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Table of Contents General Information About Oropharyngeal Cancer
Stages of Oropharyngeal Cancer
Recurrent Oropharyngeal Cancer
Treatment Option Overview
Treatment Options by Stage
Treatment Options for Recurrent Oropharyngeal Cancer
To Learn More About Oropharyngeal Cancer
Get More Information From NCI
Changes to This Summary (08/27/2008)
About PDQ
General Information About Oropharyngeal Cancer
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Oropharyngeal cancer is a disease in which malignant (cancer)
cells form in the tissues of the oropharynx.
The oropharynx is the
middle part of the pharynx (throat) behind the mouth, and includes the back one-third of the tongue, the soft palate, the side and back walls of the throat, and the tonsils. The pharynx is a hollow tube about 5 inches long that starts
behind the nose and ends at the top of the trachea (windpipe) and esophagus (the tube that goes from the throat to
the stomach). Air and food pass
through the pharynx on the way to the trachea or the esophagus.
Most oropharyngeal cancers are squamous cell carcinomas. Squamous cells are the thin, flat cells that line the inside of the oropharynx.
Use of tobacco products and drinking too much alcohol can increase the risk
of developing oropharyngeal cancer.
Anything that increases your risk of getting a disease is called a risk factor. Risk factors include the following:
- Smoking and chewing tobacco.
- Heavy alcohol use.
- A diet low in fruits and vegetables.
- Drinking maté, a stimulant drink common in South America.
- Chewing betel quid, a stimulant commonly used in parts of Asia.
- Being infected with human papillomavirus (HPV).
Possible signs of oropharyngeal cancer include a sore throat
and a lump in the neck.
These and other symptoms may be caused by oropharyngeal cancer. Other conditions may cause the same symptoms. A doctor should be consulted if any of the following
problems occur:
- A sore throat that does not go away.
- A dull pain behind the breastbone.
- Cough.
- Trouble swallowing.
- Weight loss for no known reason.
- Ear pain.
- A lump in the back of the mouth, throat, or neck.
- A change in voice.
Tests that examine the mouth and throat are used to help detect
(find), diagnose, and stage oropharyngeal cancer.
The following tests and procedures may be used:
- Physical exam and 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 doctor does a complete exam of the mouth and neck and looks down the throat with a small,
long-handled mirror to check for abnormal areas. A history of the patient’s health habits and past illnesses and treatments will also be taken.
- CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.
- MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI).
- X-rays: An x-ray of the organs and bones. An x-ray is a type of energy beam that can go through the body and onto film, making pictures of areas inside the body.
- PET scan (positron emission tomography scan): A procedure to find malignant tumor cells in the body. A small amount of radionuclide glucose (sugar) is injected into a vein. The PET scanner rotates around the body and makes a picture of where glucose is being used in the body. Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells do.
- Endoscopy: A procedure to look at organs and tissues inside the body to check for abnormal areas. An endoscope is inserted through the
patient’s nose or mouth to look at areas in the throat that cannot be seen
during a physical exam of the throat. An endoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove tissue or lymph node samples, which are checked under a microscope for signs of disease.
- Biopsy: The removal of cells or tissues so they can be viewed under a microscope by a pathologist to check for signs of cancer.
Certain factors affect prognosis (chance
of recovery) and treatment options.
The prognosis (chance of recovery) depends on
the following:
- The stage and grade of the cancer.
- The location of
the tumor.
- Whether the tumor is associated with HPV infection.
Treatment options depend on the following:
- The stage and grade of the cancer.
- The location of
the tumor.
- The patient's general health.
Back to Top Stages of Oropharyngeal Cancer
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After oropharyngeal cancer has been diagnosed, tests
are done to find out if cancer cells have spread within the oropharynx or to
other parts of the body.
The process used to find out if cancer has spread within the oropharynx or
to other parts of the body is called staging. The information gathered from the staging
process determines the stage of the
disease. It is important to know the stage in order to plan treatment. The results of some of the tests used to diagnose oropharyngeal cancer are often used to stage the disease.
There are three ways that cancer spreads in the body.
The three ways that cancer spreads in the body are:
- Through tissue. Cancer invades the surrounding normal tissue.
- Through the lymph system. Cancer invades the lymph system and travels through the lymph vessels to other places in the body.
- Through the blood. Cancer invades the veins and capillaries and travels through the blood to other places in the body.
When cancer cells break away from the primary (original) tumor and travel through the lymph or blood to other places in the body, another (secondary) tumor may form. This process is called metastasis. The secondary (metastatic) tumor is the same type of cancer as the primary tumor. For example, if breast cancer spreads to the bones, the cancer cells in the bones are actually breast cancer cells. The disease is metastatic breast cancer, not bone cancer.
The following stages are used for oropharyngeal
cancer:
Stage 0 (Carcinoma in Situ)
In stage 0, abnormal cells are found in the lining of the oropharynx.
