Oropharyngeal Cancer (Tonsil Cancer)

Oropharyngeal cancer, originates in the oropharynx, the middle part of the throat that includes the tonsils, base of the tongue, soft palate, and the throat walls. Because of its location, it’s considered a distinct form of head and neck cancer. These cancers often look and act differently depending on where they begin. For instance, tonsil cancer might cause a sore throat or a lump in the neck, while cancer at the base of the tongue can make swallowing painful.

Unlike other cancers in the head and neck region, oropharyngeal cancer has been increasingly linked to HPV infection, marking a significant shift in understanding its causes and influencing treatment approaches. This connection to HPV has also introduced a new demographic of patients, often younger and with a different set of risk factors than those traditionally associated with head and neck cancers caused by tobacco and alcohol use.

Oropharyngeal cancer arises from various causes and risk factors, intertwining lifestyle choices, environmental exposures, and viral infections. Recognizing these factors is pivotal in prevention and early detection strategies.

Lifestyle and Environmental Factors

Smoking and Alcohol Use

• Smoking: The leading risk factor for oropharyngeal cancer, tobacco use in any form, cigarettes, cigars, pipes, and smokeless tobacco, increases risk.
• Alcohol Consumption: Heavy drinking, especially when combined with smoking, elevates the risk significantly.

Viral Infections

Human Papillomavirus (HPV)

• HPV Infection: A significant number of oropharyngeal cancers are associated with HPV, particularly HPV type 16. The virus is transmitted through sexual contact, including oral sex.
• Prognosis Difference: Patients with HPV-positive oropharyngeal cancer often have a better prognosis compared to those with HPV-negative cancers. This distinction is crucial for treatment planning and outcome prediction.

Understanding these risk factors empowers individuals to make informed lifestyle choices and seek timely medical advice for any concerning symptoms. The University of Cincinnati Cancer Center is committed to providing comprehensive care and support for those affected by oropharyngeal cancer, emphasizing prevention, early detection, and innovative treatment strategies.

Oropharyngeal cancer, affecting the throat region, presents symptoms that may initially be mistaken for common conditions. Recognizing these signs early can significantly impact outcomes.

Common Symptoms of Oropharyngeal Cancer

• Lump in the neck: An unexplained lump or swelling in the neck could be a symptom of cancer in the oropharynx.
• Persistent sore throat: Unlike a typical sore throat, this discomfort does not improve with standard remedies and persists over time.
• Difficulty swallowing: Experiencing pain or a sensation of food being stuck in the throat can be a warning sign.
• Ear pain: Pain in the ear, not related to an ear infection, may indicate oropharyngeal cancer.

Early diagnosis of oropharyngeal cancer can lead to more effective treatment. If you notice persistent symptoms, especially if they do not improve with usual care or if they seem to progress, it's crucial to consult a healthcare professional. Seeking medical advice promptly can make a significant difference in the management and outcome of oropharyngeal cancer.

Diagnosing oropharyngeal cancer involves a series of steps to accurately identify the presence and extent of the cancer. This process is crucial for developing an effective treatment plan tailored to the individual's needs.

Diagnostic Tests

Endoscopy

A specialist uses a thin, flexible tube with a light and camera (endoscope) to examine the throat, oropharynx, and nearby structures. This allows for a detailed view of areas where cancer might be present.

Imaging

• CT (Computed Tomography) scans provide detailed cross-sectional images of the body, helping to locate the cancer, determine its size, and identify if it has spread.
• MRI (Magnetic Resonance Imaging) scans offer detailed images of soft tissues in the throat and neck, useful for assessing the tumor's extent.
• PET (Positron Emission Tomography) scans can detect cancerous cells throughout the body, showing if oropharyngeal cancer has spread.

Biopsy and Histopathology

A biopsy, the removal of a small tissue sample for examination under a microscope, is the definitive way to diagnose cancer. Histopathology analysis determines the type of cells involved and the aggressiveness of the cancer.

TNM Staging System

The TNM system is used to describe the size and spread of cancer:

• T (Tumor): Size and location of the tumor.
• N (Nodes): Whether cancer has spread to the lymph nodes.
• M (Metastasis): Whether cancer has spread to other parts of the body.

