Oropharyngeal cancer

Last updated
Oropharyngeal cancer
Oropharyngeal Cancer.jpg
3D medical illustration showing the cancer formation in the tissues of the oropharynx
Specialty Oncology, head and neck surgery
Symptoms Sore or blister in back of mouth, difficulty with speech, swallowing or breathing, swelling in neck, loss of appetite, loss of weight, and weakness
Causes Human papillomavirus (HPV), [1] [2] [3] [4] tobacco use (smoking and chewing), [1] alcohol use disorder (long-term effects) [1]
Diagnostic method Endoscopy, biopsy, staining for p16, CT scan
Prevention HPV vaccine [1] [2] [3]
Treatment Surgery, [1] radiation, [1] chemotherapy [1]

Oropharyngeal cancer, [1] [2] [3] also known as oropharyngeal squamous cell carcinoma and tonsil cancer, [1] is a disease in which abnormal cells with the potential to both grow locally and spread to other parts of the body are found in the oral cavity, in the tissue of the part of the throat (oropharynx) that includes the base of the tongue, the tonsils, the soft palate, and the walls of the pharynx. [1] [2] [3] [5]

Contents

The two types of oropharyngeal cancers are HPV-positive oropharyngeal cancer, which is caused by an oral human papillomavirus infection; [1] [2] [3] [4] and HPV-negative oropharyngeal cancer, which is linked to use of alcohol, tobacco, or both. [1] [6]

Oropharyngeal cancer is diagnosed by biopsy of observed abnormal tissue in the throat. Oropharyngeal cancer is staged according to the appearance of the abnormal cells on the biopsy coupled with the dimensions and the extent of the abnormal cells found. Treatment is with surgery, chemotherapy, or radiation therapy; or some combination of those treatments.

Signs and symptoms

The signs and symptoms of oropharyngeal cancer may include: [5] [7] [8]

Risk factors

The risk factors that can increase the risk of developing oropharyngeal cancer are: [1] [7]

Major

Minor

Precancerous lesions

High-risk

  • Erythroplakia;
  • Speckled erythroplakia;
  • Chronic hyperplastic candidiasis.

Medium-risk

  • Oral submucosal fibrosis;
  • Syphilitic glossitis;
  • Sideropenic dysphagia (Paterson-Kelly-Brown syndrome).

Low-risk

  • Oral lichen planus; [13]
  • Discoid lupus erythematosus;
  • Discoid keratosis congenita.

Pathophysiology

The cancer can spread three ways: [7]

Diagnosis

Oropharyngeal cancer (from right tonsil, HPV-negative), T4a N2c, 48-year-old man. OropharyngealCancer, 2017, 2,16-30.svg
Oropharyngeal cancer (from right tonsil, HPV-negative), T4a N2c, 48-year-old man.

Diagnosis is by biopsy of observed abnormal tissue in the oropharynx.

Stages

The National Cancer Institute (2016) provides the following definition: [14]

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 mm or smaller and has not spread outside the oropharynx.

Stage 2

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

Stage 3

  • Cancer is larger than 40 mm 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 mm or smaller.

Stage 4A

  • Cancer has spread to tissues near the oropharynx, including the larynx (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 is larger than 60 mm.
  • Cancer is any size and has spread to one lymph node that is larger than 30 mm, but not larger than 60 mm on the same side of the neck as the cancer or to more than one lymph node, none larger than 60 mm, 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 mm 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.

Prevention

Regarding the primary prevention of HPV-positive oropharyngeal cancer, HPV vaccines show more than 90% efficacy in preventing vaccine-type HPV infections and their correlated anogenital precancerous lesions. [1] A research conducted in 2017 demonstrated that HPV vaccination induces HPV antibodies levels at the oral cavity that correlate with circulating levels. [1]

Regarding the primary prevention of HPV-positive oropharyngeal cancer, safe oral sex habits should be advised [1] (see Sex education). Regarding the primary prevention of HPV-negative oropharyngeal cancer, educating people on the risks of chewing betel quid, alcohol use, and tobacco smoking is of the prime importance in the control and prevention of oropharyngeal cancers. [1]

Prognosis

Types of oropharyngeal cancer and associated survival rates Oropharyngeal cancer types and survival rates.png
Types of oropharyngeal cancer and associated survival rates

