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Macmillan and Cancerbackup merged in 2008. Together we provide free, high quality information for people affected by cancer through our publications, website and phone service. Find out more|.
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This information is about cancer of the oropharynx (oropharyngeal cancer). There are different cancers which affect the oropharynx, but the most common is squamous cell cancer. This information is about squamous cell cancer of the oropharynx.
You may find it helpful to read it alongside our general information about head and neck cancers|, which discusses the treatments and their effects in more detail.
The oropharynx is the part of the throat that is directly behind the mouth. Oro means mouth and pharynx is the throat. Speaking and swallowing are its main functions. The oropharynx includes the:
Side view of structures in the head and neck
Cancer of the oropharynx is not common. About 890 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 and it’s more common in men.
There are different types of oropharyngeal cancer, but the most common is squamous cell carcinoma. Other rarer types include salivary gland cancer, lymphoma, small cell cancer and sarcoma. This information is about squamous cell carcinoma of the oropharynx.
The main causes of cancer of the oropharynx are smoking and drinking heavily and the risk is greater if you do both. A virus called the human papilloma virus (HPV)|, and eating a poor diet is also linked to an increased risk. Oropharyngeal cancer, like other cancers, is not infectious and can’t be passed on to other people.
The most common symptoms of cancer of the oropharynx are:
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 at an early stage. Tell your doctor if you have any of these symptoms which don’t improve after a few days.
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 in order 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 will be removed and then examined under a microscope (biopsy). 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 which 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.
MRI (magnetic resonance imaging) scan This scan uses magnetism to form a series of cross-sectional pictures of the inside of the body. During the scan, you will be asked to lie very still on a couch inside a metal chamber. You may be given an injection of liquid that helps to make the picture clearer. The test can take up to an hour and is painless. If you don’t like enclosed spaces, you might find the machine claustrophobic. It’s also quite noisy but you’ll be given earplugs or headphones to wear.
CT (computerised tomography) scan This is a special type of x-ray which builds up a three-dimensional picture of the inside of the body. The scan is painless but takes longer than an x-ray (about 10–15 minutes). Most people are given a drink or injection that helps to make the picture clearer. Before having the injection or drink, it is important to tell the person doing this test if you are allergic to iodine or have asthma.
Bone scan 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. Two to three 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.
The stage of a cancer is a term used to describe its size and whether or not it has spread beyond its original site. Once doctors know the stage of the cancer they can decide on the most appropriate treatment for you. The most commonly used staging system for cancer of the oropharynx is called is called the TNM system.
Tumour size (T)
Lymph nodes (N)
Lymph nodes are small bean-like structures and are part of the body’s lymphatic system. The lymphatic system is part of the body’s defence against infection and disease.
One of the ways in which a cancer may spread is through the lymph nodes that are close to the cancer. This is what the N refers to.
Metastases (M)
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 like normal cells. High-grade means the cells look abnormal.
A low-grade tumour will usually grow more slowly and be less likely to spread than a high-grade tumour.
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 surgery|, radiotherapy|, chemotherapy| and monoclonal antibodies|.
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| treats cancer by using high-energy rays to destroy cancer cells, while doing as little harm as possible to normal tissue. The types of radiotherapy used to treat cancer of the oropharynx are external radiotherapy (from a radiotherapy machine) and occasionally internal radiotherapy (placing radioactive material close to the cancer).
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). Radiotherapy can be given together with chemotherapy (called chemo-radiation). It can also be given to the lymph nodes in the neck.
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 painful. Your doctor can prescribe you 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 (naso-gastric (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 to you. People having more complicated surgery may be looked after in a high dependency unit/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 as well as where it is. Your surgeon will also try to remove a section of normal tissue free of cancer cells. 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 larger operations involving removing part of their jawbone or their 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.
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. Some people may have a change in their appearance.
You will usually see a dietician and speech therapist after the operation. They will help you to cope with some of these changes.
Chemotherapy| is the use of anti-cancer (cytotoxic) drugs to destroy cancer cells.
Chemotherapy may be given:
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 chemotherapy drug is usually given by injection into a vein (intravenously). It can temporarily reduce the number of normal cells in your blood. When your blood count is low you are more likely to get an infection. During chemotherapy your blood will be tested regularly and, if necessary, you may be given antibiotics to treat any infection. Blood transfusions| may be given if you become anaemic due to chemotherapy.
Chemotherapy may also cause side effects such as feeling tired|, a sore mouth|, feeling sick (nauseous) 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.
Monoclonal antibodies are drugs that attach themselves to proteins (receptors) found in particular cancers.
Some cancer cells have special types of receptors known as epidermal growth factor receptors (EGFR). When chemical messengers in the body called growth factors attach to these receptors, the cancer cells are stimulated to grow and divide. Monoclonal antibodies can stop the cancer cells from growing by locking onto these receptors. They may also make the cancer cells more sensitive to the effects of radiotherapy and chemotherapy.
Cetuximab (Erbitux®)| is a monoclonal antibody which is given as a drip (infusion) into a vein. It can be used in combination with radiotherapy to treat squamous cell oropharyngeal cancers that have begun to spread into surrounding tissues (locally advanced cancer). Cetuximab can only be given to people who can’t have chemoradiation with cisplatin or carboplatin.
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 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. It’s natural to experience these feelings and it’s important for you to be able to express them.
Each person has their own way of coping with difficult situations. Some people find it helpful to talk to friends or family, 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.
Many people find it helpful to talk to other people going through a similar experience. Our cancer support specialists| can give you more information about support groups in your area.
This section has been compiled using information from a number of reliable sources including:
For further references, please see the general bibliography|.
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