The oropharynx is the part of the throat directly behind the mouth. Symptoms of oropharyngeal cancer include:
If you have symptoms, it is important to have them checked by your GP. They may refer you to a specialist for tests. These may include a test to examine your throat closely. The doctor may also take a small sample of tissue (biopsy) to make a diagnosis.
Treatments for oropharyngeal cancer include:
Your doctor will discuss with you the best treatment for you. Side effects of treatment depend on your situation and the treatment you have. You may get a sore or dry mouth and have difficulty eating. Your hospital team will tell you more about what to expect. There are lots of things that can help you manage side effects during and after treatment.
The oropharynx is the part of the throat directly behind the mouth. This area helps you speak and swallow. 'Oro' means mouth and the 'pharynx' is the throat. The oropharynx includes the:
Your risk of oropharyngeal cancer is increased if you:
Your risk of developing oropharyngeal cancer is higher if you do both.
Many cases of oropharyngeal cancer are linked to an infection called human papilloma virus (HPV). HPV is a common virus that spreads through skin contact, often during sex. Most people who are sexually active have HPV at some time during their life.
The body’s immune system is normally able to get rid of an HPV infection, and usually infections do not cause any problems. But it is thought that the virus can sometimes be inactive for many months or even years before causing cell changes. Over time, these cell changes may develop into cancer.
Most people with HPV in the mouth do not develop oropharyngeal cancer.
Often the first symptom or oropharyngeal cancer is a painless swelling or lump in the neck.
Other common symptoms include:
These symptoms can be caused by other conditions. But it is important to have them checked by your doctor. Oropharyngeal cancer can be treated more successfully when it is diagnosed early.
You usually start by seeing your GP or dentist. They will examine your mouth closely.
They will refer you to a hospital specialist if:
The specialist doctor will ask you about your symptoms and general health. They will examine your mouth and throat using a bright light.
If your only symptom is a lump in your neck, you may be referred to a hospital that has a neck lump clinic.
You may have some of the following tests.
You may have this test in the outpatient clinic. The doctor passes a thin, flexible tube called a nasendoscope into your nose, over the back of your tongue and down into the upper part of your throat. The tube has a light and camera at the end, to help the doctor get a better view of the back of your throat. You might find this a bit uncomfortable, but it only takes about a minute.
Before the test, the doctor may numb your nose and throat with an anaesthetic spray. Some people prefer to have this done without the anaesthetic spray. If you have this spray, do not eat or drink for about an hour afterwards, or until the numbness wears off. This is because there is a risk that food and drink may go down the wrong way into your lungs when you swallow. You could also burn your mouth or throat with hot food or drinks.
To make a diagnosis, your doctor needs to remove a small piece of tissue or some cells from the area that looks abnormal. This is called a biopsy. A doctor who specialises in analysing cells (pathologist) looks at the sample under a microscope. They check the sample for any cancer cells.
A biopsy can be taken in different ways. 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.
This is a one-stop clinic where you can have all the tests needed to check for cancer in a neck lump.
You usually have an ultrasound scan and a sample of tissue taken from the lump using fine needle aspiration. Sometimes your throat is also examined using a nasendoscope.
The clinic may give you the results of your tests on the same day. But sometimes you may need to wait up to 7 to 10 days.
This test uses sound waves to produce a picture of your neck and lymph nodes on a computer screen. Lymph nodes are part of the lymphatic system, which helps to protect us from infection and disease.
The scan is painless and only takes a few minutes. The doctor puts some gel onto your neck and moves a small device which produces sound waves over the area. They look for any changes in the size or appearance of the lymph nodes in your neck.
You may have this test if the lymph nodes in your neck do not feel or look normal on the scan. It is done to see whether there are any cancer cells in the lymph nodes.
The doctor passes a fine needle into the lymph node. They withdraw (aspirate) some cells into a syringe. Sometimes the doctor uses an ultrasound scan to help guide the needle into the area.
The test might be uncomfortable, but it is very quick. You do not usually need a local anaesthetic to numb the area. It is common to have some bruising or soreness in the area the sample was taken from. The soreness may last for a week or so. Taking mild painkillers should help. Ask your nurse or doctor what they recommend.
