Oropharyngeal Cancer
Oropharyngeal cancer forms in the middle section of your throat and can affect your ability to eat, drink, and speak. While the disease is relatively rare, affecting about 53,000 people in the U.S. each year, its incidence is rising—especially cases linked to human papillomavirus (HPV) infection, which now accounts for 60% to 70% of all oropharyngeal cancers.
Table of contents
- What is oropharyngeal cancer?
- Where oropharyngeal cancer develops
- Types of oropharyngeal cancer
- What causes oropharyngeal cancer
- Risk factors
- Signs and symptoms
- How doctors diagnose oropharyngeal cancer
- Treatment options
- How to reduce your risk
- Living with oropharyngeal cancer
What is oropharyngeal cancer?
Oropharyngeal cancer is a type of head and neck cancer that develops in the oropharynx, the middle part of your throat. Your throat, also called the pharynx, is a hollow tube about 5 inches long that starts behind your nose and runs down your neck. The pharynx is divided into three sections: the nasopharynx (upper part behind the nose), the oropharynx (middle part), and the hypopharynx (lower part near the voice box).[1][2]
The oropharynx plays an essential role in your daily life. It helps produce saliva, keeps your mouth and throat moist, and assists with digesting food. When you breathe or swallow, the pharynx acts as a passageway for air to reach your lungs and food to reach your stomach.[2]
Although oropharyngeal cancer is relatively rare compared to other cancers—about 53,000 people in the U.S. are diagnosed each year, compared to more than 290,000 breast cancer cases—its incidence has been increasing at an alarming rate, especially among younger people. This rise is largely due to infections with human papillomavirus (HPV).[1][8]
Where oropharyngeal cancer develops
- Back one-third of the tongue (base of tongue)
- Tonsils
- Soft palate (back part of the roof of your mouth)
- Side and back walls of the throat
Cancer can develop in any of these areas. Sometimes, a person can have more than one cancer at the same time in the oropharynx and in other nearby areas such as the mouth, nose, voice box (larynx), windpipe (trachea), or esophagus.[2][3]
Types of oropharyngeal cancer
More than 90% of oropharyngeal cancers are squamous cell carcinomas. Squamous cells are thin, flat cells that line the inside of your oropharynx. This type of cancer develops when these cells begin to grow uncontrollably.[3][7]
Although rare, lymphoma—cancer affecting cells in the lymphatic system—can also occur at the base of the tongue and in the tonsils, which are made up of lymph tissue.[8]
Tonsil cancer is the most common type of oropharyngeal cancer. People may also develop cancer in other parts of the oropharynx, including the gums and the floor of the mouth.[1]
Doctors now distinguish between two main categories of oropharyngeal cancer: HPV-related oropharyngeal cancers and HPV-negative oropharyngeal cancers. The good news is that HPV-related oropharyngeal cancers tend to respond much better to treatment, with high cure rates, particularly when tumors are small and occur in non-smokers.[8]
What causes oropharyngeal cancer
Human papillomavirus (HPV) infection is the most common cause of oropharyngeal cancer. HPV is a sexually transmitted infection that can spread to the mouth through oral sex or possibly in other ways. HPV makes proteins that interfere with the genes that manage the cells lining your mouth and throat, including how fast these cells grow. When genes stop managing cell growth properly, cells grow uncontrollably and form tumors.[1][4]
Among the many types of HPV, HPV type 16 is the most common type found in oropharyngeal cancers. HPV is thought to cause 60% to 70% of oropharyngeal cancers in the United States, and about 70% of all oropharyngeal cancers in the U.S. are caused by HPV.[4][7][8]
Many people are exposed to oral HPV during their lifetime. About 10% of men and 3.6% of women have oral HPV, and oral HPV infection is more common with older age. Most people clear HPV within 1 to 2 years, but HPV infection persists in some people. It usually takes years after being infected with HPV for cancers to develop in the oropharynx.[4]
Tobacco use is another major cause of oropharyngeal cancer. Tobacco—including smoking cigarettes and cigars and using chewing tobacco—damages the cells that line your throat. When cells in your throat are damaged, they divide more than usual to replace the damaged cells, which means they’re making more copies of their DNA than usual. The more cells have to divide to compensate for damaged cells, the more likely it is that cells will make mistakes in copying their DNA. This increases the chance that cells will become cancerous.[1]
Drinking beverages containing alcohol may also damage cells in your throat, affecting their ability to repair DNA. Oropharyngeal cancer is caused by certain changes in how oropharyngeal cells function, especially how they grow and divide into new cells.[1][2]
