Oropharyngeal Cancer

Description

What is cancer of the oropharynx?

Cancer of the oropharynx is a disease in which cancer cells are found in the tissues of the oropharynx. The oropharynx is the middle part of the throat (also called the pharynx). The pharynx is a hollow tube about 5 inches long that starts behind the nose and goes down to the neck to become part of the esophagus (tube that goes to the stomach). Air and food pass through the pharynx on the way to the windpipe (trachea) or the esophagus. The oropharynx includes the base of the tongue, the tonsils, the soft palate (the back of the mouth), and the walls of the pharynx.

Cancer of the oropharynx most commonly starts in the cells that line the oropharynx. (Refer to the PDQ summaries on Adult Non-Hodgkin?s Lymphoma Treatment and Childhood Non-Hodgkin?s Lymphoma Treatment for more information on cancer that started in the lymph cells of the oropharynx.)

A doctor should be seen if a person has a sore throat that does not go away, trouble swallowing, weight loss, a lump in the back of the mouth or throat, a change in the voice, or pain in the ear.

If there are symptoms, a doctor will examine the throat using a mirror and lights. The doctor will also feel the throat for lumps. If tissue that is not normal is found, the doctor will need to cut out a small piece and look at it under the microscope to see if there are any cancer cells. This is called a biopsy.

The chance of recovery (prognosis) depends on where the cancer is in the throat, whether the cancer is just in the throat or has spread to other tissues (the stage), and the patient?s general state of health. After the treatment, a doctor should be seen regularly because there is a chance of having a second primary cancer in the head or neck region. Smoking or drinking alcohol after treatment increases the chance of developing a second primary cancer.

Stage Explanation

Stages of cancer of the oropharynx

Once cancer of the oropharynx is found, more tests will be done to find out if cancer cells have spread to other parts of the body. This is called staging. A doctor needs to know the stage of the disease to plan treatment. Imaging tests may be done, including special x-rays and an MRI (magnetic resonance imaging) scan, which uses a magnet, radio waves, and a computer to make a picture of the inside of the body. The following stages are used for cancer of the oropharynx.

Stage 0

Cancer is found only in cells lining the oropharynx. Stage 0 cancer is also called carcinoma in situ.

Stage I

The cancer is 2 centimeters (about � inch) or smaller and has not spread outside the oropharynx.

Stage II

The cancer is larger than 2 centimeters, but not larger than 4 centimeters (about 1� inches), and has not spread outside the oropharynx.

Stage III

Stage III is either of the following:

• The cancer is larger than 4 centimeters and has not spread outside the oropharynx.

• The cancer is any size and has spread to only one lymph node on the same side of the neck as the cancer. (Lymph nodes are small, bean-shaped structures found throughout the body. They help fight infection and disease.) The lymph node that contains cancer is 3 centimeters (just over one inch) or smaller.

Stage IVA

Stage IVA is either of the following:

• The cancer 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. Cancer may have spread to one or more nearby lymph nodes, none larger than 6 centimeters (almost 2� inches).

• The cancer is any size, is only in the oropharynx, and has spread to one lymph node that is larger than 3 centimeters but no larger than 6 centimeters, or to more than one lymph node, none larger than 6 centimeters.

Stage IVB

Stage IVB is either of the following:

• The cancer is found in a lymph node that is larger than 6 centimeters and may have spread to other tissues around the oropharynx.

• Cancer 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; the cancer may have spread to nearby lymph nodes.

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.

Recurrent

Recurrent disease means that the cancer has come back (recurred) after it has been treated. It may come back in the oropharynx or in another part of the body.

Treatment Option Overview

How cancer of the oropharynx is treated

There are treatments for all patients with cancer of the oropharynx. Three kinds of treatment are used:

• Surgery (taking out the cancer).

• Radiation therapy (using high-dosex-rays or other high-energy rays to kill cancer cells).

• Chemotherapy (using drugs to kill cancer cells).

Surgery is a common treatment of cancer of the oropharynx. A doctor may remove the cancer and some of the healthy tissue around the cancer. If cancer has spread to lymph nodes, the lymph nodes will be removed (lymph node dissection). A new type of surgery called micrographic surgery is being tested in clinical trials for early cancers of the oropharynx. Micrographic surgery removes the cancer and as little normal tissue as possible. During this surgery, the doctor removes the cancer and then uses a microscope to look at the cancerous area to make sure there are no cancer cells remaining.

