Oropharyngeal cancera disease where abnormal cells split without control and spread to other nearby body tissue and/or organs is a rare form of throat cancer that forms in the oropharynx in the middle portion of the throat (pharynx). Most oropharyngeal cancers develop as squamous cell carcinomas (cancers arising from the squamous cellsthe basic structural and functional unit of all living things in the tissues that line the pharynx), however in rare cases they can develop as other types.
The pharynx/throat is a hollow tube that consists of three main portions: the nasopharynx, the oropharynx, and the hypopharynx. The nasopharynx is located at the uppermost portion of the throat, behind the nose and above the soft palate (muscle in the mouth preventing food from entering the nasal passages). The middle portion of the throat, the oropharynx, is the area from the soft palate and tongue to the back of the mouth, including the tonsils. The oropharynx acts as a passage of air from the nose and mouth to the lungs, and pushes food and drink from the mouth to the oesophagus. The last portion of the throat is the hypopharynx, which functions as a guide for food into the oesophagus and not into the larynx and lungs.
Oropharyngeal cancer is more common in males, and is generally diagnosed over the age of 60. However, anyone can develop this disease.
Treatment
If oropharyngeal cancer is detected, it will be staged and graded based on size, metastasiswhen the cancer has spread to other parts of the body, also known as mets, and how the cancer cells look under the microscope. Stagingthe process of determining how big the cancer is, where it started and if it has spread to other areas and grading helps your doctors determine the best treatment for you.
Cancers can be staged using the TNM staging system:
- T (tumoura tissue mass that forms from groups of unhealthy cells) indicates the size and depth of the tumour.
- N (nodea small lump or mass of tissue in your body) indicates whether the cancer has spread to nearby lymph nodessmall bean-shaped structures that filters harmful substances from lymph fluid.
- M (metastasis) indicates whether the cancer has spread to other parts of the body.
This system can also be used in combination with a numerical value, from stage 0-IV:
- Stage 0: this stage describes cancer cells in the place of origin (or ‘in situ’) that have not spread to nearby tissuea group of cells that work together to perform a function.
- Stage I: cancer cells have begun to spread to nearby tissue. It is not deeply embedded into nearby tissue and had not spread to lymph nodes. This stage is also known as early-stage cancer.
- Stage II: cancer cells have grown deeper into nearby tissue. Lymph nodes may or may not be affected. This is also known as localisedaffecting only one area of body cancer.
- Stage III: the cancer has become larger and has grown deeper into nearby tissue. Lymph nodes are generally affected at this stage. This is also known as localised cancer.
- Stage IV: the cancer has spread to other tissues and organs in the body. This is also known as advancedat a late stage, far along or metastatic cancer.
Cancers can also be graded based on the rate of growth and how likely they are to spread:
- Gradea description of how abnormal cancer cells and tissue look under a microscope when compared to healthy cells I: cancer cells present as slightly abnormal and are usually slow growing. This is also known as a low-grade tumour.
- Grade II: cancer cells present as abnormal and grow faster than grade-I tumours. This is also known as an intermediate-grade tumour.
- Grade III: cancer cells present as very abnormal and grow quickly. This is also known as a high-grade tumour.
Once your tumour has been staged and graded, your doctor may recommend genetic testinga procedure that analyses DNA to identify changes in genes, chromosomes and proteins, which can be used to analyse tumour DNA to help determine which treatment has the greatest chance of success, which analyses your tumour DNA and can help determine which treatment has the greatest chance of success. They will then discuss the most appropriate treatment option for you.
Treatment is dependent on several factors, including location, stage of disease and overall health.
Treatment options for oropharyngeal cancer may include:
- Surgerytreatment involving removal of cancerous tissue and/or tumours and a margin of healthy tissue around it to reduce recurrence, potentially including:
- Trans-oral robotic surgery (TORS)a minimally invasive procedure that can remove cancers of the head and neck with a robotic system or laser surgery without making any external incisions.
- Lymphadenectomysurgical removal of lymph node(s).
- Mandibulotomya type of surgery that involves cutting the jawbone to allow better access to the back of the throat, before a jaw reconstruction with titanium plates.
- Flap surgerya type of plastic surgery where healthy tissue is moved from one area of the body to another to reconstruct an area that was damaged or removed.
- Tracheostomya surgical procedure to create an opening in the neck and into the trachea to allow air to enter the lungs.
- Feeding tubes, potentially including a gastronomy tube (G-tube)a feeding tube surgically inserted through an incision in the abdominal wall directly into the stomach to get fluids/food/liquids to and from the stomach or nasogastric tube (NG tube)a thin, soft tube that goes in through the nose, down the throat, and into the stomach to get fluids/food/liquids to and from the stomach, also known as a NG tube to help feed you after surgery.
- Radiation therapya treatment that uses controlled doses of radiation to damage or kill cancer cells.
- Chemotherapya cancer treatment that uses drugs to kill or slow the growth of cancer cells, while minimising damage to healthy cells.
- Clinical trialsresearch studies performed to test new treatments, tests or procedures and evaluate their effectiveness on various diseases.
- Palliative carea variety of practices and exercises used to provide pain relief and improve quality of life without curing the disease.
Risk factors
While the cause of oropharyngeal cancer remains unknown, these factors may increase your riskthe possibility that something bad will happen in developing oropharyngeal cancer:
- Having been infected with the human papillomavirus (HPV).
- Having a history of smoking and/or excessive alcohol intake.
Not everyone with these risk factors will develop the disease, and some people who have the disease may have none of these risk factors. See your general practitioner (GP) if you are concerned.
Symptoms
The symptoms of oropharyngeal cancers may include:
- A persistent sore throat.
- Throat sores/ulcers.
- A lump in the throat and/or the neck.
- Difficulties swallowing food or moving the tongue.
- Difficulties opening the mouth.
- Difficulties breathing.
- Unexplained noisy breathing.
- Unexplained ear pain.
- Coughing up bloodthe red bodily fluid that transports oxygen and other nutrients around the body.
- Changes in the voice.
- Unexplained weight loss.
Not everyone with the symptoms above will have cancer, but see your general practitioner (GP) if you are concerned.
Diagnosis
If your doctor suspects you have a oropharyngeal cancer, they may order the following tests to confirm the diagnosis and refer you to a specialist for treatment:
- Physical examinationan examination of your current symptoms, affected area(s) and overall medical history.
- Imagingtests that create detailed images of areas inside the body tests, potentially including:
- MRI (magnetic resonance imaging)a type of medical imaging that uses radiowaves, a strong magnet and computer technology to create detailed images of the body.
- CT (computed tomography) scana type of medical imaging that uses x-rays and computer technology to create detailed images of the body.
- PET (positron emission tomography) scana type of medical imaging that uses radioactive tracers to create detailed images of the body.
- Blood teststesting done to measure the levels of certain substances in the blood.
- Nasoendoscopyexamination of the lining of the nasal passages and the nasopharynx with a small, flexible instrument known as a nasoendoscope.
- Biopsyremoval of a section of tissue to analyse for cancer cells.
