Oropharyngeal cancer (OPC), also known as oropharyngeal squamous cell carcinoma (OPSCC) and tonsil cancer, is a disease in which abnormal cells with the potential to both grow locally and spread to other parts of the body are found in the

oral cavity In animal anatomy, the mouth, also known as the oral cavity, or in Latin cavum oris, is the opening through which many animals take in food and issue vocal sounds. It is also the cavity lying at the upper end of the alimentary canal, bounded on ...

, in the tissue of the part of the throat (

oropharynx The pharynx (plural: pharynges) is the part of the throat behind the mouth and nasal cavity, and above the oesophagus and trachea (the tubes going down to the stomach and the lungs). It is found in vertebrates and invertebrates, though its struct ...

) that includes the

base of the tongue The tongue is a muscular organ in the mouth of a typical tetrapod. It manipulates food for mastication and swallowing as part of the digestive process, and is the primary organ of taste. The tongue's upper surface (dorsum) is covered by taste b ...

, the

tonsils The tonsils are a set of lymphoid organs facing into the aerodigestive tract, which is known as Waldeyer's tonsillar ring and consists of the adenoid tonsil, two tubal tonsils, two palatine tonsils, and the lingual tonsils. These organs play an ...

, the soft

palate The palate () is the roof of the mouth in humans and other mammals. It separates the oral cavity from the nasal cavity. A similar structure is found in crocodilians, but in most other tetrapods, the oral and nasal cavities are not truly sepa ...

, and the walls of the

pharynx The pharynx (plural: pharynges) is the part of the throat behind the mouth and nasal cavity, and above the oesophagus and trachea (the tubes going down to the stomach and the lungs). It is found in vertebrates and invertebrates, though its struc ...

. The two types of oropharyngeal cancers are

HPV-positive oropharyngeal cancer Human papillomavirus-positive oropharyngeal cancer (HPV-positive OPC or HPV+OPC), is a cancer (squamous cell carcinoma) of the throat caused by the human papillomavirus type 16 virus (HPV16). In the past, cancer of the oropharynx (throat) was ass ...

, which is caused by an oral

human papillomavirus infection Human papillomavirus infection (HPV infection) is caused by a DNA virus from the ''Papillomaviridae'' family. Many HPV infections cause no symptoms and 90% resolve spontaneously within two years. In some cases, an HPV infection persists and res ...

; and HPV-negative oropharyngeal cancer, which is linked to use of

alcohol Alcohol most commonly refers to: * Alcohol (chemistry), an organic compound in which a hydroxyl group is bound to a carbon atom * Alcohol (drug), an intoxicant found in alcoholic drinks Alcohol may also refer to: Chemicals * Ethanol, one of sev ...

tobacco Tobacco is the common name of several plants in the genus '' Nicotiana'' of the family Solanaceae, and the general term for any product prepared from the cured leaves of these plants. More than 70 species of tobacco are known, but the ...

, or both. Oropharyngeal cancer is diagnosed by

biopsy A biopsy is a medical test commonly performed by a surgeon, interventional radiologist, or an interventional cardiologist. The process involves extraction of sample cells or tissues for examination to determine the presence or extent of a diseas ...

of observed abnormal tissue in the throat. OPC is staged according to the appearance of the abnormal cells on the biopsy coupled with the dimensions and the extent of the abnormal cells found. Treatment is with surgery, chemotherapy, or radiation therapy; or some combination of those treatments.

Signs and symptoms

The signs and symptoms of oropharyngeal cancer may include: *A sore throat that persists for over 2 weeks *Throat pain or difficulty swallowing *Unexplained rapid weight loss *Voice changes (more hoarse) *Ear pain *A

lump Lump may refer to: * "Lump" (song), a 1995 song by The Presidents of the United States of America * ''Lump'' (compilation album), a 2000 best-of album by The Presidents of the United States of America * Lump (dog), a dog who inspired Pablo Pic ...

in the back of the throat or mouth *A lump in the neck *A dull pain behind the

sternum The sternum or breastbone is a long flat bone located in the central part of the chest. It connects to the ribs via cartilage and forms the front of the rib cage, thus helping to protect the heart, lungs, and major blood vessels from injury. Sh ...

