How Is Oropharynx Cancer Diagnosed?

Oropharyngeal cancer is caused by a mass or ulcer due to abnormal and uncontrolled cell growth at the base of the tongue, tonsils, or soft palate. Causes and risk factors include:

• Human papillomavirus (HPV)
• Chewing betel nut
• Alcohol consumption
• Tobacco consumption 
• Poor nutrition

The World Health Organization estimates that 657,000 new cases of oral cancer are diagnosed each year, with over 330,000 deaths. Oropharyngeal cancer is rare, accounting for about 3% of oral cancers. Symptoms may include:

• Pain
• Swelling
• Bleeding ulcers that do not heal
• Difficulty swallowing
• Difficulty opening the mouth
• Difficulty speaking

If oropharyngeal cancer has been diagnosed, staging is important to determine whether the cancer has spread.

• Stage 0 (cancer in situ)
  • Oropharynx lining contains abnormal cells that are not yet cancerous
• Stage I
  • Cancer has grown to a size of 2 mm or less but is restricted to the oropharynx
  • No evidence of cancer in surrounding lymph nodes or other areas of the body
• Stage II
  • Cancer is found only in the oropharynx and is larger than 2 cm but not more than 4 cm
  • Cancer has not spread to other parts of the body and has not been detected in nearby lymph nodes
• Stage III
  • Cancer may be 4 cm in diameter or less
  • Tumor may have spread to the epiglottis but has not spread to lymph nodes or has spread to one lymph node on the same side of the neck
  • Cancer has not spread to other areas of the body
• Stage IV
  • Stage IVA
    • Cancer has spread to the larynx, roof of the mouth, lower jaw, and epiglottis
    • Cancer may have spread to one or more lymph nodes although they are no more than 6 mm in diameter
    • Cancer has not spread to other areas of the body
  • Stage IVB
    • Tumors can be of any size and may encircle the carotid artery or have spread to the jaw muscles and bones, nasopharynx, or base of the skull
    • Although cancer has not spread to other parts of the body, it has affected one or more lymph nodes
  • Stage IVC
    • Tumor may be of any size and has spread to other areas of the body from the oropharynx

Treatment for oropharyngeal cancer depends on the stage:

• Treatment stage 0
  • Wait and watch
  • Removal of risk factors, as well as dietary and lifestyle changes
• Treatment stage I
  • Radiation therapy and surgery
• Treatment stage II
  • Radiation therapy and surgery
• Treatment stage III
  • Surgery to remove the tumor, followed by radiation therapy
  • Clinical trial of chemotherapy followed by surgery or radiation therapy
  • Clinical trial of chemotherapy combined with radiation therapy
  • Clinical trial of new radiation therapy methods
• Treatment stage IV: 
  • For cases in which oropharyngeal cancer can be removed via surgery, treatment may include one of the following:
    • Surgery to remove cancer followed by radiation therapy
    • Radiation therapy alone
    • Clinical trial combining radiation therapy and chemotherapy
    • Clinical trial of new radiation therapy methods
  • For cases in which cancer cannot be removed via surgery, treatment may include one of the following:
    • Clinical trial of radiation therapy administered with chemotherapy or radiosensitizers (drugs to make the cancer cells more sensitive to radiation therapy)
    • Clinical trial of new radiation therapy methods
    • Clinical trial of hyperthermia and radiation therapies

The outcome for patients with oropharyngeal cancer varies depending on factors such as age, overall health, and the stage of the disease. 

Lifetime follow-up exams may be necessary because the cancer can spread to other parts of the body. Furthermore, risk factors such as smoking and drinking that increase the chance of cancer recurrence must be avoided. 

The overall 5-year survival rate for oropharyngeal cancer is 65%, meaning that about 6 out of 10 people with the disease will live for at least 5 years after diagnosis.