Risk factors
A risk factor is anything that increases your chance of getting a disease. Some risk factors for oropharyngeal cancer, like tobacco use, can be changed. Risk factors also include things you cannot change, like your family history.[2]
The most significant risk factor for developing oropharyngeal cancer is being infected with HPV, particularly HPV type 16. Other important risk factors include:[1][2][3]
- A history of smoking cigarettes for more than 10 pack years and other tobacco use
- Heavy alcohol consumption
- Personal history of head and neck cancer
- Chewing betel quid, a stimulant commonly used in parts of Asia
- History of radiation therapy to your head and neck
Tobacco and alcohol are still important factors for developing oropharyngeal cancers. Many risk factors do not directly cause cancer, but they increase the chance of DNA damage in cells that may lead to oropharyngeal cancer.[2]
Signs and symptoms
Oropharyngeal cancer symptoms may resemble symptoms of other less serious medical issues, which can make early detection challenging. Sometimes oropharyngeal cancer does not cause early signs or symptoms at all.[3]
Common oropharyngeal cancer symptoms include:[1][2][3]
- A sore throat that doesn’t go away
- Pain or difficulty with swallowing (a condition called dysphagia)
- Trouble opening your mouth fully (called trismus) or moving your tongue
- Unexplained weight loss
- Voice changes that don’t go away
- Ear pain that doesn’t go away
- A lump in the back of your throat or mouth
- A lump in your neck
- Coughing up blood
- A white patch on your tongue or lining of your mouth that doesn’t go away
If you have any of these symptoms lasting longer than two weeks, you should see your doctor or dentist right away. Early diagnosis is very important for effectively treating oropharyngeal cancer.[1]
How doctors diagnose oropharyngeal cancer
Oropharyngeal cancer diagnosis often begins with a physical exam conducted by your doctor, or sometimes your dentist. Your healthcare provider will ask about your symptoms and your medical history, including whether you smoke or use tobacco products, drink alcohol, or have a history of HPV infection.[1][3]
Tests that examine the mouth and throat are used to diagnose and stage oropharyngeal cancer. The following tests and procedures may be used:[3]
- Physical exam and health history: An exam of the body to check general signs of health, including checking for signs of disease, such as swollen lymph nodes in the neck or anything else that seems unusual. The medical doctor or dentist does a complete exam of the mouth and neck
- Endoscopy: A procedure to look inside the body using a thin, lighted tube
- Biopsy: A sample of tissue is removed and examined under a microscope to check for cancer cells
- Imaging tests: These may include CT scans, MRI scans, PET scans, or X-rays to see inside your body and determine if cancer has spread
Understanding the status of regional lymph nodes is critical to the care of patients with head and neck cancer. A restorative dental specialist may also assess your teeth before you have treatment and may recommend that you have some teeth removed if they are decaying or loose, so they don’t cause problems later on.[11][15]
Treatment options
Healthcare providers have different ways to treat oropharyngeal cancer. Your treatment depends on several factors, including where in your mouth or oropharynx your cancer is, the type of cancer, how big it is, whether it has spread anywhere else in your body, your age, overall health, and your personal goals.[1][15]
A team of doctors and other professionals, called a multidisciplinary team, will discuss the best treatment and care for you. This team typically includes:[15]
- Specialist head and neck surgeons
- Cancer specialists in radiotherapy (clinical oncologists) and drug treatment (medical oncologists)
- Restorative dental specialists
- Head and neck clinical nurse specialists
- Dietitians
- Speech and language therapists
- Other health professionals as needed
Common treatments for oropharyngeal cancer include:[8][17]
Surgery: Surgery may be used to remove the cancer. The goal is to eliminate cancer cells while preserving your ability to speak and swallow as normally as possible. Plastic surgery may be needed to rebuild the area where the surgeon has removed cancer—this is called reconstruction.
Radiation therapy: Radiation therapy uses high-energy rays to kill cancer cells and stop them from spreading. It’s focused only on the area where the cancer is found. Most often, radiation comes from an external machine. Radiation is commonly used after surgery, but it can be used alone for oropharyngeal cancer or combined with chemotherapy to enhance effectiveness.