People with HPV-positive oropharyngeal cancer tend to have higher survival rates. [1] [6] However, HPV is tested for by the presence of the biomarker p16, which normally increases in the presence of HPV. Some people can have elevated levels of p16 but test negative for HPV and vice versa. This is known as discordant cancer. The five-year survival for people who test positive for HPV and p16 is 81%, for discordant cancer it is 53 – 55%, and 40% for those who test negative for p16 and HPV. [15] [16] The prognosis for people with oropharyngeal cancer depends on the age and health of the person and the stage of the disease. [1] 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. [5]

Management

Traditionally, oropharyngeal cancer has been managed through combination of surgery and radiotherapy. Other treatments have been developed including a combination of surgery, radiotherapy, chemotherapy and immunotherapy, but with limited improvement in survival rates. [17] Studies comparing different combinations of treatment on patient outcomes have shown insufficient evidence that any treatment combination is superior to others. [17]

Society and culture

See also

Related Research Articles

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<span class="mw-page-title-main">Human papillomavirus infection</span> Human disease

Human papillomavirus infection is caused by a DNA virus from the Papillomaviridae family. Many HPV infections cause no symptoms and 90% resolve spontaneously within two years. In some cases, an HPV infection persists and results in either warts or precancerous lesions. These lesions, depending on the site affected, increase the risk of cancer of the cervix, vulva, vagina, penis, anus, mouth, tonsils, or throat. Nearly all cervical cancer is due to HPV, and two strains – HPV16 and HPV18 – account for 70% of all cases. HPV16 is responsible for almost 90% of HPV-positive oropharyngeal cancers. Between 60% and 90% of the other cancers listed above are also linked to HPV. HPV6 and HPV11 are common causes of genital warts and laryngeal papillomatosis.

<span class="mw-page-title-main">Esophageal cancer</span> Gastrointestinal system cancer that is located in the esophagus

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<span class="mw-page-title-main">Laryngeal cancer</span> Cancer originating in the larynx (voice box)

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<span class="mw-page-title-main">Head and neck cancer</span> Cancer arises in the head or neck region

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p16 Mammalian protein found in humans

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<span class="mw-page-title-main">HPV-positive oropharyngeal cancer</span> Cancer of the throat

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References

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  11. ↑ Muñoz N, Bosch FX, de Sanjosé S, Herrero R, Castellsagué X, Shah KV, et al. (International Agency for Research on Cancer Multicenter Cervical Cancer Study Group) (February 2003). "Epidemiologic classification of human papillomavirus types associated with cervical cancer". The New England Journal of Medicine. 348 (6): 518–27. doi:10.1056/NEJMoa021641. hdl: 2445/122831 . PMID   12571259. S2CID   1451343.
  12. ↑ Helgadottir H, Höiom V, Jönsson G, Tuominen R, Ingvar C, Borg A, et al. (August 2014). "High risk of tobacco-related cancers in CDKN2A mutation-positive melanoma families". Journal of Medical Genetics. 51 (8): 545–52. doi:10.1136/jmedgenet-2014-102320. PMC   4112445 . PMID   24935963.
  13. ↑ Idrees M, Kujan O, Shearston K, Farah CS (January 2020). "Oral lichen planus has a very low malignant transformation rate: A systematic review and meta-analysis using strict diagnostic and inclusion criteria". Journal of Oral Pathology & Medicine. 50 (3): 287–298. doi:10.1111/jop.12996. PMID   31981238. S2CID   210891674.
  14. ↑ "Oropharyngeal Cancer Treatment". Head and neck Cancer - Patient version. National Institutes of Health - National Cancer Institute. December 2016. Retrieved 12 June 2017.
  15. ↑ Mehanna, Hisham; Taberna, Miren; von Buchwald, Christian; Tous, Sara; Brooks, Jill; Mena, Marisa; Morey, Francisca; Grønhøj, Christian; Rasmussen, Jacob Høygaard; Garset-Zamani, Martin; Bruni, Laia; Batis, Nikolaos; Brakenhoff, Ruud H; Leemans, C René; Baatenburg de Jong, Robert J (March 2023). "Prognostic implications of p16 and HPV discordance in oropharyngeal cancer (HNCIG-EPIC-OPC): a multicentre, multinational, individual patient data analysis". The Lancet Oncology. 24 (3): 239–251. doi:10.1016/s1470-2045(23)00013-x. hdl: 2445/198366 . ISSN   1470-2045. PMID   36796393.
  16. ↑ "Testing for both HPV and p16 can give more precise prognoses in oropharyngeal (throat) cancer". NIHR Evidence. 12 September 2023. doi:10.3310/nihrevidence_59749.
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