Dialog Box

Loading...

Definition of oral cancer:

Cancer that forms in tissues of the oral cavity (the mouth) or the oropharynx (the part of the throat at the back of the mouth). 

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.

Anatomy of the pharynx; drawing shows the nasopharynx, oropharynx, and hypopharynx. Also shown are the nasal cavity, oral cavity, esophagus, trachea, and larynx.

Anatomy of the pharynx (throat). The three parts of the pharynx are the nasopharynx, oropharynx, and hypopharynx.

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

Oropharyngeal cancer is a type of head and neck cancer

Tonsil

The anterior tonsillar pillar and tonsil are the most common location for a primary tumor of the oropharynx. Lesions involving the anterior tonsillar pillar may appear as areas of  dysplasia, inflammation, or a superficial spreading lesion. These  cancers can spread across a broad region, including the lateral soft  palate, retromolar trigone and buccal mucosa, and tonsillar fossa.The lymphatic drainage is primarily to level II nodes. 

Tumors of the posterior tonsillar pillar can extend inferiorly to involve the pharyngoepiglottic fold and the posterior aspect of the thyroid cartilage. These lesions more frequently involve level V nodes.

Lesions of the tonsillar  fossa may be either exophytic or ulcerative and have a pattern of  extension similar to those of the anterior tonsillar pillar. These  tumors present as advanced-stage disease more often than do cancers of  the tonsillar pillar. Approximately 75% of patients will present with  stage III or stage IV disease. The lymphatic drainage is primarily to level V nodes. Tumors of the  posterior tonsillar pillar can extend inferiorly to involve the  pharyngoepiglottic fold and the posterior aspect of the thyroid  cartilage. These lesions more frequently involve level V nodes.

Signs and symptoms of tonsillar lesions may include the following:

  • Pain.
  • Dysphagia.
  • Weight loss.
  • Ipsilateral referred otalgia.
  • A mass in the neck.

Base of the tongue

Clinically, cancers of the base of the  tongue are insidious. These cancers can grow in either an infiltrative  or exophytic pattern. Because the base of the tongue is devoid of pain  fibers, these tumors are often asymptomatic until there is significant  tumor progression.

Signs and symptoms of advanced base-of-the-tongue cancers may include the following:

  • Pain.
  • Dysphagia.
  • Weight loss.
  • Referred otalgia secondary to cranial nerve involvement.
  • Trismus secondary to pterygoid muscle involvement.
  • Fixation of the tongue that is caused by infiltration of the deep muscle.
  • A mass in the neck.

Lymph node metastasis is common because  of the rich lymphatic drainage of the base of the tongue. Approximately  70% or more of patients with advanced base-of-the-tongue cancers have  ipsilateral cervical nodal metastases; 30% or fewer of such patients  have bilateral, cervical lymph–node metastases. The cervical lymph nodes involved commonly include levels II, III, IV, and V and retropharyngeal lymph nodes. 

Soft palate

Soft palate tumors are primarily found on the anterior surface. Lesions in this area may remain superficial and in early stages. The lymphatic drainage is primarily to level II nodes.  

Pharyngeal wall

Pharyngeal wall lesions can spread superiorly to involve the nasopharynx, posteriorly to infiltrate the prevertebral fascia, and inferiorly to involve the pyriform sinuses and hypopharyngeal walls. Primary lymphatic drainage is to the retropharyngeal nodes and level II and III nodes. Because most pharyngeal tumors extend past the midline, bilateral cervical metastases are common.

Early-stage tumors are often asymptomatic. Tumors of the pharyngeal wall are typically diagnosed in an advanced stage.

Signs and symptoms of advanced pharyngeal wall tumors may include the following:

  • Pain.
  • Bleeding.
  • Dysphagia.
  • Weight loss.
  • A mass in the neck. 

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

Anything that increases your risk of getting a disease is called a risk factor. Having a risk factor does not mean that you will get cancer; not having risk factors doesn't mean that you will not get cancer. Talk with your doctor if you think you may be at risk. Risk factors for oropharyngeal cancer 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).

Signs and symptoms of oropharyngeal cancer include a lump in the neck and a sore throat.

These and other signs and symptoms may be caused by oropharyngeal cancer or by other conditions. Check with your doctor if you have any of the following:

  • 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 medical doctor or dentist 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 tumour 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 tumour 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.
  • Where the tumour is in the body.
  • Whether the tumour is associated with HPV infection.

Treatment options depend on the following:

  • The stage and grade of the cancer.
  • Where the tumour is in the body.
  • Keeping the patient's ability to speak and swallow as normal as possible.
  • The patient's general health.

For more information on Oropharyngeal Cancer click here

This link is to the National Cancer Institute (NCI) cancer website in the United States. There may be references to drugs and clinical trials that are not available here in Australia.