Chemotherapy: Chemotherapy involves medications that travel through the body to kill cancer cells. These drugs can prevent cancer cells from replicating. Chemotherapy might be used with surgery and radiation or on its own when surgery isn’t possible.
Targeted therapy: Targeted therapy uses drugs or other substances to identify and attack specific cancer cells without harming healthy cells. These treatments often cause fewer side effects than chemotherapy.
Immunotherapy: Immunotherapy, also known as biological therapy, helps your immune system fight cancer. It’s typically used for oral or oropharyngeal cancers that have returned or spread.
For advanced cancer, radiation can help relieve symptoms like pain. A recent study showed that proton beam therapy improved outcomes for patients treated for head and neck oropharyngeal cancer, with fewer patients requiring feeding tubes and better weight maintenance compared to traditional radiation.[13]
Clinical trials are constantly looking for more efficient and innovative ways to treat oropharyngeal cancer. Participating in a clinical trial can give you access to the best current treatments and potentially new, more effective ones.[17]
How to reduce your risk
Although you may not be able to avoid oropharyngeal cancer entirely, you may reduce your risk of developing it by taking several important steps:[1][4]
Get vaccinated against HPV: The HPV vaccine was developed to prevent cervical and other cancers of the reproductive system. The vaccine protects against the types of HPV that can cause oropharyngeal cancers, so it may also prevent oropharyngeal cancers. The Centers for Disease Control and Prevention (CDC) recommends HPV vaccination for 11- to 12-year-olds and for everyone through age 26 if not vaccinated already. HPV vaccination prevents new HPV infections but does not treat existing infections or diseases. This is why the HPV vaccine works best when given before any exposure to HPV.
Avoid tobacco use: Not smoking cigarettes and avoiding other forms of tobacco—including cigars and chewing tobacco—is one of the most important steps you can take to reduce your risk.
Limit alcohol consumption: Drinking beverages containing alcohol in moderation can help reduce your risk. The American Cancer Society recommends no more than 2 drinks a day for men and 1 drink a day for women.
Use protection during oral sex: When used consistently and correctly, condoms and dental dams can lower the chance that HPV is passed from one person to another.
Protect your lips from sun exposure: Lips have very sensitive skin that can easily be damaged by sunlight. Regularly using lip balm with a high sun protection factor (SPF) protects this area from harmful UV rays.
Schedule regular dental checkups: Regular visits to the dentist ensure good oral health and can help spot early signs of cancer. However, remember that a single screening alone doesn’t guarantee prevention, so it’s important to maintain consistent checkups.
Living with oropharyngeal cancer
Living with oropharyngeal cancer and the changes caused by treatment can be difficult. Getting practical and emotional support can help you cope with your diagnosis and life during and after treatment.[19]
Emotional support: You may have a number of different feelings when you’re told you have cancer. You may feel shocked, frightened, uncertain, confused, angry, guilty, or sad. You might have some or all of these feelings, or you might feel totally different. Sometimes it’s hard to take in the fact that you have cancer at all. Talking to your friends and relatives about your cancer can help and support you. You might find it easier to talk to someone other than your own friends and family, such as a counselor or support group.[19]
Physical challenges: Oropharyngeal cancer and its treatment can cause physical changes in your body. These changes can be difficult to cope with and may affect the way you feel about yourself. Surgery for mouth and oropharyngeal cancer may change the way you look, which can affect your self-esteem and the way you relate to other people. Treatment can also affect your eating and swallowing, your speech, and if you have surgery, you might need a breathing stoma—an opening in your neck that you breathe through.[19][23]
Eating and drinking: Mouth and oropharyngeal cancer and its treatment can affect your eating and swallowing. A dietitian will support you and can prescribe liquid nutrition if needed. Speech and language therapists can help you with swallowing difficulties and provide information to your family or caregiver on how to support you.[15][23]
Follow-up care: After treatment ends, you’ll need regular follow-up appointments with your healthcare team to monitor for any signs that the cancer has come back and to manage any long-term side effects of treatment. Healthcare providers can treat oropharyngeal cancer, but the disease may come back (recur) after treatment.[1]
There are many organizations, support groups, and other resources available to help you cope with oropharyngeal cancer and treatment. Your specialist nurse can be your key worker and first point of contact throughout your journey.[15][23]
