Understanding Oropharynx Cancer Symptoms: Early Detection and Diagnosis

Oropharynx Cancer Symptoms

Oropharyngeal cancer may not be a household name, but this type of head and neck cancer is increasingly affecting people around the world. The good news is that with early detection and today’s advanced treatments like proton therapy, the outlook for patients is more encouraging than ever.

 

What is Oropharyngeal Cancer?

Oropharyngeal cancer is head and neck cancer that develops in the oropharynx, the middle part of the throat (pharynx) directly behind the mouth. The oropharynx is a complex structure that plays a crucial role in both speaking and swallowing and includes the following anatomical subsites:

 

1. 1. The back one-third of the tongue (base of tongue)
2. 2. The soft palate (the soft, movable part at the back of the roof of the mouth)
3. 3. The tonsils
4. 4. The side walls of the throat (lateral pharyngeal walls)
5. 5. The back wall of the throat (posterior pharyngeal wal

 

When cancer starts in any of these areas, it is referred to as oropharyngeal cancer. More specifically, the cancer arises from the flat squamous cells that line the surfaces of the oropharynx.

It’s important to distinguish oropharyngeal cancer from other types of head and neck cancers, such as those that develop in the oral cavity (mouth), larynx (voice box), hypopharynx (lower part of the throat), or nasopharynx (upper part of the throat behind the nose). While these cancers share some similarities, each has unique characteristics that influence their management and prognosis.

 

Who is at Risk?

Several factors can increase a person’s risk of developing oropharyngeal cancer. Understanding these risk factors is important for both prevention and early detection efforts. The primary risk factors include:

 

1. 1. Tobacco use: Smoking cigarettes, cigars, or pipes, as well as using smokeless tobacco products (chewing tobacco or snuff), significantly increases the risk of oropharyngeal cancer. The risk is even higher for those who both smoke and drink alcohol heavily.
2. 2. Heavy alcohol consumption: Drinking large amounts of alcohol over time can irritate the lining of the oropharynx and make it more susceptible to cancer development. The risk is compounded when combined with tobacco use.
3. 3. Human papillomavirus (HPV) infection: Infection with certain strains of HPV, particularly HPV-16, is now recognised as a major risk factor for oropharyngeal cancer, especially in younger individuals. HPV-related oropharyngeal cancers have a better prognosis than those caused by tobacco and alcohol use.
4. 4. Age: While oropharyngeal cancer can occur at any age, it is most commonly diagnosed in people over 50.
5. 5. Gender: Men are diagnosed with oropharyngeal cancer more often than women, although this gap is narrowing due to the increasing incidence of HPV-related cases.
6. 6. Weakened immune system: People with compromised immune systems, such as those with HIV/AIDS or those taking immunosuppressive medications, may have a higher risk of developing oropharyngeal cancer.

 

What are the Symptoms of Oropharyngeal Cancer?

Oropharyngeal cancer can cause a variety of signs and symptoms, which may vary depending on the specific location and extent of the tumour. Some of the most common symptoms include:

 

1. 1. A persistent sore throat: A sore throat that doesn’t go away after a few weeks, often accompanied by discomfort or tightness in the throat.
2. 2. Difficulty swallowing (dysphagia): Pain or discomfort when swallowing, a sensation of food getting stuck in the throat, or choking while eating or drinking.
3. 3. Ear pain: Persistent pain in one ear, often without signs of infection. This referred pain occurs because the nerves supplying the oropharynx also provide sensation to the ear.
4. 4. A lump in the neck: A painless lump or swelling that persists for more than 2-3 weeks, which may represent an enlarged lymph node containing cancer cells.
5. 5. Unexplained weight loss: Unintentional weight loss of more than 5% of body weight over a 6-month period, often due to difficulty eating or swallowing.
6. 6. Voice changes: Hoarseness, a muffled voice, or other changes in voice quality that don’t improve after 2-3 weeks.
7. 7. A visible abnormality in the mouth or throat: A red or white patch, ulcer, or mass visible on the tonsils, tongue, soft palate, or other areas of the oropharynx.
8. 8. Oral bleeding: Unexplained bleeding in the mouth or throat may manifest as blood in the saliva or coughing up blood-tinged mucus
9. 9. Numbness or pain in the mouth or face: A feeling of numbness, tingling, or pain in the mouth, jaw, or face, which may be caused by the tumour pressing on nearby nerves.