After the test, a doctor who specialises in analysing cells (called a pathologist) will look at the sample under a microscope to check for cancer cells. Occasionally, a small biopsy may also be taken from the lymph node. This is often done under local anaesthetic.
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These tests may be used to help diagnose oropharyngeal cancer and to check whether it has spread.
A CT scan takes a series of x-rays, which build up a three-dimensional picture of the inside of the body. The scan takes 10 to 30 minutes and is painless. It uses a small amount of radiation. This is very unlikely to harm you and will not harm anyone you come into contact with. You may be asked not to eat or drink for at least four hours before the scan.
You may be given an injection of a dye, which allows particular areas to be seen more clearly. This may make you feel hot all over for a few minutes. It is important to let your doctor know if you are allergic to iodine or have asthma. You could have a more serious reaction to the injection.
You will probably be able to go home as soon as the scan is over.
This is a combination of a CT scan, which takes a series of x-rays to build up a three-dimensional picture, and a positron emission tomography (PET) scan. A PET scan uses low-dose radiation to measure the activity of cells in different parts of the body.
PET-CT scans give more detailed information about the part of the body being scanned. You may have to travel to a specialist centre to have one. You cannot eat for six hours before the scan, although you may be able to drink. A mildly radioactive substance is injected into a vein, usually in your arm. The radiation dose used is very small. You will wait for at least an hour before you have the scan. It usually takes 30 to 90 minutes. You should be able to go home after the scan.
An MRI scan uses magnetism to build up a detailed picture of areas of your body. The scanner is a powerful magnet so you may be asked to complete and sign a checklist to make sure it is safe for you. The checklist asks about any metal implants you may have, such as a pacemaker, surgical clips or bone pins, etc.
You should also tell your doctor if you have ever worked with metal or in the metal industry as very tiny fragments of metal can sometimes lodge in the body. If you do have any metal in your body, it is likely that you will not be able to have an MRI scan. In this situation, another type of scan can be used. Before the scan, you will be asked to remove any metal belongings including jewellery.
Some people are given an injection of dye into a vein in the arm, which does not usually cause discomfort. This is called a contrast medium and can help the images from the scan to show up more clearly. During the test, you will 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. It is also noisy, but you will be given earplugs or headphones. You can hear, and speak to, the person operating the scanner.
If you have oropharyngeal cancer, your doctor may do a test to see if the cancer is linked to the human papilloma virus (HPV). Knowing more about the type of cancer helps doctors decide on the best treatment for you.
A radiographer explains how a CT scan works, and Jyoti talks about her experience.
A radiographer explains how a CT scan works, and Jyoti talks about her experience.
The stage of a cancer describes its size and whether it has spread from where it started. Knowing the stage helps doctors decide on the best treatment for you.
The most commonly used staging systems for oropharyngeal cancer are the TNM and number staging systems.
TNM stands for tumour, node and metastases
There are usually 3 or 4 number stages for each cancer type. Stage 1 describes a cancer at an early stage when it is usually small in size and has not spread. Stage 4 describes a cancer at a more advanced stage when it has usually spread to other parts of the body.
Your doctor can tell you more about the stage of your cancer.
Your doctor may use other terms to describe the stage of the cancer:
The grade of a cancer gives the doctors an idea of how quickly it may develop. Doctors will look at a sample of the cancer cells under a microscope to find the grade of the cancer.
Your treatment will depend on the stage and grade of the cancer, as well as your general health. Your specialist doctor or nurse will explain the best treatment for you and side effects that are likely.
Your specialist doctor plans your treatment carefully. The aim is to treat the cancer while doing as little damage as possible to your throat and facial appearance. They will talk to you about the best treatment options for you and any likely side effects.
Treatments used for oropharyngeal cancer include surgery, radiotherapy, chemotherapy and targeted therapy. If you have a small, early-stage cancer, you may be treated with either surgery or radiotherapy. If the cancer is bigger or has spread to the lymph nodes, you usually have a combination of treatments. Often chemotherapy and radiotherapy are given together. This is called chemoradiation. Some people have surgery followed by radiotherapy or chemoradiation.
