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Oropharyngeal cancer is sometimes called oropharyngeal carcinoma. It is a type of head and neck cancer that develops in the oropharynx.
The oropharynx is the middle part of the throat behind the mouth. This area helps you speak and swallow. 'Oro' means mouth and the 'pharynx' is the throat. It includes the soft part of the roof of the mouth (soft palate), the base or the back of the tongue (the part you cannot see), the tonsils and the side walls of the throat.
The most common type of oropharyngeal cancer is squamous cell cancer. Squamous cell cancer of the oropharynx is one of the most common types of head and neck cancer.
The throat (pharynx)
The throat is also known as the pharynx. It is divided into 3 main parts:
This is the upper part of the pharynx, behind the nose. Cancer that develops here is called nasopharyngeal cancer or sometimes cancer of the post-nasal space.
This is the middle part of the pharynx, behind the mouth. It includes the soft part of the roof of the mouth (soft palate), the base or the back of the tongue (the part you cannot see), the tonsils and the side walls of the throat. The most common places for oropharyngeal cancer to develop are on the tonsils and the base of the tongue, or rarely the back in the throat.
This is the lower part of the pharynx, behind the voice box. Cancers that develop here are called hypopharyngeal cancers.
The most common places for oropharyngeal cancer to develop are on the tonsils and the base of the tongue.
Symptoms of cancer can include:
- a painless swelling or lump in the neck – this is the most common symptom
- a sore throat or tongue
- difficulty swallowing, or moving your mouth and jaw
- changes in your voice
- bad breath
- unexplained weight loss
- unequal-looking tonsils.
With certain head and neck symptoms, your dentist or GP should refer you to see a specialist within 2 weeks. This is called an urgent referral. An urgent referral symptom includes having a lump in the neck that does not go away.
All these symptoms can be caused by other conditions. But it is important to have them checked by your doctor. Oropharyngeal cancer can be treated most successfully when it is diagnosed early.
We have more information about the signs and symptoms of head and neck cancer.
The exact causes of oropharyngeal cancers are not known. But there are risk factors that can increase your chance of developing it.
The main risk factors for oropharyngeal cancer are:
- smoking or chewing tobacco or chewing betel quid, with or without tobacco
- regularly drinking large amounts of alcohol – the more years someone drinks for, the higher the risk.
Your risk of developing oropharyngeal cancer is higher if you do both.
Some cases of oropharyngeal cancer are linked to an infection called human papilloma virus (HPV). Oropharyngeal cancers linked to HPV often start in the tonsils or the base of the tongue.
HPVs are a group of common infections that can affect areas such as the inside of the mouth, the throat, genital area or anus. Some types of high-risk HPV can increase the risk of certain cancers. Most people have HPV at some time during their life. But most people with HPV in the mouth do not develop oropharyngeal cancer.
As with other cancers, oropharyngeal cancer is not infectious and cannot be passed on to other people.
We have more information about the causes and risk factors of head and neck cancer.
You usually begin by seeing your GP or dentist. If they think your symptoms could be linked to cancer, they will refer you to a specialist head and neck doctor.
You will usually see a specialist within 2 weeks. You may see an ear, nose and throat (ENT) specialist or an oral and maxillofacial specialist (OMFS). The specialist doctor will ask about your symptoms and general health. They will examine your mouth and throat using a small mirror and bright light.
If your only symptom is a lump in your neck, you may be referred to the ear, nose and throat (ENT) department at a hospital that has a neck lump clinic.
You may have some of the following tests:
A nasendoscope is a thin, flexible tube with a light and camera on the end. It allows your doctor to look inside your nose, the back of your nose and your throat.
To make a diagnosis, your doctor needs to remove a small piece of tissue or some cells (biopsy) from the area that looks abnormal. Your doctor may take a biopsy while they are examining you with the nasendoscope. Or they might arrange for you to have a general anaesthetic to take the biopsy.
A doctor who specialises in analysing cells is called a pathologist. They look at the sample under a microscope for cancer cells.
Ultrasound scan of the neck
If you have a lump or a swelling in your neck you usually have an ultrasound scan. This uses soundwaves to produce a picture of your neck and lymph nodes.