 

It’s crucial to remember that noncancerous conditions, such as viral or bacterial infections can also cause these symptoms. However, if any of these symptoms persist for more than 2-3 weeks or are causing significant concern, it’s essential to consult a healthcare provider promptly for further evaluation. Early detection and intervention are key to improving treatment outcomes and quality of life for people with oropharyngeal cancer.

 

Diagnosis

If oropharyngeal cancer is suspected based on a person’s symptoms and risk factors, the following diagnostic steps are typically undertaken:

 

1. 1. Physical examination: The doctor will perform a thorough examination of the mouth, throat, and neck to look for any visible abnormalities or lumps. They may use a mirror and lights to get a better view of the oropharynx.
2. 2. Biopsy: If a suspicious area is identified, the doctor will remove a small tissue sample (biopsy) for microscopic examination by a pathologist. This is the only way to diagnose cancer and determine its type and grade definitively.
3. 3. Imaging tests: Computed tomography (CT) scans, magnetic resonance imaging (MRI), and positron emission tomography (PET) scans may be used to determine the size and extent of the tumor and check for spread to nearby lymph nodes or other parts of the body.
4. 4. HPV testing: Oropharyngeal tumour samples are routinely tested for human papillomavirus (HPV), as HPV-positive cancers have a different prognosis and may respond better to specific treatments.
5. 5. Staging: Based on the diagnostic test results, the cancer will be assigned a stage (I-IV) that reflects its size, extent of spread, and other characteristics. Staging helps guide treatment decisions and provides important prognostic information.

 

Treatment

Treatment for oropharyngeal cancer is highly individualised and depends on factors such as the tumour’s location, stage, HPV status, and the patient’s overall health and preferences. The main treatment modalities include:

 

1. 1. Surgery: The primary tumour and any affected lymph nodes may be removed through traditional open surgery or minimally invasive transoral robotic surgery (TORS). The goal is to remove as much cancerous tissue as possible while preserving function and appearance.
2. 2. Radiation therapy: High-energy radiation beams are precisely targeted at the tumour to kill cancer cells. Intensity-modulated radiation therapy (IMRT) is commonly used to minimise damage to surrounding healthy tissues. Proton beam therapy, such as that offered by the Apollo Proton Cancer Centre (APCC), is an advanced form of radiation that can further reduce side effects and improve outcomes in select cases.
3. 3. Chemotherapy: Chemotherapy drugs kill cancer cells throughout the body. To enhance treatment effectiveness, chemotherapy may be given alone or in combination with radiation therapy (chemoradiation).
4. 4. Targeted therapy: Drugs that specifically target molecular abnormalities in cancer cells, such as cetuximab, may be combined with radiation therapy or chemotherapy to improve outcomes in some instances.
5. 5. Immunotherapy: Drugs that help the body’s immune system recognise and attack cancer cells, such as pembrolizumab or nivolumab, may be used in recurrent or metastatic oropharyngeal cancer cases.
6. 6. Supportive care: Patients may also receive supportive care to manage treatment side effects, maintain nutrition, and address any emotional or practical concerns that arise during the cancer journey.

 

Conclusion

Thanks to treatment advances, the outlook for people diagnosed with oropharyngeal cancer is more encouraging than ever. Care is highly tailored based on the specific characteristics of each person’s cancer. Treatment options may include surgery, radiation therapy, chemotherapy, targeted therapy, and immunotherapy. Many people also benefit from supportive care, which helps manage side effects and maintain quality of life during treatment.