Oropharyngeal cancer (cancer of the oropharynx)
There are different cancers that affect the oropharynx, but the most common is squamous cell cancer. This information is about squamous cell cancer of the oropharynx.
You might find it helpful to read this information alongside our general information about head and neck cancers.
We hope this information answers your questions. If you have any further questions, you can ask your doctor or nurse at the hospital where you are having your treatment.
The oropharynx is the part of the throat directly behind the mouth. 'Oro' means mouth and 'pharynx' is the throat. Speaking and swallowing are its main functions. The oropharynx includes the:
soft part of the roof of the mouth (soft palate)
base of the tongue (the part you can’t see)
side walls of the throat (where the tonsils are)
back wall of the throat (posterior pharyngeal wall).
Oropharyngeal cancer is uncommon. About 1,340 people are diagnosed with it each year in the UK. It can happen at any age, but it’s more likely to affect people over 50. It’s more common in men than in women.
There are different types of oropharyngeal cancer, but the most common is squamous cell carcinoma. Other rare types include salivary gland cancer, lymphoma, small cell cancer and sarcoma. This information is about squamous cell carcinoma of the oropharynx.
Causes of oropharyngeal cancer
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The main causes of oropharyngeal cancer are smoking and drinking heavily, and the risk is greater if you do both. A virus called human papilloma virus (HPV) and eating a poor diet are also linked to an increased risk. Oropharyngeal cancer, like other cancers, is not infectious and can’t be passed on to other people.
Signs and symptoms of oropharyngeal cancer
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The most common symptoms of cancer of the oropharynx are:
a painless swelling or lump in the upper neck (you may feel this yourself or it may be picked up by your doctor or dentist)
a sore throat that doesn’t get better
difficulty with swallowing
earache that doesn’t get better
difficulty opening your mouth and jaw (known as trismus)
changes in your speech
These symptoms are common in conditions other than cancer, and most people with these symptoms won’t have cancer of the oropharynx.
However, like other cancers, oropharyngeal cancer is best treated when it’s diagnosed early. Tell your doctor if you have any of these symptoms and they don’t improve after a few days.
How oropharyngeal cancer is diagnosed
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You will be examined by your GP who will refer you to a hospital to be seen by a specialist doctor.
The specialist will examine your oropharynx by using a small mirror and light. A thin, flexible tube with a light at the end (nasendoscope) may be passed into your nostril to get a better view of the back of your mouth and throat. This can be uncomfortable, and you may be given a local anaesthetic spray to numb your nose and throat. If you have a local anaesthetic to your throat, you may be told not to eat or drink for about an hour afterwards, or until the numb feeling has gone.
To make a diagnosis, a piece of affected tissue is removed (biopsy) and then examined under a microscope. This is usually carried out under a general anaesthetic so you may need to spend the night in hospital.
You’ll have blood tests and possibly a chest x-ray to check your general health. There are several other tests that may be used to help diagnose your cancer and to check whether it has spread. The results of your tests will help the specialist to decide on the best type of treatment for you.
CT (computerised tomography) scan
A CT scan takes a series of x-rays that build up a three-dimensional picture of the inside of the body. The scan is painless and takes 10-30 minutes. CT scans use a small amount of radiation, which is very unlikely to harm you and won't harm anyone you come into contact with. You will be asked not to eat or drink for at least four hours before the scan.
You may be given a drink or injection of a dye, which allows particular areas in the body to be seen more clearly. For a few minutes, this may make you feel hot all over. If you’re allergic to iodine or have asthma, you could have a more serious reaction to the injection, so it's important to let your doctor know beforehand.
MRI (magnetic resonance imaging) scan
This test uses magnetism to build up a detailed picture of areas of your body. Before the scan, you may be asked to complete and sign a checklist. This is to make sure that it’s safe for you to have an MRI scan.
