Oropharyngeal Cancer Recurrent

Recurrent oropharyngeal cancer means the cancer has returned after initial treatment. Despite advances in treatment and the generally favorable prognosis of oropharyngeal cancer—especially when linked to human papillomavirus (HPV)—some patients will experience recurrence, which requires specialized care and a personalized approach to treatment.

Table of contents

• What Is Recurrent Oropharyngeal Cancer?
• How Common Is Recurrence?
• Signs and Symptoms of Recurrence
• Diagnosis and Detection
• Treatment Options
• Factors Affecting Treatment Decisions
• Follow-Up Care After Initial Treatment

What Is Recurrent Oropharyngeal Cancer?

Recurrent oropharyngeal cancer means that the cancer has come back after it has been treated^[1][2]. The oropharynx is the middle part of your throat, located behind your mouth. It includes the back part of your tongue, your tonsils, the soft palate (the back part of the roof of your mouth), and the sides and walls of your throat^[1][2].

The cancer can return in the same location as the original tumor, in nearby areas such as the neck lymph nodes, or in distant parts of the body^[2][4]. Even though healthcare providers can successfully treat oropharyngeal cancer, the disease may recur after treatment^[1].

How Common Is Recurrence?

Rates of recurrence vary depending on several factors. After a person receives treatment intended to cure primary oropharyngeal cancer, doctors may detect recurrence in about 20% of people, usually within the first 2 years^[6]. The rate of recurrence also depends on the stage of the original cancer. According to research, recurrence may occur in 50 to 60% of people with advanced oropharyngeal cancer and 25 to 30% of people with early stage oropharyngeal cancer^[6].

Most recurrences happen within the first two years after treatment. Studies show that 86 to 94% of oropharyngeal cancer recurrence occurs during this time period^[6]. With the increasing number of oropharyngeal cancers linked to human papillomavirus (HPV), especially HPV type 16, recurrent HPV-related disease is also becoming more prevalent^[3].

Signs and Symptoms of Recurrence

If oropharyngeal cancer recurs, you may experience symptoms similar to those you had during the primary cancer. It is important to note that many of these symptoms can also be caused by other, less serious medical conditions^[1][6]. Common signs and symptoms of recurrent oropharyngeal cancer include:

• A sore throat that does not go away
• Pain or difficulty with swallowing
• Trouble opening your mouth fully or moving your tongue
• Unexplained weight loss
• Voice changes that do not go away
• Ear pain that does not go away
• A lump in the back of your throat or mouth
• A lump in your neck
• Coughing up blood
• A white, red, or grey patch on your tongue or lining of your mouth that does not go away
• Fatigue
• Shortness of breath
• Frequent infections

Having these symptoms does not automatically mean your cancer is recurring. However, if you experience any of these or other unexplained symptoms, you should check with your oncology team^[6].

Diagnosis and Detection

After initial treatment for oropharyngeal cancer, you will typically receive follow-up visits with an oncologist for many years. The risk of recurrence is highest during the first two years after treatment, so you may attend follow-ups every few months during this period, and then every 4 to 6 months in the following years^[6].

During follow-up visits, your oncologist will ask about any symptoms and perform physical examinations. They may also order various tests, including^[6]:

• Blood tests
• An endoscopy, a procedure using a tube with a camera to view the inside of your throat
• Imaging tests such as MRI (magnetic resonance imaging) or CT (computed tomography) scans

If your oncologist suspects cancer recurrence, they may take a tissue sample called a biopsy for laboratory technicians to test for cancer cells. Additional testing may also be ordered to determine the extent of recurrence^[6].

Treatment Options

The treatment for recurrent oropharyngeal cancer depends on several factors, including where the cancer has returned, the size of the cancer, which treatments you received for the original cancer, and your overall health^[4][11]. Your healthcare team will suggest treatments based on your needs and work with you to develop a treatment plan.

Surgery

You may be offered surgery for oropharyngeal tumors that come back in the same place as the original tumor or in the neck. The goal of surgery is to remove the tumor^[4][11]. A neck dissection, which removes the lymph nodes in the neck, may be performed if the cancer recurs in the lymph nodes^[4].

Other surgeries may be offered to relieve symptoms or provide supportive care for advanced oropharyngeal cancer. These include placement of a feeding tube to ensure you get enough nutrients, or placement of a breathing tube to help you breathe^[4][11].

Radiation Therapy

You may be offered radiation therapy for recurrent oropharyngeal cancer. It may be used as the main treatment if radiation was not used to treat the original cancer. In some cases, it may be given again—a process called re-irradiation—even if radiation was used to treat the original cancer^[4][11]. Radiation therapy may also be given after surgery, either alone or with chemotherapy as part of chemoradiation^[4].

Chemotherapy

You may be offered chemotherapy for recurrent oropharyngeal cancer. Cancer that cannot be removed by surgery or comes back in distant places is usually treated with chemotherapy^[4][11]. The following drugs may be used alone or in combination:

• Cisplatin
• Carboplatin
• Fluorouracil (also called 5-fluorouracil or 5-FU)
• Methotrexate
• Paclitaxel
• Docetaxel
• Bleomycin
• Ifosfamide

Chemoradiation

You may be offered chemoradiation for recurrent oropharyngeal cancer. In chemoradiation, chemotherapy is given during the same time period as radiation therapy. For recurrent oropharyngeal cancer, cisplatin is usually the chemotherapy drug given along with radiation to the tumor and lymph nodes on both sides of the neck^[4][11].

Targeted Therapy

You may be offered targeted therapy for recurrent oropharyngeal cancer. It may be given alone or with radiation therapy or chemotherapy. Cetuximab is the most common targeted therapy drug used to treat oropharyngeal cancer^[4][11].

Immunotherapy

Immunotherapy helps to strengthen or restore the immune system’s ability to fight cancer. Immunotherapy may be used to treat recurrent oropharyngeal cancer. Pembrolizumab may be used as a first-line therapy to treat unresectable recurrent oropharyngeal cancer, with or without chemotherapy. Nivolumab is used to treat recurrent oropharyngeal cancer that has stopped responding to chemotherapy with platinum drugs such as cisplatin or carboplatin^[4][11].

Factors Affecting Treatment Decisions

Treatment options depend on where the cancer comes back, the size of the cancer, which treatments you received for the original cancer, and your overall health^[4][11]. Your healthcare team will work with you to develop a personalized treatment plan based on these factors.

You may want to consider care that makes you feel better without treating the cancer itself. This may be appropriate if cancer treatments are not working, they are not likely to improve your condition, or they may cause side effects that are hard to cope with. There may also be other reasons why you cannot have or do not want cancer treatment. It is important to talk to your healthcare team about your options and what is right for you^[4][11].

Follow-Up Care After Initial Treatment

People typically receive follow-up visits with an oncologist for many years after their initial treatments for oropharyngeal cancer. The risk of recurrence is higher within the first two years after treatment, with research showing that 86 to 94% of recurrences occur during this time^[6].

You may attend follow-ups every few months during the first two years after treatment and then every 4 to 6 months in the following years. During these visits, your oncologist will ask about symptoms of possible recurrence and perform physical examinations^[6].

Regular follow-up care is essential for early detection of recurrence, which can improve treatment outcomes. Your healthcare team will monitor your recovery and address any concerns or complications that may arise after treatment^[3].