Oropharyngeal Cancer: Symptoms and Treatment

Overview

Oropharyngeal
cancer, also called throat cancer, is a disease in which malignant cells form
in the tissues of the oropharynx, the middle part of throat. The oropharynx contains
the back of tongue, tonsils, and soft palate as well as the pharynx wall. The
cells in this area are mostly made up of squamous cells. These cells grow
abnormally, which leads to the development of tumor.

Oropharyngeal
cancer is a type of head and neck cancer.

In the United States, it is estimated that 51,540 adults have been diagnosed with oral and oropharyngeal cancer and the rates are twice as high in men as in women. The average age for diagnosis is 62, though it can also occur in young people.

Causes

It
is believed that drinking alcohol and smoking can most commonly increase the
risk of getting oropharyngeal cancer. The risk is even higher if you do both.

In many
cases, oropharyngeal cancer is linked to being infected with human papilloma
virus (HPV), especially HPV type 16. HPV is a common virus spread through skin
contact, often during sex.

Eating
a poor diet with low levels of fruit and vegetables may increase the risk of
oropharyngeal cancer.

Chewing betel quid, which is a stimulant commonly used in parts of Asia, is also a risk factor of oropharyngeal cancer.

Personal history or family history of head and neck cancer can increase the potential risk of oropharyngeal cancer.

Symptoms

Sometimes,
oropharyngeal cancer does not cause signs or symptoms. When the condition
progresses, noticeable symptoms may appear. Generally, the first symptom of
oropharyngeal cancer is a painless swelling or lump in the neck. Other typical
symptoms are as follows:

  • A sore throat
  • Ear pain
  • A lump in the back of the mouth, throat, or neck
  • Difficulty swallowing
  • Difficulty opening the mouth fully
  • Difficulty moving the tongue
  • Changes in your voice
  • Chronic bad breath
  • Coughing up blood
  • Weight loss
  • Fatigue
  • Loss of appetite

Diagnosis

The
diagnostic procedures may first start with a complete medical history of the
patient and physical examination. The doctor will use a thin, flexible tube
with a light and a camera at the end, which is called nasendoscope, to get a
better view of the back of your throat and check for abnormal areas. Besides, the
following tests may be used:

  • Biopsy. In this procedure, the doctor will remove a small piece of tissue or cells and examine it under a microscope to look for signs of cancer. The patient may have an injection of an anaesthesia to numb the area, then the doctor will collect tissue or cells.

  • Ultrasound scan. This test uses sound waves to produce a picture of the neck and lymph nodes on a computer screen. Lymph nodes are part of the body’s system to protect people from infection and disease. Sometimes oropharyngeal cancer can spread to the neck lymph nodes.

  • CT (computerized tomography) scan. It can show detailed pictures of areas inside the body, such as the head and neck, taken from different angles. A dye is injected into a vein or swallowed to make the organs or tissues show up more clearly.

  • MRI scan. It uses a magnet, radio waves, and a computer to make detailed pictures of areas inside the body.

  • PET scan. It can be used to find malignant tumor cells in the body. A small amount of radioactive glucose is injected into a vein. The PET scanner rotates around the body and takes a picture of where glucose is being used in the body.

  • Fine needle aspiration (FNA) of the lymph nodes. If the lymph nodes in the neck don’t look normal on the scan, FNA will be recommended. It is used to see if there are any cancer cells in the lymph nodes. The doctor passes a fine needle into the lymph node and removes some cells into a syringe. The procedure might feel a little uncomfortable but it is very quick.

  • Staging. The stage of a cancer describes its size and whether it has spread. Knowing the stage can help doctors determine the best treatment for the patient.

If
cancer is found, the following test may be done to study the cancer cells:

HPV test (human papillomavirus test). It is a laboratory test used to check the sample of tissue for certain types of HPV infection. This is because oropharyngeal cancer can be caused by HPV.

Treatment

There
are different types of treatment for oropharyngeal cancer, which depend on the
stage and grade of the cancer as well as your general health.

  • Surgery

Surgery
is a common treatment of all stages of oropharyngeal cancer. The doctor may
remove both the tumor and some of the healthy tissue around the cancer. Although
the surgery may remove all the tumors, some patients still need chemotherapy or
radiation therapy after surgery to kill the cancer cells that are left.

  • Radiation therapy

Radiation
therapy uses high-energy X-rays or other types of radiation to destroy the
cancer cells, while doing as little harm as possible to normal tissue. It can
reduce the risk of cancer coming back. 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.

  • Chemotherapy

Chemotherapy
uses anti-cancer drugs to stop the growth of cancer cells, by killing the cells
or stopping them from dividing. For oropharyngeal cancer, it is usually given
with radiotherapy. Chemotherapy can also be given alone if cancer has spread to
other parts of the body.

  • Targeted therapy

Targeted therapy uses drugs or other substances to attack specific cancer cells. Targeted therapy usually causes less harm to normal cells than chemotherapy and radiation therapy do. Cetuximab is the most commonly used targeted therapy to treat oropharyngeal cancer.

Keywords: Oropharyngeal cancer

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