Before the scan, you’ll be asked to remove any metal belongings, including jewellery. Some people are given an injection of dye into a vein in the arm. This is called a contrast medium and can help the images from the scan to show up more clearly. During the test you will be asked to lie very still on a couch inside a long cylinder (tube) for about 30 minutes. It is painless but can be slightly uncomfortable, and some people feel a bit claustrophobic during the scan. It’s also noisy, but you’ll be given earplugs or headphones.
This test shows up any abnormal areas of bone. A small amount of a mildly radioactive substance is injected into a vein, usually in the arm. About 2-3 hours later, a scan is taken of the whole body. Any abnormal areas show up on the scan as highlighted areas (sometimes known as hot spots).
This scan will not make you radioactive, and it’s perfectly safe for you to be with other people afterwards.
Staging and grading of oropharyngeal cancer
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The stage of a cancer is a term used to describe its size and whether or not it has spread beyond its original site. Knowing the particular type and stage of a cancer helps the doctors decide on the most appropriate treatment for you.
The most commonly used staging system for cancer is called the TNM system:
T refers to the size or position of the primary tumour (where the cancer first started in the body).
N refers to which lymph nodes are affected, if any.
M refers to whether the cancer has spread to other parts of the body (metastasis).
The T, N and M will often have numbers attached to describe the detail. For example, a T1 tumour may be very small and just in one layer of tissue, whereas a T4 tumour may be larger and spread through several layers of tissue.
The exact details of the T, N and M will depend on the type of cancer.
In addition to TNM staging, you’ll probably hear the doctors use a number staging system. There are usually three or four number stages for each cancer type.
Stage 1 describes a cancer at an early stage when it's usually small in size and hasn’t spread, whereas stage 4 describes cancer at a more advanced stage when it has usually spread to other parts of the body. Stages 2 and 3 are in between these stages.
The number stages are made up of different combinations of the TNM stages. So a stage 1 cancer may be described as either T1, N0, M0 or T2, N0, M0.
Number stages may also be subdivided to give more detailed information about tumour size and spread. For example, a stage 3 cancer may be subdivided into stage 3a, stage 3b and stage 3c. A stage 3b cancer may differ from a stage 3a cancer in either the tumour size or if the cancer has spread to lymph nodes.
Other terms used
You may hear other terms used to describe cancer:
‘Early’ or ‘local’ may be used to describe a cancer that hasn’t spread.
‘Locally advanced’ describes a cancer that has begun to spread into surrounding tissues or nearby lymph nodes.
‘Local recurrence’ means the cancer has come back in the same area after treatment.
‘Secondary’, ‘advanced’, ‘widespread’ or ‘metastatic’ means the cancer has spread to other parts of the body.
Grading refers to the appearance of the cancer cells under the microscope and gives an idea of how the cancer may behave. Low-grade means that the cancer cells look similar to normal cells. High-grade means the cells look more abnormal. A low-grade tumour will usually grow more slowly and be less likely to spread than a high-grade tumour.
Treatment for oropharyngeal cancer
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Your treatment will depend on the stage and grade of your cancer as well as your general health. Your specialist will explain more about the most appropriate treatment for your cancer. You may also be seen by a specialist nurse who will give you information and emotional support.
The usual treatments for oropharyngeal cancer include:
Your doctor will recommend the treatment that is likely to be the most successful in treating your cancer. They will also consider the side effects you’re likely to have and how treatment will affect your ability to speak and swallow. In early oropharyngeal cancer, both surgery and radiotherapy are equally effective. You’ll probably have radiotherapy if surgery is likely to seriously affect your speech and swallowing. Larger cancers are often treated with a combination of different treatments.
The following treatments can either be given separately or combined in a number of ways.
Radiotherapy for oropharyngeal cancer
Radiotherapy treats cancer by using high-energy rays to destroy cancer cells, while doing as little harm as possible to normal tissue.
It is given from a radiotherapy machine, which is similar to an x-ray machine. It is also sometimes called external beam radiotherapy. It does not make you radioactive.