*Persistent cough *Breathing problems *Hoarseness or other changes in the voice

Risk factors

The risk factors that can increase the risk of developing oropharyngeal cancer are:

Major

*Performing open-mouthed kissing or oral/mouth-genital sex on a person(s) with a

(HPV); there are nearly 200 distinct human papillomaviruses (HPVs), and many HPV types are

carcinogenic A carcinogen is any substance, radionuclide, or radiation that promotes carcinogenesis (the formation of cancer). This may be due to the ability to damage the genome or to the disruption of cellular metabolic processes. Several radioactive substan ...

. *

Smoking Smoking is a practice in which a substance is burned and the resulting smoke is typically breathed in to be tasted and absorbed into the bloodstream. Most commonly, the substance used is the dried leaves of the tobacco plant, which have bee ...

and

chewing tobacco Chewing tobacco is a type of smokeless tobacco product that is placed between the cheek and lower gum to draw out its flavor. Some users chew it, others do not. It consists of coarsely chopped aged tobacco that is flavored and often sweetened; ...

(see

Health effects of tobacco Tobacco use has predominantly negative effects on human health and concern about health effects of tobacco has a long history. Research has focused primarily on cigarette smoking. Tobacco smoke contains more than 70 chemicals that cause can ...

); * Heavy alcohol use (see

Long-term effects of alcohol consumption The long-term heavy consumption of alcohol (alcohol use disorder) can cause severe detrimental effects. Health effects associated with alcohol intake in large amounts include an increased risk of developing an alcohol use disorder, malnutrition, ...

Minor

*A diet low in

fruits In botany, a fruit is the seed-bearing structure in flowering plants that is formed from the ovary after flowering. Fruits are the means by which flowering plants (also known as angiosperms) disseminate their seeds. Edible fruits in particula ...

and

vegetables Vegetables are parts of plants that are consumed by humans or other animals as food. The original meaning is still commonly used and is applied to plants collectively to refer to all edible plant matter, including the flowers, fruits, stems, ...

; *Chewing

paan Betel nut chewing, also called betel quid chewing or areca nut chewing, is a practice in which areca nuts (also called "betel nuts") are chewed together with slaked lime and betel leaves for their stimulant and narcotic effects. The practice ...

(

betel quid Betel nut chewing, also called betel quid chewing or areca nut chewing, is a practice in which areca nuts (also called "betel nuts") are chewed together with slaked lime and betel leaves for their stimulant and narcotic effects. The practice ...

), a stimulant commonly used in

Southern Southern may refer to: Businesses * China Southern Airlines, airline based in Guangzhou, China * Southern Airways, defunct US airline * Southern Air, air cargo transportation company based in Norwalk, Connecticut, US * Southern Airways Express, M ...

and

Southeast Asia Southeast Asia, also spelled South East Asia and South-East Asia, and also known as Southeastern Asia, South-eastern Asia or SEA, is the geographical United Nations geoscheme for Asia#South-eastern Asia, south-eastern region of Asia, consistin ...

; *

Marijuana smoking Cannabis smoking (or Colloquialism, colloquially smoking pot) is the inhalation of smoke or vapor released by heating the flowers, leaves, or extracts of Cannabis (drug), cannabis and releasing the main Psychoactive drug, psychoactive chemical ...

(see

Effects of cannabis The effects of cannabis are caused by chemical compounds in the cannabis plant, including 113 different cannabinoids such as tetrahydrocannabinol (THC) and 120 terpenes, which allow its drug to have various psychological and physiological eff ...

