more side effects than are desired. For these reasons, clinical trials
are designed to find better ways to treat cancer patients and are based on the
most up-to-date information. Clinical trials are ongoing in many parts of the
country for patients with cancer of the oropharynx. To learn more about
clinical trials, call the Cancer Information Service at 1-800-4-CANCER
(1-800-422-6237); TTY at 1-800-332-8615.
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Stage I Oropharyngeal Cancer
Treatment may be one of the following
- Radiation therapy or surgery.
- A clinical trial of new ways of giving radiation therapy.
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Stage II Oropharyngeal Cancer
Treatment will be surgery to remove the cancer or radiation therapy.
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Stage III Oropharyngeal Cancer
Treatment may be one of the following:
- Surgery to remove the cancer followed by radiation therapy.
- Radiation therapy.
- A clinical trial of chemotherapy followed by surgery or radiation therapy.
- A clinical trial of chemotherapy combined with radiation therapy.
- A clinical trial of new ways of giving radiation therapy.
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Stage IV Oropharyngeal Cancer
If the cancer can be removed by surgery, treatment may be one of the following:
- Surgery to remove the cancer followed by radiation therapy.
- Radiation therapy.
- A clinical trial of radiation therapy combined with chemotherapy.
- A clinical trial of new ways of giving radiation therapy.
If the cancer cannot be removed by surgery, treatment may be one of the
following:
- Radiation therapy.
- A clinical trial of chemotherapy followed by surgery or radiation therapy.
- A clinical trial of radiation therapy given with chemotherapy or with drugs to make the cancer cells more sensitive to radiation therapy
(radiosensitizers).
- A clinical trial of new ways of giving
radiation therapy.
- A clinical trial of hyperthermia therapy plus radiation therapy.
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Recurrent Oropharyngeal Cancer
Treatment may be one of the following:
- Surgery to remove the cancer.
- Radiation therapy.
- A clinical trial of chemotherapy.
- A clinical trial of hyperthermia therapy plus radiation therapy.
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Changes to This Summary (08/20/2004)
The PDQ cancer information summaries are reviewed regularly and updated as new information becomes available. This section describes the latest changes made to this summary as of the date above.
Changes were made to this summary to match those made to the health professional version.
This information is provided from the PDQ® database in collaboration with the NCI.
