The oropharynx is the middle portion of the throat (pharynx), beginning at the back of the mouth. It includes the base of the tongue, the tonsils, and the soft palate.
Oropharyngeal cancer develops when the cells that make up the oropharynx grow and multiply abnormally. This can happen if the genes in a cell that control growth no longer work properly. As a result, the cell divides uncontrollably and may form a tumor.
Oropharyngeal Cancer Symptoms
The most common signs of oropharyngeal cancer include:
- a lump in the neck or throat
- a persistent sore throat
- hoarseness that doesn’t go away
- difficulty swallowing
- ear or jaw pain
Oropharyngeal Cancer Risk Factors
The main cause of oropharyngeal cancer in the United States is prior infection with the human papillomavirus (HPV). In fact, according to the Centers for Disease Control, more than 70 percent of oropharyngeal cancer is associated with HPV.
If you’ve received a diagnosis of oropharyngeal cancer, it is important to find out the HPV status of the tumor. Knowing this information can help your doctor select the best treatment approach for you. At Memorial Sloan Kettering, HPV testing is standard for all cancers of the oropharynx.
Smoking and chewing tobacco as well as heavy alcohol use are also common risk factors for oropharyngeal cancer.
Oropharyngeal Cancer Treatment
Treatment for oropharyngeal cancer may include radiation therapy, chemotherapy, or surgery. Often these treatments are given in combination. For example, chemotherapy may be given at the same time as radiation to boost the effectiveness of your care. Radiation may be given after surgery.
Which approach is right for you will depend on factors such as the size, stage, and HPV status of the tumor, as well as your overall health and treatment preferences.
MSK’s oropharyngeal cancer experts take a highly collaborative approach to treatment planning. Each week the team comes together to discuss your care. This includes surgeons, radiation oncologists, and medical oncologists. Your treatment plan is designed with input from the entire group. This collaborative approach helps ensure that all possible treatment scenarios are considered and that you receive just the right amount of care.
Surgery for Oropharyngeal Cancer
Many oropharyngeal tumors can be removed through the opening of the mouth. Others may require a more extensive approach. Sometimes your surgeon may recommend a minimally invasive approach, such as laser surgery or robotic surgery.
Which surgery is right for you depends on factors such as the size, stage, and location of the tumor.
Radiation Therapy for Oropharyngeal Cancer
Radiation therapy is another important treatment option for people with oropharyngeal cancer. An approach called intensity-modulated radiation therapy (IMRT) has proven particularly effective against the disease. IMRT allows for the delivery of more-precise doses of radiation to the tumor. At the same time, it reduces the risk that healthy tissue is exposed. This approach was developed at Memorial Sloan Kettering and is now used around the world for a variety of cancers.
Proton therapy is another form of radiation therapy. It has been extremely helpful for many people. Memorial Sloan Kettering is one of a limited number of centers nationwide that offer proton therapy.
At MSK, all throat cancer patients who are having radiation therapy have a weekly MRI scan as well. This regularly updated map of the tumor gives the care team an opportunity to tailor the radiation plan in real time. Our vigilant approach allows for more-precise delivery of radiation to the tumor. At the same time, it spares normal tissue and reduces potential side effects.
Chemotherapy can increase the sensitivity of the tumor to radiation treatment. That’s why doctors usually recommend the chemotherapy drug cisplatin (Platinol®). Taking the drug before and after radiation treatments reduces the chances that the tumor will come back. This combination of radiation plus chemotherapy is called chemoradiation.
Drug Therapies for Advanced Oropharyngeal Cancer
Drug therapies such as chemotherapy, targeted therapy, or immunotherapy are commonly part of the treatment plan for people with more-advanced disease.
At MSK, our medical oncologists (the doctors who treat cancer using drug therapies) bring extraordinary skill to caring for people with advanced oropharyngeal cancer. We have deep knowledge of the newest clinical trials for oropharyngeal cancer. These studies may give you access to advanced therapies years before they’re available elsewhere.
Specialized Approaches for HPV-Positive Oropharyngeal Cancer
The good news for people with HPV-positive tumors is that they often respond very well to treatment. In part this is because people with HPV-positive disease are on average younger than other people with oropharyngeal cancer. That means they are better able to tolerate treatment. HPV-positive tumors also tend to be more sensitive to currently used treatments.
At MSK, our experts are working diligently to develop personalized care for people with HPV-positive oropharyngeal cancer. We have pioneered promising new approaches designed to keep the side effects to a minimum without affecting your chances of a cure.
In some cases, surgery may be the only treatment needed. Other people may benefit from radiation or drug therapy after surgery. Our doctors are experts in determining whether surgery is the best option for you. If you do need surgery, we can assess whether you may be able to safely avoid postoperative radiation therapy or chemotherapy or perhaps receive a reduced dose.
Similarly, we create tailored care plans for people with HPV-positive tumors who require chemoradiation. We may be able to offer you a less-intense dose of radiation, chemotherapy, or both.
Quality of Life after Oropharyngeal Cancer Treatment
Quality-of-life considerations are a vital component of your care. Our head and neck cancer team takes a proactive approach to symptom management. Even before treatment begins, we evaluate your swallowing function and begin making a plan for any therapy you may need. And once treatment begins, we keep a vigilant watch to make sure that the people we care for get the resources and support they need to cope with any side effects that come up.
In addition, the team has developed an online questionnaire called FACE-Q. It allows patients to report their treatment experience to us in real time. The information is automatically fed into the medical record. It helps the team make prompt referrals to other experts in rehabilitation, pain management, or social work.