Oropharyngeal Cancers

 Oropharyngeal cancers are usually seen in the middle-aged group and elderly, with the exception of Human Papilloma Virus (HPV) related cancers which occur in the younger age group. Men are more commonly affected than women.

Where exactly is the oropharynx?

The oropharynx lies between the nasopharynx and hypopharynx.

It consists of:

1. Soft palate
2. Tonsils
3. Back of throat (posterior pharyngeal walls)
4. Posterior one-third of the tongue

What are the symptoms of oropharyngeal cancers?

Most patients complain of:

1. Persistent presence of blood in saliva
2. Pain upon eating/swallowing
3. Chronic sore throat
4. Change in voice
5. Persistent feeling of lump in throat
6. Persistent earache
7. Difficulty in mouth opening
8. Lump in the neck (which usually indicates a spread of the cancer to the lymph nodes)

What are the risk factors?

Risk factors include:

1. Smoking
2. Heavy alcohol consumption
3. Human Papilloma Virus (HPV) infection
4. Poor nutrition especially low in dietary fibre
5. Immunocompromised states, e.g. patients on immunosuppresants, HIV

How do we work-up and diagnose oropharyngeal cancers?

A thorough head and neck examination is performed which includes examination of the oral cavity, the neck and a nasoendoscopy.

A biopsy of the oropharyngeal lesion may be attempted in the clinic under local anaesthesia if it is visible and accessible via the oral cavity. Otherwise, a panendoscopy and biopsy under general anaesthesia are done in the operating theatre. For tonsillar cancers, a tonsillectomy may be performed during the panendoscopy for diagnosis.

A fine needle aspiration cytology is also performed of any neck node. Either a computed tomography scan or magnetic resonance imaging (CT or MRI) is done to evaluate the extent of the oropharyngeal lesion and possible neck node involvement. If the biopsy confirmed the diagnosis of cancer, a CT scan of the thorax and liver is done as part of the staging work-up, looking for distant spread to the lungs or the liver.

How do we treat oropharyngeal cancers?

All cases will be discussed at the multidisciplinary tumour board where the best recommended treatment options will be detailed. Treatment modality depends on:

1. Age and general health of the patient
2. Extent of the oropharyngeal lesion infiltration
3. Stage of the cancer
4. Patient’s expectations and preferences

For early stage disease, single modality treatment is considered either with radiotherapy or surgery of the primary oropharyngeal lesion and the associated nodes in the neck. For more advanced stages, multi-modality treatment is needed, either a combination of chemoradiotherapy or surgery with postoperative radiotherapy, with or without chemotherapy.

Surgery for oropharyngeal cancers can be done through the mouth (transoral approach) or may require open approaches that involve splitting the lip and/or the mandible or through the neck. With the increasing use of robotic surgery, transoral approach can be applied to many more cases of oropharyngeal cancers that previously needed the open approaches for access.

Even after completion of treatment of cancer, patients often have to undergo months of rehabilitation due to altered speech and swallowing. Hence, intensive speech and swallowing therapy, as well as regular dietician review, is to be expected by our patients.