Occasionally, a specialised radiotherapy technique is used called intensity-modulated radiotherapy (IMRT). With IMRT, the radiotherapy beams are shaped very precisely to the area of cancer. This makes sure that a higher dose of radiation is given to the tumour while healthy surrounding cells and nearby structures receive a lower dose of radiation. This can reduce the diotherapy treatment, such as a dry mouth. IMRT is only available in some hospitals.
Radiotherapy can be given alone with the aim of curing a cancer (radical radiotherapy) or after surgery to reduce the risk of the cancer coming back (adjuvant therapy). It can also be used if the cancer comes back in someone who has had previous surgery (but no radiotherapy). For locally advanced tumours of the oropharynx, radiotherapy may be given together with chemotherapy (called chemoradiation). It can also be given to the lymph nodes in the neck.
Side effects of radiotherapy
During radiotherapy, the skin over your face and neck will usually redden or darken and become sore (like sunburn). This starts after about two weeks of treatment and may last for 2-4 weeks after treatment has finished. Sometimes your skin will peel or break. The radiotherapy team will tell you how to look after your skin.
Your mouth and throat will usually become sore and inflamed after a couple of weeks of treatment and you may develop some mouth ulcers. Your voice may also become hoarse. There may be changes to your sense of taste and smell.
Eating food can become difficult and swallowing can become painful. Your doctor can prescribe some medicines to help improve this.
Occasionally, some people may need to have artificial feeding through a tube if they’re unable to eat and losing a lot of weight. A tube may be passed through the nose and into the stomach, called a nasogastric (NG) tube, or passed directly into the stomach. This is only done for a short time until treatment is finished and your swallowing is back to normal.
Radiotherapy to this area can cause the salivary glands to produce less saliva. The lining of the mouth and throat may become dry and this can make eating and speech difficult. There are artificial saliva sprays that can help make your mouth feel more comfortable. You can read more about this in our information on coping with a dry mouth.
Most of these side effects are usually temporary and will gradually improve once your treatment is over. However, many people continue to have problems with a dry mouth after their treatment is over.
Surgery may also be used, although radiotherapy on its own or with chemotherapy is more commonly used. Surgery can also be used if the cancer comes back after previous radiotherapy, or to relieve symptoms.
The length of time you spend in hospital will depend on the extent of the surgery you need. Your surgeon will explain more about this. People having more complicated surgery may be looked after in a high dependency unit or intensive care for a while after their operation.
The surgeon will usually make a cut (incision) in your neck or jawbone to remove the cancer. The amount of tissue removed will depend on the size of the cancer and where it is. Your surgeon will also try to remove a section of normal tissue from the area surrounding the cancer. This is known as a clear margin and helps reduce the chance of the cancer coming back. You may also have some of the lymph nodes in your neck removed (called a neck dissection).
Some people may need to have a larger operation that involves removing part of their jawbone or tongue. This will be done by a specialist head and neck surgeon. The surgery will involve rebuilding the area using tissue, skin or bone taken from somewhere else in the body. People having this type of surgery may need to stay in hospital for up to a few weeks.
Side effects of surgery
These depend on the type and extent of surgery that you have. They may affect your speech, swallowing or your sense of taste and smell. You will usually see a dietitian and speech therapist after the operation. They will help you cope with some of these changes.
Some people may have a change in their appearance. If you struggle to come to terms with this, speak to a nurse or doctor. They can offer support or refer you to a counsellor.
Chemotherapy for oropharyngeal cancer
Chemotherapy is the use of anti-cancer (cytotoxic) drugs to destroy cancer cells. Chemotherapy may be given:
before radiotherapy or (rarely) before surgery
at the same time as radiotherapy (chemoradiation)
after radiotherapy or surgery (adjuvant chemotherapy)
if the cancer has spread to other parts of the body.
Chemoradiation may be used instead of surgery if the cancer has spread from where it started to areas nearby (locally advanced). This can avoid the effects on speech and swallowing that surgery may cause. It’s important that someone is fit enough to cope with having the two treatments. The side effects, particularly a sore skin and mouth, are worse when chemotherapy and radiotherapy are given together.
