Oropharyngeal cancer

Oropharyngeal cancer is a disease in which malignant cells form in the tissue of oropharynx. Oropharynx is a middle part of the throat which includes the base of the tongue, the tonsils, the soft palate, and the walls of the pharynx. Oropharyngeal cancers can be divided into two types, HPV-positive, which are related to human papillomavirus infection, and HPV-negative cancers, which are usually linked to alcohol or tobacco use.

Studies

For patients with advanced oropharyngeal cancer the combination of radiotherapy and chemotherapy appears to be as efficient as surgical management. Shiley et al compared the maintenance of swallowing function with the two approaches. They studied 27 patients who underwent the advanced stage (III and IV) of oropharyngeal cancer. Among those patients, 67% had base of tongue lesions and 82% of them used gastrostomy tube either before or during the treatment. Three months after the chemoradiation, 33% of the patients were consuming all nutrition orally, 45% had some oral intake but still had the tube feeding, and 22% had no oral intake at all. The results showed that the short-term incidence of gastrostomy tube dependence after chemo radiation was similar to that after surgical management of oropharyngeal cancer at their institution.

Symptoms

Following are the possible signs of oropharyngeal cancer.

• A sore throat that persists
• Pain or difficulty with swallowing
• Unexplained weight loss
• Voice changes
• Ear pain
• A lump in the back of the throat or mouth
• A lump in the neck
• A dull pain behind the sternum
• Cough

Risk factors

Following are the risk factors that can increase the risk of developing oropharyngeal cancer.

• Smoking and chewing tobacco.
• Heavy alcohol use.
• A diet low in fruits and vegetables.
• Chewing betel quid, a stimulant commonly used in parts of Asia.
• Mucosal infection with human papilloma virus (HPV) (HPV-mediated oropharyngeal cancer)
• EBV infection.
• plummer-Vinson syndrome.
• poor nutrition.
• Asbestos exposure.
• P53 mutation.

CONDITIONS ASSOCIATED WITH MALIGNANT TRANSFORMATION

High-risk lesions

• Erythroplakia
• speckled Erythroplakia
• Chronic hyperplastic candidiasis

Medium- risk lesions.

• oral submucosal fibrosis
• syphilitic glossitis
• sideropenic dysphagia (or paterson-kelly-brown syndrome)

low-risk lesions.

• oral lichen planus
• discoid lupus erythematosus
• discoid keratosis congenita.

Prognosis

Patients with HPV-mediated oropharyngeal cancer tend to have higher survival rates. The prognosis for people with oropharyngeal cancer depends on the age and health of the person and the stage of the disease. It is important for people with oropharyngeal cancer to have follow-up exams for the rest of their lives as cancer can occur in nearby areas. In addition, it is important to eliminate risk factors such as smoking and drinking alcohol, which increase the risk for second cancers.

Spread

There are three ways of cancer spreading in the body.

• Cancer invades the surrounding normal tissues.
• Cancer invades the lymph system and travels through the lymph vessels to other places in the body.
• Cancer invades the veins and capillaries and travels through the blood to other places in the body.

Stages

Stage 0 carcinoma in situ

Abnormal cells are found in the lining of the oropharynx, These may become cancer and spread into nearby normal tissue.

Stage 1

Cancer has formed and is 20 millimetres or smaller and has not spread outside the oropharynx.

Stage 2

Cancer has formed and is larger than 20 millimetres but not larger than 40 millimetres. Also it has not yet spread outside the oropharynx.

Stage 3

• Cancer is larger than 40 millimetres and has not spread outside the oropharynx
• 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 30 millimetres or smaller.

Stage 4A

• 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 and may have spread to one or more nearby lymph nodes; none larger than 60 millimetres.
• Cancer is any size and has spread to one lymph node that is larger than 30 millimetres but not larger than 60 millimetres on the same side of the neck as the cancer or to more than one lymph node, none larger than 60 millimetres, on one of both sides of the neck.

Stage 4B

• 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 and may have spread to nearby lymph nodes
• Cancer has spread to a lymph node that is larger than 60 millimetres and may have spread to tissues around the oropharynx.

Stage 4C

Cancer has spread to other parts of the body; the tumor may be any size and may have spread to lymph nodes.

Glossary

Oropharyngeal squamous cell carcinomas

Oropharyngeal squamous cell carcinomas (OSCC) is a type of head and neck cancer that begins in the oropharynx, the middle part of the throat that includes the soft palate, the base of the tongue, the tonsils and the side and back wall of the throat. Squamous cell cancers of the tonsils are more strongly associated with human papillomavirus infection than are cancers of other regions of the head and neck.

Society and culture

In 2010 American actor Michael Douglas reported to have oropharyngeal cancer.

In 2014, Japanese musician and composer Ryuichi Sakamoto released a statement indicating that he had been diagnosed with oropharyngeal cancer in late June of the same year.

In 2014, American musician and lead guitar player of Green Day, Jason White, was diagnosed with oropharyngeal cancer on December 3.