); *

Asbestos Asbestos () is a naturally occurring fibrous silicate mineral. There are six types, all of which are composed of long and thin fibrous crystals, each fibre being composed of many microscopic "fibrils" that can be released into the atmosphere b ...

exposure (see

Asbestos-related diseases Asbestos-related diseases are disorders of the lung and pleura caused by the inhalation of asbestos fibres. Asbestos-related diseases include non-malignant disorders such as asbestosis (pulmonary fibrosis due to asbestos), diffuse pleural thicken ...

); *Certain genetic changes including: P53 mutation and CDKN2A (

p16 p16 (also known as p16INK4a, cyclin-dependent kinase inhibitor 2A, CDKN2A, multiple tumor suppressor 1 and numerous other synonyms), is a protein that slows cell division by slowing the progression of the cell cycle from the G1 phase to the S p ...

) mutations; *

Poor nutrition Malnutrition occurs when an organism gets too few or too many nutrients, resulting in health problems. Specifically, it is "a Deficiency (medicine), deficiency, excess, or imbalance of energy, protein and Vitamin deficiency, other nutrients" wh ...

; *

Plummer–Vinson syndrome Plummer–Vinson syndrome is a rare disease characterized by difficulty swallowing, iron-deficiency anemia, glossitis, cheilosis and esophageal webs. Treatment with iron supplementation and mechanical widening of the esophagus generally provides a ...

Precancerous lesions

High-risk

Erythroplakia Erythroplakia is a clinical term to describe any erythematous (red) area on a mucous membrane, that cannot be attributed to any other pathology. The term erythroplasia was coined by Louis Queyrat to describe a precancerous red lesion of the penis ...

; * Speckled erythroplakia; * Chronic hyperplastic candidiasis.

Medium-risk

* Oral submucosal fibrosis; * Syphilitic glossitis; * Sideropenic dysphagia (Paterson-Kelly-Brown syndrome).

Low-risk

* Oral lichen planus; * Discoid lupus erythematosus; * Discoid keratosis congenita.

Pathophysiology

The cancer can spread three ways: *Cancer invades the surrounding normal tissues; *Cancer invades the

lymph system The lymphatic system, or lymphoid system, is an organ system in vertebrates that is part of the immune system, and complementary to the circulatory system. It consists of a large network of lymphatic vessels, lymph nodes, lymphatic or lymphoi ...

and travels through the

lymph vessels The lymphatic vessels (or lymph vessels or lymphatics) are thin-walled vessels (tubes), structured like blood vessels, that carry lymph. As part of the lymphatic system, lymph vessels are complementary to the cardiovascular system. Lymph vessel ...

to other places in the body; *Cancer invades the

veins Veins are blood vessels in humans and most other animals that carry blood towards the heart. Most veins carry deoxygenated blood from the tissues back to the heart; exceptions are the pulmonary and umbilical veins, both of which carry oxygenated b ...

and

capillaries A capillary is a small blood vessel from 5 to 10 micrometres (μm) in diameter. Capillaries are composed of only the tunica intima, consisting of a thin wall of simple squamous endothelial cells. They are the smallest blood vessels in the body: ...

and travels through the blood to other places in the body.

Diagnosis

Diagnosis is by

of observed abnormal tissue in the oropharynx.

Stages

The

National Cancer Institute The National Cancer Institute (NCI) coordinates the United States National Cancer Program and is part of the National Institutes of Health (NIH), which is one of eleven agencies that are part of the U.S. Department of Health and Human Services. ...

(2016) provides the following definition:

Stage 0 (carcinoma ''in situ'')

Abnormal cells are found in the lining of the

. These may become cancer and spread into nearby normal tissue.

Stage 1

Cancer has formed and is 20 mm or smaller and has not spread outside the oropharynx.

Stage 2

Cancer has formed and is larger than 20 mm, but not larger than 40 mm. Also, it has not yet spread outside the oropharynx.