These abnormal cells may become cancer and spread into nearby normal tissue. Stage 0 is also called carcinoma in
situ.
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| Pea, peanut, walnut, and lime show tumor sizes. |
Stage I
In stage I, cancer has formed and is
2 centimeters or smaller and has not spread outside the oropharynx.
Stage II
In stage II, the cancer is larger than 2 centimeters, but not larger than 4 centimeters, and has not spread outside the oropharynx.
Stage III
In stage III, the cancer is either:
- larger than 4 centimeters and has not spread outside the oropharynx; or
- any size and has spread to only one lymph node on the same side of the neck as the cancer. The lymph node with cancer is 3 centimeters or smaller.
Stage IVA
In stage IVA, the cancer either:
- 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, and may have spread to one or more nearby lymph nodes, none larger than 6 centimeters; or
- is any size and has spread to one lymph node that is larger than 3 centimeters but not larger than 6 centimeters on the same side of the neck as the cancer, or to more than one lymph node, none larger than 6 centimeters, on one of both sides of the neck.
Stage IVB
In stage IVB, the cancer either:
- 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, and may have spread to nearby lymph nodes; or
- has spread to a lymph node that is larger than 6 centimeters and may have spread to tissues around the oropharynx.
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.
Back to Top Recurrent Oropharyngeal Cancer
Recurrent oropharyngeal
cancer is cancer that has recurred
(come back) after it has been treated. The cancer may come
back in the oropharynx or in other
parts of the body.
Back to Top Treatment Option Overview
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There are different types of treatment for patients with oropharyngeal
cancer.
Different types of treatment are available for patients with oropharyngeal
cancer. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. A
treatment clinical trial is a research study meant to help improve current
treatments or obtain information on new treatments for patients with cancer.
When clinical trials show that a new treatment is better than the standard treatment, the new
treatment may become the standard treatment. Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.
Patients with oropharyngeal cancer should have their treatment planned by a team of doctors with expertise in treating head and neck cancer.
The patient's treatment will be overseen by a medical oncologist, a doctor who specializes in treating people with cancer. 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. The medical oncologist may refer the patient to other health professionals with special training in the treatment of patients with head and neck cancer. These may include the following specialists:
Two types of standard treatment are used:
Surgery
Surgery (removing the cancer in an operation) is a common
treatment of all stages of
oropharyngeal cancer. A doctor may remove the cancer and some of the healthy tissue around the cancer. Even if
the doctor removes all the cancer that can be seen at the time of the
surgery, some patients may be given chemotherapy or radiation therapy after surgery to kill any cancer cells that are left. Treatment given
after the surgery, to increase the chances of a cure, is called adjuvant therapy.
Radiation therapy
Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated. Fractionated radiation therapy divides the total dose of radiation therapy into several smaller, equal doses given over several days.
Radiation therapy may be more effective in patients who have
stopped smoking before beginning treatment.
Radiation therapy to the thyroid or
pituitary gland increases the risk of hypothyroidism (too little thyroid hormone). Thyroid function tests should be done before and after treatment.
New types of treatment are being tested in clinical
trials.
This summary section describes treatments that are being studied in clinical trials. It may not mention every new treatment being studied. Information about clinical trials is available from the NCI Web site.
Chemotherapy
Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the spinal column, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). The way the chemotherapy is given depends on the type and stage of the cancer being treated.
Radiosensitizers
Radiosensitizers are drugs that make tumor cells more sensitive to radiation therapy. Combining radiation therapy with radiosensitizers may kill more tumor cells.
Hyperthermia therapy
Hyperthermia therapy is a
treatment in which body tissue is exposed to increased temperature to damage
and kill cancer cells or to make cancer cells more sensitive to the effects of
radiation and certain anticancer drugs.
Patients may want to think about taking part in a clinical trial.
For some patients, taking part in a clinical trial may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment.
Many of today's standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment.
Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward.
Patients can enter clinical trials before, during, or after starting their cancer treatment.
Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from recurring (coming back) or reduce the side effects of cancer treatment.
Clinical trials are taking place in many parts of the country. See the Treatment Options section that follows for links to current treatment clinical trials. These have been retrieved from NCI's clinical trials database.
Follow-up tests may be needed.
Some of the tests that were done to diagnose the cancer or to find out the stage of the cancer may be repeated. Some tests will be repeated in order to see how well the treatment is working. Decisions about whether to continue, change, or stop treatment may be based on the results of these tests. This is sometimes called re-staging.
Some of the tests will continue to be done from time to time after treatment has ended. The results of these tests can show if your condition has changed or if the cancer has recurred (come back). These tests are sometimes called follow-up tests or check-ups.
After treatment for oropharyngeal cancer, frequent and careful
follow-up is important because of the risk of developing a second cancer in the
head or neck.
Back to Top Treatment Options by Stage
A link to a list of current clinical trials is included for each treatment section. For some types or stages of cancer, there may not be any trials listed. Check with your doctor for clinical trials that are not listed here but may be right for you.