Radiation therapy uses high-energy x-rays to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external radiation therapy) or from putting materials that produce radiation (radioisotopes) through thin plastic tubes in the area where the cancer cells are found (internal radiation therapy). Fractionated radiation therapy is given in several smaller, equal doses over a period of several days. External radiation to the thyroid or the pituitary gland may change the way the thyroid gland works. The doctor may test the thyroid gland before and after therapy to make sure it is working properly. Giving drugs with the radiation therapy to make the cancer cells more sensitive to radiation (radiosensitization) is being tested in clinical trials. If smoking is stopped before radiation therapy is started, there is a better chance of surviving longer.

Chemotherapy uses drugs to kill cancer cells. Chemotherapy may be taken by pill, or it may be put into the body by a needle in the vein or muscle. Chemotherapy is called a systemic treatment because the drug enters the bloodstream, travels through the body, and can kill cancer cells throughout the body.

People with oropharyngeal cancer have a higher risk of getting other cancers in the head and neck area. Clinical trials of chemoprevention therapy are testing whether certain drugs can prevent second cancers from developing in the mouth, throat, windpipe, nose, or esophagus (the tube that connects the throat to the stomach).

Hyperthermia therapy (warming the body to kill cancer cells) is being tested in clinical trials. Hyperthermia therapy uses a special machine to heat the body for a certain period of time to kill cancer cells. Because cancer cells are often more sensitive to heat than normal cells, the cancer cells die and the cancer shrinks.

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. A doctor will consult with several kinds of doctors who can help determine the best treatment. Trained medical staff can also help patients recover from treatment and adjust to new ways of eating and talking. Plastic surgery, or help learning to eat and speak, may be needed if a large part of the oropharynx is taken out.

Treatment by stage

Treatment of cancer of the oropharynx depends on where the cancer is in the oropharynx; the stage of the disease; the effect of treatment on the patient's ability to talk, eat, and breathe normally; and the patient?s age and overall health.

Standard treatment may be considered because of its effectiveness in patients in past studies, or participation in a clinical trial may be considered. Not all patients are cured with standard therapy and some standard treatments may have more side effects than are desired. For these reasons, clinical trials are designed to find better ways to treat cancer patients and are based on the most up-to-date information. Clinical trials are ongoing in many parts of the country for patients with cancer of the oropharynx. To learn more about clinical trials, call the Cancer Information Service at 1-800-4-CANCER (1-800-422-6237); TTY at 1-800-332-8615.

Stage I Oropharyngeal Cancer

Treatment may be one of the following

1. Radiation therapy or surgery.

2. A clinical trial of fractionated radiation therapy.

Stage II Oropharyngeal Cancer

Treatment will be surgery to remove the cancer or radiation therapy.

Stage III Oropharyngeal Cancer

Treatment may be one of the following:

1. Surgery to remove the cancer followed by radiation therapy with or without chemotherapy.

2. Radiation therapy alone (which may be fractionated radiation therapy), for cancer in the tonsils or base of the tongue.

3. Radiation therapy combined with chemotherapy.

4. A clinical trial of chemotherapy followed by surgery or radiation therapy.

5. A clinical trial of chemotherapy combined with radiation therapy for cancer that cannot be removed by surgery.

6. A clinical trial of new ways of giving radiation therapy.

Stage IV Oropharyngeal Cancer

If the cancer can be removed by surgery, treatment may be one of the following:

1. Surgery to remove the cancer followed by radiation therapy with or without chemotherapy.

2. Radiation therapy.

3. A clinical trial of chemotherapy combined with radiation therapy.

4. A clinical trial of new ways of giving radiation therapy.

If the cancer cannot be removed by surgery, treatment may be one of the following:

1. Radiation therapy with or without chemotherapy.

2. A clinical trial of chemotherapy followed by surgery or radiation therapy.

3. A clinical trial of chemotherapy with radiation therapy and drugs to make the cancer cells more sensitive to radiation therapy (radiosensitizers).

4. A clinical trial of chemotherapy and fractionated radiation therapy given at the same time.

5. A clinical trial of new ways of giving radiation therapy.

6. A clinical trial of hyperthermia therapy combined 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.

Recurrent Oropharyngeal Cancer

Treatment may be one of the following:

1. Surgery to remove the cancer.

2. Radiation therapy.

3. A clinical trial of chemotherapy.

4. A clinical trial of hyperthermia therapy plus 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.

Changes to This Summary (06/30/2006)

The PDQcancer 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.

Changes were made to this summary to match those made to the health professional version.

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