Stage 3

*Cancer is larger than 40 mm and has not spread outside the oropharynx. *Any size and has spread to only one

lymph node A lymph node, or lymph gland, is a kidney-shaped organ of the lymphatic system and the adaptive immune system. A large number of lymph nodes are linked throughout the body by the lymphatic vessels. They are major sites of lymphocytes that inclu ...

on the same side of the neck as the cancer. The lymph node with cancer is 30 mm or smaller.

Stage 4A

*Cancer has spread to tissues near the oropharynx, including the larynx (voice box), roof of the mouth,

lower jaw In anatomy, the mandible, lower jaw or jawbone is the largest, strongest and lowest bone in the human facial skeleton. It forms the lower jaw and holds the lower teeth in place. The mandible sits beneath the maxilla. It is the only movable bone ...

muscle of the tongue The tongue is a muscular organ in the mouth of a typical tetrapod. It manipulates food for mastication and swallowing as part of the digestive process, and is the primary organ of taste. The tongue's upper surface (dorsum) is covered by taste bu ...

, or central muscles of the jaw, and may have spread to one or more nearby lymph nodes; none is larger than 60 mm. *Cancer is any size and has spread to one lymph node that is larger than 30 mm, but not larger than 60 mm on the same side of the neck as the cancer or to more than one lymph node, none larger than 60 mm, on one of both sides of the neck.

Stage 4B

*Cancer surrounds the main

artery An artery (plural arteries) () is a blood vessel in humans and most animals that takes blood away from the heart to one or more parts of the body (tissues, lungs, brain etc.). Most arteries carry oxygenated blood; the two exceptions are the pul ...

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. *Cancer has spread to a lymph node that is larger than 60 mm and may have spread to tissues around the oropharynx.

Stage 4C

Cancer has spread to other parts of the body; the

tumor A neoplasm () is a type of abnormal and excessive growth of tissue. The process that occurs to form or produce a neoplasm is called neoplasia. The growth of a neoplasm is uncoordinated with that of the normal surrounding tissue, and persists ...

may be any size and may have spread to lymph nodes.

Prevention

Regarding the primary prevention of

HPV vaccines Human papillomavirus (HPV) vaccines are vaccines that prevent infection by certain types of human papillomavirus (HPV). Available HPV vaccines protect against either two, four, or nine types of HPV. All HPV vaccines protect against at least HP ...

show more than 90% efficacy in preventing vaccine-type HPV infections and their correlated anogenital

precancerous lesions A precancerous condition is a condition, tumor or lesion involving abnormal cells which are associated with an increased risk of developing into cancer. Clinically, precancerous conditions encompass a variety of abnormal tissues with an increased ...

. A research conducted in 2017 demonstrated that HPV vaccination induces HPV antibodies levels at the

that correlate with circulating levels. Regarding the primary prevention of HPV-positive oropharyngeal cancer, safe oral sex habits should be advised (see

Sex education Sex education, also known as sexual education, sexuality education or sex ed, is the instruction of issues relating to human sexuality, including emotional relations and responsibilities, human sexual anatomy, Human sexual activity, sexual acti ...

). Regarding the primary prevention of HPV-negative oropharyngeal cancer, educating people on the risks of chewing

alcohol use An alcoholic beverage (also called an alcoholic drink, adult beverage, or a drink) is a drink that contains ethanol, a type of Alcohol (chemistry), alcohol that acts Alcohol (drug), as a drug and is produced by Ethanol fermentation, fermentat ...

, and

tobacco smoking Tobacco smoking is the practice of burning tobacco and ingesting the resulting smoke. The smoke may be inhaled, as is done with cigarettes, or simply released from the mouth, as is generally done with pipes and cigars. The practice is believed ...

is of the prime importance in the control and prevention of oropharyngeal cancers.

Prognosis

People with

tend to have higher survival rates. The

prognosis Prognosis (Greek: πρόγνωσις "fore-knowing, foreseeing") is a medical term for predicting the likely or expected development of a disease, including whether the signs and symptoms will improve or worsen (and how quickly) or remain stabl ...

for people with oropharyngeal cancer depends on the age and health of the person and the stage of the disease. It is important for people with oropharyngeal cancer to have follow-up exams for the rest of their lives, as cancer can occur in nearby areas. In addition, it is important to eliminate risk factors such as smoking and drinking alcohol, which increase the risk for second cancers.