Importance of HPV Status in Treatment Planning

HPV-positive oropharyngeal cancers often have a better prognosis and may respond differently to treatment than HPV-negative cancers. Testing for HPV is an important step in planning the most effective treatment approach.

At the University of Cincinnati Cancer Center, oropharyngeal cancer treatment is shaped by each patient’s unique needs. We look at the cancer’s stage, location, HPV status, and overall health before mapping out the best approach. Our team brings together leading-edge science and personalized support to help patients get back to living fully.

Here’s a closer look at the main treatment options.

Surgery

Surgery is often recommended for early-stage cancers or when a tumor can be removed without harming key functions like speech and swallowing.

• Robotic Surgery: Transoral Robotic Surgery (TORS) is a minimally invasive technique that uses robotic arms to remove tumors through the mouth. It allows for precise access to hard-to-reach areas, reduces hospital stays, and often leads to faster recovery and less impact on talking and eating.
• Neck Dissection: If cancer has spread to the lymph nodes, surgery may include removing affected nodes to prevent further spread.

Surgery may be followed by other treatments depending on what’s found during the procedure.

Radiation Therapy

Radiation therapy is a standard and often highly effective treatment for oropharyngeal cancer, especially for tumors that can’t be surgically removed or when preserving anatomical structures is a priority.

• Intensity-Modulated Radiation Therapy (IMRT): This advanced technique allows doctors to direct radiation with pinpoint accuracy. It targets cancer cells while sparing nearby healthy tissue, which can help reduce side effects.
• Proton Therapy: A newer option for some patients, proton therapy uses a beam of protons rather than traditional X-rays. It delivers high doses directly to the tumor while limiting radiation exposure to surrounding healthy tissue—especially valuable in the head and neck region where critical structures are close together.

Radiation therapy is sometimes used alone, or in combination with chemotherapy, depending on the individual case.

Chemotherapy and Targeted Therapy

Chemotherapy is used to kill cancer cells, slow their growth, or increase the effectiveness of radiation therapy. It may be used before, during, or after other treatments.

• Common chemotherapy drugs: Cisplatin and carboplatin are often used, either alone or with radiation.
• Targeted Therapy: These drugs home in on specific proteins or genetic changes in cancer cells, aiming to disrupt their ability to grow.
• Immunotherapy: By activating the body’s immune system, immunotherapy treatment helps it recognize and attack cancer cells—an option for some patients with advanced or recurrent cancer.

Patients at the University of Cincinnati Cancer Center have access to clinical trials that aren’t available anywhere else in the region. As the region’s only academic medical center, we lead the way in research-driven treatment and are proud to offer options that reflect the very latest in cancer science.

Clinical trials give patients access to promising new therapies, some of which may be more effective or better tolerated than standard treatments. These trials are carefully designed and reviewed, offering hope and new possibilities, especially for cancers that are advanced, recurrent, or resistant to current therapies.

Living with oropharyngeal cancer presents unique challenges, but with the right support and management strategies, individuals can maintain a good quality of life. Addressing the physical and emotional aspects of this journey is crucial for patients and their caregivers.

Managing Side Effects

Effective management of side effects is key to improving life during and after treatment. Here are ways to address common issues:

• Swallowing and Speech Therapy: Specialized therapists can provide exercises and strategies to help maintain or improve swallowing and speech functions.
• Nutritional Support: Working with a dietitian can ensure nutritional needs are met, especially if swallowing is difficult. They may recommend specific diets or feeding tubes in severe cases.

Emotional and Social Support

The emotional impact of oropharyngeal cancer is significant. Finding the right support can make a difference:

• Counseling and Support Groups: Emotional and psychological support through counseling or support groups can help patients and families navigate the complexities of cancer, offering a space to share experiences and coping strategies.
• Caregiver Resources: Caregivers also need support. Resources and respite care options can provide much-needed breaks and assistance in managing the care of a loved one with cancer.

Living with oropharyngeal cancer involves adapting to new challenges, but with comprehensive care and support, patients can navigate their treatment and recovery with strength and resilience.