Surgery can be used to remove early-stage oropharyngeal cancer. Sometimes surgery is used to treat more advanced stages of oropharyngeal cancer.
How the surgeon removes the cancer depends on its size and where it is. They explain the operation to you beforehand, and you can ask any questions you have about it.
For small cancers, it may be possible to do the operation through the mouth. This is called transoral surgery. The surgeon carefully removes the cancer, often using a laser. Transoral surgery does not leave any scars on the neck or face. You may also recover faster and have fewer problems with your speech or ability to swallow.
If the cancer is bigger or in a difficult position, the surgeon may do the operation through a cut in the neck. Sometimes they need to divide 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.
The surgeon may also remove some lymph nodes from the neck. They do this through a cut in the neck. They may do this to remove cancer that has spread to the lymph nodes, or to reduce the risk of the cancer coming back.
How long you stay in hospital depends on the operation you need. If your surgery is more complicated, you might stay in hospital for up to 3 weeks. And you may be looked after in a high-dependency unit or intensive care for a while after the operation. Your specialist doctor can tell you more about the type of operation and how long you may need to stay in hospital.
We have more information about what to expect before and after surgery.
Depending on the type of operation you have, it might:
Your surgeon will explain what to expect and what support is available. A speech and language therapist (SLT) will help you prepare for the operation. They will also help you cope with any changes to your speech or how you swallow.
You can read more in our general information about head and neck cancers. You may also find some of these organisations helpful:
A speech and language therapist and someone who has had a laryngectomy discuss different ways to communicate.
A speech and language therapist and someone who has had a laryngectomy discuss different ways to communicate.
Radiotherapy uses high-energy rays to destroy cancer cells, while doing as little harm as possible to normal cells.
Radiotherapy can be given on its own with the aim of curing an early-stage cancer. It may also be used with surgery, chemotherapy or targeted therapy to treat bigger cancers and cancer that has spread to the lymph nodes.
Radiotherapy can also be used after surgery to reduce the risk of the cancer coming back. The lymph nodes in the neck are often treated if there are no signs of cancer there. This is because some of the lymph nodes may contain some cancer cells that cannot be seen on scans.
Chemoradiation is often used as the main treatment for locally advanced oropharyngeal cancer. It may also be given after surgery. Having chemoradiation is more effective than having chemotherapy or radiotherapy alone, but it can cause more severe side effects. It is important that you are well enough to cope with having both treatments together.
To make sure that your radiotherapy is as effective as possible, it has to be carefully planned. Planning your treatment makes sure the radiotherapy is aimed precisely at the cancer, so it causes the least possible damage to the surrounding healthy tissue. The treatment is planned by a specialist doctor called a clinical oncologist.
You usually need to have a clear plastic mould or mask made before your treatment is planned. This helps keep your head in the same position for each session of radiotherapy. The mask should not be uncomfortable and does not affect your breathing. We have a video that shows how radiotherapy masks are made. If you are worried about the mask, let your radiotherapy team know so they can help.
Radiotherapy is normally given as a series of short, daily outpatient treatments with a rest at the weekend. Each treatment only takes a few minutes. It is given in the radiotherapy department using equipment similar to a large x-ray machine. Radiotherapy only treats the area of the body the rays are aimed at. It does not make you radioactive.
There are different types of radiotherapy. The type of radiotherapy usually used to treat head and neck cancers is called intensity-modulated radiotherapy (IMRT). IMRT uses high-energy rays that are shaped very precisely to target the area of cancer. This means a higher dose of radiation is given to the tumour, and healthy areas nearby get a lower dose. This can reduce side effects.
The number of treatments you have depends on the aim of your treatment. Your doctor or nurse will tell you how many treatments you are likely to have.
You may have side effects during radiotherapy. These usually get better slowly over a few weeks or months after treatment finishes, but many people continue to have a dry mouth.
Some side effects develop later on after treatment finishes and can last longer. These are less common, but can happen months or even years after your treatment. Your radiotherapy team will let you know what to expect. Tell them about any side effects you have. There are often things that can be done to help.
The skin over your face and neck will slowly redden or darken, depending on your skin tone. It may also feel sore and itchy (a bit like sunburn). This starts after about 2 weeks of treatment and lasts for up to about 4 weeks after radiotherapy has finished.