Management

Traditionally, oropharyngeal cancer has been managed through combination of surgery and radiotherapy. Other treatments have been developed including a combination of surgery, radiotherapy, chemotherapy and immunotherapy, but with limited improvement in survival rates. Studies comparing different combinations of treatment on patient outcomes have shown insufficient evidence that any treatment combination is superior to others.

Society and culture

* In 1989, Monty Python member

Graham Chapman Graham Chapman (8 January 1941 – 4 October 1989) was a British actor, comedian and writer. He was one of the six members of the surreal comedy group Monty Python. He portrayed authority figures such as The Colonel and the lead role in two P ...

died of oropharyngeal cancer, on the eve of Monty Python's 20th anniversary. *In 1995, actress

Lana Turner Lana Turner ( ; born Julia Jean Turner; February 8, 1921June 29, 1995) was an American actress. Over the course of her nearly 50-year career, she achieved fame as both a pin-up model and a film actress, as well as for her highly publicized per ...

died from oropharyngeal cancer three years after diagnosis. * In 2010, American actor

Michael Douglas Michael Kirk Douglas (born September 25, 1944) is an American actor and film producer. He has received numerous accolades, including two Academy Awards, five Golden Globe Awards, a Primetime Emmy Award, the Cecil B. DeMille Award, and the AF ...

reported that he was diagnosed with oropharyngeal cancer. * In 2014, Japanese musician and composer

Ryuichi Sakamoto is a Japanese composer, pianist, singer, record producer and actor who has pursued a diverse range of styles as a solo artist and as a member of Yellow Magic Orchestra (YMO). With his bandmates Haruomi Hosono and Yukihiro Takahashi, Sakamoto inf ...

released a statement indicating that he had been diagnosed with oropharyngeal cancer in late June of the same year. * In 2014, American musician and

rhythm guitar In music performances, rhythm guitar is a technique and role that performs a combination of two functions: to provide all or part of the rhythmic pulse in conjunction with other instruments from the rhythm section (e.g., drum kit, bass guitar ...

player of

Green Day Green Day is an American rock band formed in the East Bay of California in 1987 by lead vocalist and guitarist Billie Joe Armstrong, together with bassist and backing vocalist Mike Dirnt. For most of the band's career, they have been a powe ...

, Jason White, was diagnosed with oropharyngeal cancer on December 3. * In 2015, British musician

Bruce Dickinson Paul Bruce Dickinson (born 7 August 1958) is an English singer who has been the lead vocalist of the heavy metal band Iron Maiden from 1981 to 1993 and 1999–present. He is known for his wide-ranging operatic vocal style and energetic stage ...

was diagnosed, and took a one-year break from

Iron Maiden Iron Maiden are an English heavy metal band formed in Leyton, East London, in 1975 by bassist and primary songwriter Steve Harris. While fluid in the early years of the band, the lineup for most of the band's history has consisted of Harri ...

while undergoing treatment. * In 2017,

Rob Derhak ''Robert Derhak'', also known simply as Rob, is the bass guitar player and a founding member of the American jam band moe. History Derhak's earliest known time performing as a member of a band was on Halloween 1989, playing at a party with gui ...

, bassist of the jam band

moe Moe, MOE, MoE or m.o.e. may refer to: In arts and entertainment Characters * Moe Szyslak, from the animated television show ''The Simpsons'' * Moe, leader of The Three Stooges, played by Moe Howard * Moe Higurashi, supporting character in ''Yash ...

, was diagnosed, prompting the band to go on indefinite hiatus.

References

External links

{{DEFAULTSORT:Oral And Maxillofacial Surgery Otorhinolaryngology Head and neck cancer