Fine needle aspiration (FNA) of the lymph nodes
You may have a fine needle aspiration test to see whether there are any cancer cells in the lymph nodes. But it can also be done to take samples from the mouth or throat. The doctor passes a fine needle into the lump. They withdraw (aspirate) some cells into the syringe. Sometimes they use an ultrasound scan to help the doctor to guide the needle into the correct area.
We have more information about tests for head and neck cancer.
Further tests for oropharyngeal cancer
Your specialist may arrange further tests. These may help diagnose oropharyngeal cancer or be used to check whether it has spread:
Testing for for human papilloma virus (HPV)
Waiting for test results can be a difficult time, we have more information that can help.
The results of the tests help your doctors find out more about the size and position of the cancer and whether it has spread. This is called staging. The most commonly used staging systems for oropharyngeal cancers are the TNM and number staging systems.
Some oropharyngeal cancers may also be given a grade. This is how the cancer cells look under the microscope. The grade of the cancer gives an idea how quickly the cancer may grow.
Oropharyngeal cancer and HPV
If oropharyngeal cancer contains human papilloma virus (HPV), it is called HPV positive oropharyngeal cancer. If there is no HPV, it is called HPV negative oropharyngeal cancer.
Doctors stage HPV positive oropharyngeal cancers differently to HPV negative oropharyngeal cancers. Your doctor can tell you the stage of oropharyngeal cancer you have.
HPV negative oropharyngeal cancers are graded in the same way as other head and neck cancers. Doctors do not grade HPV positive oropharyngeal cancers.
Knowing the stage and grade of oropharyngeal cancer and whether it is positive or negative for HPV helps your doctors plan the best treatment for you.
We have more information about staging and grading of head and neck cancer.
Treatments for oropharyngeal cancer include surgery, radiotherapy and chemotherapy. Sometimes an immunotherapy may be used.
A team of specialists will meet to discuss the best possible treatment for you. This is called a multidisciplinary team (MDT).
Your cancer doctor or specialist nurse will explain the different treatments, any possible side effects and support you will have. They will also talk to you about things to consider when making treatment decisions before you agree (consent) to have treatment.
You will also usually be given advice about preparing for your treatment (sometimes called prehabilitation). This helps to improve your fitness and diet and help to get you ready mentally before treatment. If you smoke, it can also help you with stopping smoking.
Your treatment will depend on the stage of the cancer of the cancer, as well as your general health.
Treatment for oropharyngeal cancer may include:
Surgery may be used to remove small, early-stage oropharyngeal cancer. It can sometimes be used to treat more advanced stages of oropharyngeal cancer.
For small cancers, it may be possible to do the operation through the mouth. This is called transoral surgery. Surgeons often use techniques including laser or robotic surgery to remove a cancer in the back of the throat. Transoral surgery does not leave any scars on the neck or face.
If the cancer is larger or in a difficult position, the surgeon may remove the cancer through a cut in the neck. Sometimes they need to separate part of the jawbone or tongue to remove all the cancer. The surgeon may use tissue, skin or bone taken from somewhere else in the body to rebuild these areas. This is called reconstructive surgery.
Depending on your operation, some people may have a feeding tube put in before or during surgery. It can usually be removed once you are able to swallow. If you are likely to need this, your team will discuss it with you before your operation.
We have more information about recovering from your operation.
RadiotherapyRadiotherapy uses high-energy rays to destroy the cancer cells. Doctors use certain types of radiotherapy that give a higher dose to the area being treated while reducing the dose to normal tissue.
Radiotherapy can be given on its own, with the aim of curing an early-stage cancer. It may also be used with surgery or chemotherapy to treat larger cancers and cancers that have spread to the lymph nodes.
Radiotherapy can also be used after surgery to reduce the risk of the cancer coming back. It may also be used to treat the neck area if there are signs of cancer in the lymph nodes.
You may have side effects during and for a few weeks after radiotherapy. These usually get better slowly after treatment finishes.
Chemotherapy uses anti-cancer (cytotoxic) drugs to destroy cancer cells. For oropharyngeal cancer, it is usually given with radiotherapy. This is called chemoradiation. Chemotherapy may be given on its own if cancer has spread to other parts of the body. The chemotherapy drugs most often used to treat oropharyngeal cancer are:
Chemoradiation is when you have chemotherapy with radiotherapy.
Chemoradiation is often used as the main treatment for locally advanced oropharyngeal cancer. It may also be given after surgery to reduce the risk of cancer returning.
