Oropharyngeal cancer

Oropharyngeal cancer (OPC) also known as 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 tissue of the part of the throat (oropharynx) that includes the base of the tongue, the tonsils, the soft palate, and the walls of the pharynx.[1] The two types of oropharyngeal cancers are HPV-positive oropharyngeal cancer, which is caused by an oral human papillomavirus infection; and HPV-negative oropharyngeal cancer, which is linked to use of alcohol, tobacco, or both.[2]

Oropharyngeal cancer
3D medical illustration showing the cancer formation in the tissues of the oropharynx
SpecialtyOncology, head and neck surgery
SymptomsSore or blister in back of mouth, difficulty with speech, swallowing or breathing, swelling in neck, loss of appetite, loss of weight, and weakness
CausesHuman papilloma virus, tobacco use, alcohol use
Diagnostic methodEndoscopy, biopsy, staining for p16, CT scan
PreventionVaccination
TreatmentSurgery, radiation, chemotherapy

OPC is diagnosed by biopsy 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:[1][3][4]

  • 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 in the back of the throat or mouth
  • A lump in the neck
  • A dull pain behind the sternum
  • 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:[3]

Major
  • Performing oral/mouth-genital sex on a person(s) with a human papillomavirus (HPV) genital infection.[5]
  • Smoking and chewing tobacco
  • Heavy alcohol use

Minor
  • A diet low in fruits and vegetables
  • Chewing betel quid, a stimulant commonly used in parts of Asia
  • Plummer–Vinson syndrome
  • Poor nutrition
  • Asbestos exposure
  • Certain genetic changes including: P53 mutation and CDKN2A (p16) mutations.[6]

High-risk
  • Erythroplakia
  • Speckled erythroplakia
  • Chronic hyperplastic candidiasis

Medium-risk
  • Oral submucosal fibrosis
  • Syphilitic glossitis
  • Sideropenic dysphagia (Paterson-Kelly-Brown syndrome)

Low-risk
  • Oral lichen planus[7]
  • Discoid lupus erythematosus
  • Discoid keratosis congenita

Pathophysiology

The cancer can spread three ways:[3]

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

Diagnosis
Oropharyngeal cancer (from right tonsil, HPV-negative), T4a N2c, 48 year old man.

Diagnosis is by biopsy of observed abnormal tissue in the oropharynx.

Stages

The National Cancer Institute (2016) provides the following definition:[8]

Stage 0 (carcinoma in situ)

Abnormal cells are found in the lining of the oropharynx. 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 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, muscle of the tongue, 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 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 may be any size and may have spread to lymph nodes.

Prognosis

People with HPV-positive oropharyngeal cancer tend to have higher survival rates.[2] The prognosis 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.[1]

Society and culture
  • In 1989, Monty Python member Graham Chapman died of oropharyngeal cancer, on the eve of Monty Python's 20th anniversary.
  • In 1995, actress Lana Turner died from oropharyngeal cancer three years after diagnosis.[9][10]
  • In 2010, American actor Michael Douglas reported that he was diagnosed with oropharyngeal cancer.[11]
  • In 2014, Japanese musician and composer Ryuichi Sakamoto released a statement indicating that he had been diagnosed with oropharyngeal cancer in late June of the same year.[12]
  • In 2014, American musician and rhythm guitar player of Green Day, Jason White, was diagnosed with oropharyngeal cancer on December 3.[13][14]
  • In 2015, British musician Bruce Dickinson was diagnosed, and took a one-year break from Iron Maiden while undergoing treatment.
  • In 2017, Rob Derhak, bassist of the jam band moe, was diagnosed, prompting the band to go on indefinite hiatus.[15]

See also

References
  1. "Oropharyngeal Cancer Overview". Cleveland Clinic. 2007-09-07. Retrieved 2011-04-18.
  2. Nordqvist C (October 4, 2011). "HPV Linked Oropharyngeal Cancer Rates Rise Dramatically". Medical News Today.
  3. "Oropharyngeal Cancer Treatment (PDQ®)". National Cancer Institute. Retrieved 2011-04-18.
  4. "Throat Cancer". MD Anderson Cancer Center. Retrieved 2019-02-12.
  5. Isayeva T, Li Y, Maswahu D, Brandwein-Gensler M (July 2012). "Human papillomavirus in non-oropharyngeal head and neck cancers: a systematic literature review". Head and Neck Pathology. 6 Suppl 1: S104-20. doi:10.1007/s12105-012-0368-1. PMC 3394168. PMID 22782230.
  6. Helgadottir H, Höiom V, Jönsson G, Tuominen R, Ingvar C, Borg A, et al. (August 2014). "High risk of tobacco-related cancers in CDKN2A mutation-positive melanoma families". Journal of Medical Genetics. 51 (8): 545–52. doi:10.1136/jmedgenet-2014-102320. PMC 4112445. PMID 24935963.
  7. Idrees, M; Kujan, O; Shearston, K; Farah, CS (25 January 2020). "Oral lichen planus has a very low malignant transformation rate: A systematic review and meta-analysis using strict diagnostic and inclusion criteria". Journal of Oral Pathology & Medicine. doi:10.1111/jop.12996. PMID 31981238.
  8. "Oropharyngeal Cancer Treatment". Head and neck Cancer - Patient version. National Institutes of Health - National Cancer Institute. December 2016. Retrieved 12 June 2017.
  9. "Movie star Lana Turner part of Hollywood lore". Milwaukee Journal Sentinel. June 30, 1995. p. 6B.
  10. "Lana Turner reveals she has throat cancer". The Union Democrat. May 26, 1992. p. 5A. Retrieved June 25, 2017 – via Google News.
  11. DeNoon DJ (September 1, 2010). "Michael Douglas and Throat Cancer FAQ". WebMD Health News. WebMD. Retrieved 2011-04-18.
  12. Sakamoto R (July 10, 2014). "Announcement from commons". WebMD Health News. Retrieved 2014-08-06.
  13. "The Big Cats — Timeline Photos". www.facebook.com. The Big Cats. 3 December 2014. Retrieved 6 December 2014.
  14. White J. "Jason White has been diagnosed with cancer". www.greendayauthority.com. Green Day Authority. Retrieved 6 December 2014.
  15. "moe. Announces Indefinite Hiatus Following Rob Derhak Cancer Diagnosis". JamBase. 2017-07-17. Retrieved 2017-07-18.
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