When you wash your face and neck, it is important to use only the soaps, creams and lotions your radiotherapy team recommend. This is because chemicals in some products can make the skin more sensitive to radiation. Moisturisers need to be sodium lauryl sulphate (SLS) free. Your radiotherapy team can give you more information about how to care for your skin when you have radiotherapy and after you have finished treatment. They can also tell you when and how to use sun-protection cream after your treatment.
We have more information about skin care when you have radiotherapy to the head and neck area.
It is important to look after your mouth during radiotherapy. Following a mouth care routine to keep your mouth clean helps prevent problems. Your mouth and throat may become sore after a couple of weeks of treatment. You may develop mouth ulcers. You might also find it difficult to speak, or notice changes to your sense of taste and smell. Eating food can become difficult and you may find it painful to swallow. Your doctor can prescribe medicines to help.
We have more information about coping with a sore mouth.
Radiotherapy to the head and neck may reduce the amount of spit (saliva) you make. It can make the mouth and throat dry. This can affect eating, speaking and sleeping. It also makes you much more likely to have tooth decay. So it is really important to care for your teeth during and after treatment.
It also helps to carry a bottle of water with you so you can take frequent sips of water. Or you could use a water spray instead. Artificial saliva can also help moisten your mouth and throat. It comes in different forms, such as gels, sprays, mouthwashes, pastilles or tablets. Your doctor or dentist can prescribe artificial saliva, or you can buy it from a chemist.
We have more information aboutcoping with a sore mouth.
Radiotherapy to the head and neck affects the salivary glands. Your saliva may become thicker, stringy and sticky. Your mouth and throat may also feel dry. This can make eating and talking difficult.
Rinsing your mouth regularly can help with this. Your specialist head and neck team can give advice on the type of mouth rinse that might be best for you. Sometimes a build-up of mucus can cause coughing, especially at night. Your nurse or doctor may prescribe a nebuliser to help to loosen the mucus. A nebuliser is a machine that changes a liquid medicine into a mist or fine spray. Your nurse or doctor can also prescribe mouthwashes, lozenges, artificial saliva sprays or gels to help.
Changes in the saliva usually get better within about 8 weeks of radiotherapy ending, but sometimes it continues for several months or longer.
If you find it hard to eat and drink because of any side effects, let your doctor or nurse know. They can give you advice and medicines to help. They may refer you to a dietitian for more advice. You may need food supplements to add extra energy or protein to your diet. Some supplements can be used to replace meals, and others are used in addition to your normal diet. You can get some of these from your chemist or the supermarket. Your doctor, nurse or dietitian can also prescribe them for you.
Some people need to be fed through a tube if they cannot eat and are losing lots of weight. This is known as nutritional support or tube feeding. It is usually only done for a short time until treatment is finished and their swallowing is back to normal.
This is a common side effect that may last for a couple of months after treatment. Try to get plenty of rest and pace yourself. Balance this with some physical activity, such as short walks. This will give you more energy.
Your doctor, specialist nurse or therapy radiographer can tell you whether your treatment may cause any late effects. They will also tell you what you can do to help reduce your risk of problems. And they can tell you what support is available.
Our general information about head and neck cancers has more about:
Consultant Clinical Oncologist Vincent Khoo describes external beam radiotherapy, how it works, and what it involves.
Consultant Clinical Oncologist Vincent Khoo describes external beam radiotherapy, how it works, and what it involves.
Chemotherapy uses anti-cancer (cytotoxic) drugs to destroy cancer cells. For oropharyngeal cancer, it is usually given with radiotherapy. Chemotherapy may be given alone if cancer has spread to other parts of the body.
Chemotherapy is usually given as several sessions of treatment, called treatment cycles. Each treatment cycle is followed by a rest period, to give the body time to recover.
The side effects depend on the drug or combination of drugs you are given. Your doctor or nurse will explain any treatment you are offered and what to expect.
The chemotherapy drugs most often used to treat oropharyngeal cancer are:
These are usually given into a vein (intravenously).
Chemotherapy can reduce the number of white blood cells in the blood during treatment. This makes you more likely to get an infection. Your doctor or nurse will give you advice about what to do if this happens.