The drugs usually used to treat cancer of the oropharynx are cisplatin, fluorouracil (5FU), carboplatin, docetaxel (Taxotere®) and paclitaxel (Taxol®).
The drugs are usually given by injection into a vein (intravenously). They can temporarily reduce the number of normal blood cells in your blood. When your blood count is low you're more likely to get an infection. During chemotherapy your blood will be tested regularly. If necessary, you may be given antibiotics to treat any infection. Blood transfusions may be given if you become anaemic (have a low number of red blood cells) due to chemotherapy.
Chemotherapy can also cause side effects such as feeling tired, a sore mouth, feeling sick (nausea) or being sick (vomiting), diarrhoea and hair loss. Let your doctor or nurse know about any side effects as they can often prescribe drugs to reduce these.
Targeted therapies for oropharyngeal cancer
In order to grow and divide, cancer cells ‘communicate’ with each other using chemical signals. Targeted therapies are drugs that interfere with this process and so affect the cancer’s ability to grow.
Cetuximab is the most commonly used targeted therapy to treat oropharyngeal cancer. It’s given as a drip (infusion) into a vein.
It may be used:
in combination with radiotherapy for people who aren’t fit enough to cope with the side effects of chemoradiation
as part of a clinical trial in combination with chemoradiation
with palliative chemotherapy (treatment to control symptoms).
How cetuximab works
Most squamous cell cancers of the oropharynx have proteins called epidermal growth factor receptors (EGFRs) on their surface. When chemical messengers in the body called growth factors attach to these receptors, it stimulates the cancer to grow.
Cetuximab stops the growth factors from attaching to receptors on the cancer and so may stop it growing. It may also make the cancer more sensitive to the effects of radiotherapy.
Your specialist will be able to tell you more about this and whether it’s a suitable treatment for you.
After your treatment is completed, you will have regular check-ups and possibly scans or x-rays. These will probably continue for several years. If you have any problems or notice any new symptoms between these times, let your GP or hospital doctor know as soon as possible.
You are likely to experience a number of different feelings, from shock and disbelief to feeling frightened and angry. These feelings can be overwhelming and difficult to control, particularly if you have experienced changes in your appearance. These feelings are natural and it’s important for you to be able to express them.
Everyone has their own way of coping with difficult situations. Some people find it helpful to talk to family or friends, while others prefer to get help from people outside their situation. Some people prefer to keep their feelings to themselves. There’s no right or wrong way to cope.
You can talk to your doctor or specialist nurse about how you’re feeling. They may be able to refer you to a trained counsellor who can listen and help you deal with difficult emotions. Our cancer support specialists can also give you advice about finding a counsellor in your area.
Many people find it helpful to talk to other people going through a similar experience. We can give you more information about support groups in your area. You may also find our online community helpful, where you can talk to people any time about what you’re going through.
This fact sheet has been compiled using information from a number of reliable sources, including:
National Institute for Health and Clinical Excellence (NICE). Cetuximab for the treatment of locally advanced squamous cell cancer of the head and neck. June 2008.
Scottish Intercollegiate Guidelines Network (SIGN). Diagnosis and management of head and neck cancer. Guideline No 90. November 2006.
Genden M, Vavares M. Head and Neck Cancer: An Evidence-Based Team Approach. 2008. Thieme Publishers.
National Institute for Health and Clinical Excellence (NICE). Improving Outcomes in Head and Neck Cancers. November 2004.
Tobias, Hochauser. Cancer and its management. 6th edition. 2010. Oxford Blackwell Scientific Publications.
UpToDate. Treatment of early (stage 1 and 2) head and neck cancer: The oropharynx. (accessed September 2012).
UpToDate. Treatment of locally advanced (stage 3 and 4) head and neck cancer: The oropharynx. (accessed September 2012).
With thanks to Dr Amen Sibtain, Consultant Clinical Oncologist, and the people affected by cancer who reviewed this edition. Reviewing information is just one way of the ways you could help when you join our Cancer Voices network.