Chemotherapy can make the cancer cells more sensitive to radiotherapy treatment.
Immunotherapies are treatments that use the immune system to find and attack cancer cells.
An immunotherapy drug called pembrolizumab may be used to treat some oropharyngeal cancers that have spread or cannot be removed with surgery. It may be used on its own or in combination with chemotherapy.
Nivolumab is an immunotherapy that may be used for head and neck cancer if chemotherapy treatment has not been effective. Pembrolizumab and nivolumab may also be called checkpoint inhibitors.
We have more information about immunotherapies for head and neck cancer.
You may have some treatments as part of a clinical trial.
You have regular follow-up appointments after treatment with your specialist doctor. These may continue for several years. You may also have regular follow-up appointments with your multidisciplinary team (MDT), including a speech and language therapist (SLT), dietitian, restorative dentist and dental hygienist and sometimes a physiotherapist.
If you have any problems or notice new symptoms between appointments, let your doctor or nurse know as soon as possible.
Long-term or late effects
Some treatment side effects may take a long time to improve after treatment finishes, or they may become permanent. These are called long-term effects. Other side effects can develop months or even years after treatment has finished. These are known as late effects. We have more information about long-term and long-term and late effects of head and neck cancer treatment.
Head and neck cancer and its treatment can sometimes have an effect on your sex life.
If you are worried about this, talk to your doctor or nurse. You can read about things that may help in our information on cancer and sex.
Some cancer treatments can also affect whether you can get pregnant or make someone pregnant. If you are worried about this, it is important to talk with your doctor before you start treatment.
We have more information about:
Well-being and recovery
Even if you already have a healthy lifestyle, you may choose to make some positive lifestyle changes during and after treatment. For example, if you smoke or drink alcohol, it is best to avoid smoking or reduce the amount of alcohol.
Eating well and keeping active can improve your health and well-being. It can also help your body recover. Your dietitian can help with any difficulties you might have with eating after treatment.
It may take several months to recover from treatment. It can be hard if treatment has changed your appearance, how you eat or drink, or your voice. This may also affect your body image but there are ways to help you to manage any changes.
There are also national support groups that you may find helpful:
- The Mouth Cancer Foundation
The Mouth Cancer Foundation gives information and support to people affected by head and neck cancers.
- Changing Faces
Changing Faces offers advice and information to anyone who is affected by a change in their appearance.
- The Swallows Head and Neck Cancer Support Group
The Swallows offers a 24-hour support line to anyone affected by head and neck cancer.
- Salivary Gland Cancer UK
Salivary Gland Cancer UK supports people with rare salivary gland cancers, such as adenoid cystic carcinoma, ACC, and unknown carcinoma.
Macmillan is also here to support you. If you would like to talk, you can:
Below is a sample of the sources used in our oropharyngeal cancer information. If you would like more information about the sources we use, please contact us at firstname.lastname@example.org
British Association of Head and Neck Oncologists. BAHNO Standards, 2020. Available from: bahno.org.uk/_userfiles/pages/files/final_bahno_standards_2020.pdf (accessed August 2022).
Squamous cell carcinoma of the oral cavity, larynx, oropharynx and hypopharynx: EHNS–ESMO–ESTRO Clinical practice guidelines for diagnosis, treatment and follow-up. November 2020. Available from www.annalsofoncology.org/article/S0923-7534(20)39949-X/fulltext (accessed August 2022).
British Association of Head and Neck Oncologists. Head and neck cancer: United Kingdom National Multidisciplinary Guidelines. 2016. Available from: www.bahno.org.uk/_userfiles/pages/files/ukheadandcancerguidelines2016.pdf (accessed August 2022).
National Institute for Health and Care Excellence (NICE). Cancer of the upper aerodigestive tract: assessment and management in people aged 16 and over NICE guideline NG36 Published: 10 February 2016. Last updated: 06 June 2018. Available from: www.nice.org.uk/guidance/ng36/chapter/recommendations (accessed August 2022)
This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert medical and health professionals and people living with cancer. It has been approved by Senior Medical Editor, Dr Chris Alcock, Consultant Clinical Oncologist.
Our cancer information has been awarded the PIF TICK. Created by the Patient Information Forum, this quality mark shows we meet PIF’s 10 criteria for trustworthy health information.