Stage I Oropharyngeal Cancer
Treatment of stage I oropharyngeal
cancer may include the following:
Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with stage I oropharyngeal cancer. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site.
Stage II Oropharyngeal Cancer
Treatment of stage II oropharyngeal
cancer may include the following:
Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with stage II oropharyngeal cancer. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site.
Stage III Oropharyngeal Cancer
Treatment of stage III oropharyngeal
cancer may include the following:
Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with stage III oropharyngeal cancer. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site.
Stage IV Oropharyngeal Cancer
Treatment of stage IV oropharyngeal
cancer that can be treated by surgery may include the
following:
Treatment of stage IV oropharyngeal cancer that cannot be treated
by surgery may include the following:
- Radiation therapy with or without chemotherapy.
- A clinical trial of chemotherapy with radiation therapy
and/or radiosensitization.
- A clinical trial
of fractionated and/or internal radiation therapy.
- A clinical trial of radiation therapy with or without
chemotherapy.
- A clinical trial of hyperthermia therapy with radiation therapy.
Following treatment, it is important to have careful head and neck
examinations to look for recurrence. Check-ups will be done monthly in the first year, every 2
months in the second year, every 3 months in the third year, and every 6
months thereafter.
Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with stage IV oropharyngeal cancer. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site.
Back to Top Treatment Options for Recurrent Oropharyngeal Cancer
Treatment of recurrent oropharyngeal
cancer may include the
following:
Following treatment, it is important to have careful head and neck
examinations to look for recurrence. Check-ups will be done monthly in the first year, every 2
months in the second year, every 3 months in the third year, and every 6
months thereafter.
Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with recurrent oropharyngeal cancer. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site.
Back to Top To Learn More About Oropharyngeal Cancer
For more information from the National Cancer Institute about oropharyngeal cancer, see the following:
For general cancer information and other resources from the National Cancer Institute, see the following:
Back to Top Get More Information From NCI
Call 1-800-4-CANCER
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Search the NCI Web site
The NCI Web site provides online access to information on cancer, clinical trials, and other Web sites and organizations that offer support and resources for cancer patients and their families. For a quick search, use our “Best Bets” search box in the upper right hand corner of each Web page. The results that are most closely related to your search term will be listed as Best Bets at the top of the list of search results.
There are also many other places to get materials and information about cancer treatment and services. Hospitals in your area may have information about local and regional agencies that have information on finances, getting to and from treatment, receiving care at home, and dealing with problems related to cancer treatment.
Find Publications
The NCI has booklets and other materials for patients, health professionals, and the public. These publications discuss types of cancer, methods of cancer treatment, coping with cancer, and clinical trials. Some publications provide information on tests for cancer, cancer causes and prevention, cancer statistics, and NCI research activities. NCI materials on these and other topics may be ordered online or printed directly from the NCI Publications Locator. These materials can also be ordered by telephone from the Cancer Information Service toll-free at 1-800-4-CANCER (1-800-422-6237), TTY at 1-800-332-8615.
Back to Top Changes to This Summary (08/27/2008)
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.
Editorial changes were made to this summary.
Back to Top About PDQ
PDQ is a comprehensive cancer database available on NCI's Web site.
PDQ is the National Cancer Institute's (NCI's) comprehensive cancer information database. Most of the information contained in PDQ is available online at NCI's Web site. PDQ is provided as a service of the NCI. The NCI is part of the National Institutes of Health, the federal government's focal point for biomedical research.
PDQ contains cancer information summaries.
The PDQ database contains summaries of the latest published information on cancer prevention, detection, genetics, treatment, supportive care, and complementary and alternative medicine. Most summaries are available in two versions. The health professional versions provide detailed information written in technical language. The patient versions are written in easy-to-understand, nontechnical language. Both versions provide current and accurate cancer information.
The PDQ cancer information summaries are developed by cancer experts and reviewed regularly.
Editorial Boards made up of experts in oncology and related specialties are responsible for writing and maintaining the cancer information summaries. The summaries are reviewed regularly and changes are made as new information becomes available. The date on each summary ("Date Last Modified") indicates the time of the most recent change.
PDQ also contains information on clinical trials.
A clinical trial is a study to answer a scientific question, such as whether one treatment is better than another. Trials are based on past studies and what has been learned in the laboratory. Each trial answers certain scientific questions in order to find new and better ways to help cancer patients. During treatment clinical trials, information is collected about the effects of a new treatment and how well it works. If a clinical trial shows that a new treatment is better than one currently being used, the new treatment may become "standard." Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.
Listings of clinical trials are included in PDQ and are available online at NCI's Web site. Descriptions of the trials are available in health professional and patient versions. Many cancer doctors who take part in clinical trials are also listed in PDQ. For more information, call the Cancer Information Service 1-800-4-CANCER (1-800-422-6237); TTY at 1-800-332-8615.
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