Oropharyngeal Cancer

General Information | Treatment Options | Additional Resources

General Information
  • About
  • Risk Factors
  • Signs & Symptoms
  • Detection
  • Stages

Oropharyngeal cancer is a disease in which malignant (cancer) cells form in the tissues of the oropharynx.

The oropharynx is the middle part of the pharynx (throat) behind the mouth, and includes the back one-third of the tongue, the soft palate, the side and back walls of the throat, and the tonsils. The pharynx is a hollow tube about 5 inches long that starts behind the nose and ends at the top of the trachea (windpipe) and esophagus (the tube that goes from the throat to the stomach). Air and food pass through the pharynx on the way to the trachea or the esophagus.

Most oropharyngeal cancers are squamous cell carcinomas. Squamous cells are the thin, flat cells that line the inside of the oropharynx.

Use of tobacco products and drinking too much alcohol can increase the risk of developing oropharyngeal cancer.

Anything that increases your risk of getting a disease is called a risk factor. Risk factors include the following:

  • Smoking and chewing tobacco.
  • Heavy alcohol use.
  • A diet low in fruits and vegetables.
  • Drinking maté, a stimulant drink common in South America.
  • Chewing betel quid, a stimulant commonly used in parts of Asia.
  • Being infected with human papillomavirus (HPV).

Possible signs of oropharyngeal cancer include a sore throat and a lump in the neck.

These and other symptoms may be caused by oropharyngeal cancer. Other conditions may cause the same symptoms. A doctor should be consulted if any of the following problems occur:

  • A sore throat that does not go away.
  • A dull pain behind the breastbone.
  • Cough.
  • Trouble swallowing.
  • Weight loss for no known reason.
  • Ear pain.
  • A lump in the back of the mouth, throat, or neck.
  • A change in voice.

Tests that examine the mouth and throat are used to help detect (find), diagnose, and stage oropharyngeal cancer.

The following tests and procedures may be used:

  • Physical exam and history: An exam of the body to check general signs of health, including checking for signs of disease, such as swollen lymph nodes in the neck or anything else that seems unusual. The doctor does a complete exam of the mouth and neck and looks down the throat with a small, long-handled mirror to check for abnormal areas. A history of the patient's health habits and past illnesses and treatments will also be taken.
  • CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.
  • MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI).
  • X-rays: An x-ray of the organs and bones. An x-ray is a type of energy beam that can go through the body and onto film, making pictures of areas inside the body.
  • PET scan (positron emission tomography scan): A procedure to find malignant tumor cells in the body. A small amount of radionuclide glucose (sugar) is injected into a vein. The PET scanner rotates around the body and makes a picture of where glucose is being used in the body. Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells do.
  • Endoscopy: A procedure to look at organs and tissues inside the body to check for abnormal areas. An endoscope is inserted through the patient's nose or mouth to look at areas in the throat that cannot be seen during a physical exam of the throat. An endoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove tissue or lymph node samples, which are checked under a microscope for signs of disease.
  • Biopsy: The removal of cells or tissues so they can be viewed under a microscope by a pathologist to check for signs of cancer.

Certain factors affect prognosis (chance of recovery) and treatment options.

The prognosis (chance of recovery) depends on the following:

  • The stage and grade of the cancer.
  • The location of the tumor.
  • Whether the tumor is associated with HPV infection.

Treatment options depend on the following:

  • The stage and grade of the cancer.
  • The location of the tumor.
  • The patient's general health.

After oropharyngeal cancer has been diagnosed, tests are done to find out if cancer cells have spread within the oropharynx or to other parts of the body.

The process used to find out if cancer has spread within the oropharynx or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage in order to plan treatment. The results of some of the tests used to diagnose oropharyngeal cancer are often used to stage the disease.

There are three ways that cancer spreads in the body.

The three ways that cancer spreads in the body are:

  • Through tissue. Cancer invades the surrounding normal tissue.
  • Through the lymph system. Cancer invades the lymph system and travels through the lymph vessels to other places in the body.
  • Through the blood. Cancer invades the veins and capillaries and travels through the blood to other places in the body.

When cancer cells break away from the primary (original) tumor and travel through the lymph or blood to other places in the body, another (secondary) tumor may form. This process is called metastasis. The secondary (metastatic) tumor is the same type of cancer as the primary tumor. For example, if breast cancer spreads to the bones, the cancer cells in the bones are actually breast cancer cells. The disease is metastatic breast cancer, not bone cancer.

The following stages are used for oropharyngeal cancer:

Stage 0 (Carcinoma in Situ)

In stage 0, abnormal cells are found in the lining of the oropharynx. These abnormal cells may become cancer and spread into nearby normal tissue. Stage 0 is also called carcinoma in situ.

Stage I

In stage I, cancer has formed and is 2 centimeters or smaller and has not spread outside the oropharynx.

Stage II

In stage II, the cancer is larger than 2 centimeters, but not larger than 4 centimeters, and has not spread outside the oropharynx.

Stage III

In stage III, the cancer is either:

  • larger than 4 centimeters and has not spread outside the oropharynx; or
  • any size and has spread to only one lymph node on the same side of the neck as the cancer. The lymph node with cancer is 3 centimeters or smaller.

Stage IVA

In stage IVA, the cancer either:

  • has spread to tissues near the oropharynx, including the voice box, roof of the mouth, lower jaw, muscle of the tongue, or central muscles of the jaw, and may have spread to one or more nearby lymph nodes, none larger than 6 centimeters; or
  • is any size and has spread to one lymph node that is larger than 3 centimeters but not larger than 6 centimeters on the same side of the neck as the cancer, or to more than one lymph node, none larger than 6 centimeters, on one of both sides of the neck.

Stage IVB

In stage IVB, the cancer either:

  • surrounds the main artery in the neck or has spread to bones in the jaw or skull, to muscle in the side of the jaw, or to the upper part of the throat behind the nose, and may have spread to nearby lymph nodes; or
  • has spread to a lymph node that is larger than 6 centimeters and may have spread to tissues around the oropharynx.

Stage IVC

In stage IVC, cancer has spread to other parts of the body; the tumor may be any size and may have spread to lymph nodes.

Recurrent Oropharyngeal Cancer

Recurrent oropharyngeal cancer is cancer that has recurred (come back) after it has been treated. The cancer may come back in the oropharynx or in other parts of the body.

Cancer information from the NCI PDQ service