Chemotherapy can also cause other side effects, such as:
Let your doctor or nurse know about any side effects during treatment. They can often give you advice and help to reduce these.
We have more information about coping with the side effects of chemotherapy and about different chemotherapy drugs.
This video provides a brief overview of chemotherapy treatment, how it can be given, how it works and possible side effects.
This video provides a brief overview of chemotherapy treatment, how it can be given, how it works and possible side effects.
Targeted therapies interfere with the way cells grow and divide. They are sometimes known as biological therapies.
Cetuximab is the most commonly used targeted therapy to treat oropharyngeal cancer. This drug may stop the cancer cells growing and dividing. It may also make the cancer more sensitive to the effects of radiotherapy. It is given as a drip (infusion) into a vein once a week. You might have cetuximab with radiotherapy if you cannot have chemoradiation. You may also have it with chemotherapy to treat cancer that has spread or come back.
The most common side effect of cetuximab is a skin rash on the face, neck or body. This may start during the first 2 to 3 weeks of treatment. Your specialist nurse or doctor will give you advice on what can help. The rash usually goes away completely when treatment stops.
Cetuximab may also cause an allergic reaction while the drip is being given. This is more common with the first treatment, so you have this slowly over a few hours. The nurse gives you drugs to help prevent or reduce a reaction. If you have a reaction, they treat it quickly.
Signs of a reaction can include:
Tell your nurse straight away if you have any of these symptoms. Rarely, a reaction can happen a few hours after treatment. If you develop any of these symptoms or feel unwell after you get home, contact the hospital straight away for advice.
Cancer research trials are done to try to find new and better treatments for cancer. Trials that are done on patients are known as clinical trials.
Research into treatments for oropharyngeal cancer is ongoing. But because oropharyngeal cancer is rare, there may not always be a relevant trial in progress. If there is, you may be asked to take part. Your doctor must discuss the treatment with you, so you fully understand the trial and what it means to take part. You can decide not to take part, or to withdraw from a trial at any stage. You will still receive the best standard treatment available.
After your treatment finishes, you will have regular check-ups and tests. These may continue for several years. You may also have regular follow-up appointments with a speech and language therapist (SLT), dietitian, restorative dentist and dental hygienist. If you have any problems or notice new symptoms between appointments, let your doctor know as soon as possible.
For some people, it takes several months to recover from treatment. It can be hard to cope if treatment has changed your appearance, voice or how you eat and drink.
It is common to feel overwhelmed by different feelings. For example, you may feel shocked, scared, upset or angry. Everyone has their own way of coping. But it is important to be able to express how you feel.
Some people find that it helps to share their feelings with family or friends. Others get help from people outside their situation. Some people prefer to keep their feelings to themselves. There is no right or wrong way to cope. But remember that help is available if you need it.
You might want to join a local cancer support group. Meeting other people in a similar situation and sharing your experience may help you feel less alone. You can ask your specialist nurse if there are any local support groups in your area.
If you are finding it difficult to talk, our Online Community (community.macmillan.org.uk) is also a good place to meet people who may be in a similar situation.
There are national support groups that you may find helpful:
You may also want to talk to our cancer support specialists. Call us free on 0808 808 00 00 (Monday to Friday, 9am to 8pm).
and what they are
causes and risk factors of head and neck cancers
the practical, work and financial side
treating head and neck cancers and what to expect
with and after treatment for head and neck cancers
and publications to order, download and print
Order or download our free booklet about head and neck cancers. It covers symptoms, diagnosis, possible treatments, and practical issues.
Worrying about cancer can have a big impact on your feelings. Read our advice to help you cope with your emotions.
If you're deciding which charity to support with your fundraising, talk to us. We want to be there for everyone affected by cancer, and we need your help.
What's happening near you? Find out about support groups, where to get information and how to get involved with Macmillan where you are.
As part of the Community's spotlight on head and neck cancers, Chris wrote about his experience of being diagnosed, and how treatment affected his life.
A place for people affected by head and neck cancers, including oral, throat , larynx (voice box), salivary glands, middle ear, and sinus and nasopharyngeal cancer. Support one another, ask questions, and share experiences.
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