Oropharyngeal cancer

This page was reviewed under our medical and editorial policy by

Beomjune B. Kim, DMD, MD, FACS, Head and Neck and Microvascular Reconstructive Surgeon

This page was updated on May 26, 2023.

Oropharyngeal cancer happens when the cells in the middle part of the throat, behind the mouth, start to grow and spread abnormally, destroying healthy tissue. It’s a subset of throat cancer and a type of head and neck cancer.

The oropharynx includes different parts:

  • Soft palate at the top of the mouth
  • Side and back walls of the throat
  • Tonsils
  • Back third of the tongue

About 54,000 people in the United States are expected to be diagnosed with oropharyngeal cancer this year, according to The Oral Cancer Foundation.

Oropharyngeal cancer risk factors and causes

Oropharyngeal cancer and HPV

The Centers for Disease Control and Prevention (CDC) reports that the majority of oropharyngeal cancers (about 70 percent) are linked to infections with the human papillomavirus (HPV), which may be prevented with a vaccine. HPV is the most common sexually transmitted disease in the United States, and several strains pose a higher risk of cancer.

Not everyone with a high-risk strain of HPV develops oropharyngeal or other cancers. Cancer that does develop happens years down the road from the initial infection. There may be a link between HPV infection and other risk factors for oropharyngeal cancers, including tobacco use.

The only HPV vaccine currently being administered in the United States is the 9-strain Gardasil® vaccine. This vaccine helps protect against infection with high-risk HPV strains 16 and 18, and seven other common strains. The CDC recommends that all preteens get this vaccine to be protected from HPV and the cancers that are linked to this infection.

Other oropharyngeal cancer risk factors

Additional risk factors that may increase the incidence of oropharyngeal cancer include:

  • Tobacco use (smoking or chewing)
  • Excessive alcohol use
  • Excess body weight
  • Family or personal history of head and neck cancers

Demographically, those more at risk of developing oropharyngeal cancer are:

  • Male
  • Older than 55
  • White

Types of oropharyngeal cancer

Squamous cell carcinoma is the most common type of oropharyngeal cancer. Squamous cells make up the lining of the throat and mouth.

The presence of an HPV infection plays a role in the cancer’s treatment and prognosis. An HPV-positive oropharyngeal tumor has a better prognosis than those that are HPV-negative. They’re also treated differently.

Other types of cancer that originate in the oropharynx include:

  • Salivary gland cancer, which comes from the cells that make up the salivary glands
  • Lymphoma, which starts in the white blood cell tissue in the tonsils or back third of the tongue

Oropharyngeal cancer symptoms

Some patients have no symptoms and don’t discover they have oropharyngeal cancer until it’s advanced. Early symptoms are usually mild and may be caused by other conditions.

Oropharyngeal cancer symptoms include:

  • Prolonged sore throat
  • Swallowing problems or pain
  • Earaches
  • Hoarse voice
  • Swelling in the lymph nodes of the neck
  • Unexplained weight loss
  • Problems opening the mouth or moving the tongue

Anyone experiencing these symptoms should see a doctor, especially those at heightened risk for oropharyngeal cancer.

Oropharyngeal cancer diagnosis

To diagnose oropharyngeal cancer, doctors—usually ear, nose and throat (ENT) specialists or head and neck surgeons—perform a thorough examination of the head and neck. They may ask questions about health history and do a series of tests to assess the patient’s mental status, coordination and reflexes.

They may recommend an imaging test, using either a magnetic resonance imaging (MRI) scan machine or a positron emission tomography-computed tomography (PET-CT) scan machine.

If a growth is found, the patient may require a biopsy, in which a sample of tissue is taken in a separate procedure. The biopsy is often done using a lighted camera on a tube with tools that take a piece of the growth. Depending on the location of the abnormal area, the doctor may also examine it and take a biopsy directly with a needle.

The biopsied tissue sample is analyzed by a specialist doctor who looks at it under a microscope to figure out whether it’s cancer or something else. It also may be tested for evidence of an HPV infection.

Staging oropharyngeal cancer

Depending on the results of the diagnostic tests, oropharyngeal cancer is given a stage. The cancer’s stage is determined by the size of the tumor, whether it has spread to lymph nodes or other areas of the body, and whether it’s positive for HPV. The stage lets doctors compare people’s cancers to determine the best course of treatment for an individual, based on how other patients with similar cancer characteristics responded to treatments.

Oropharyngeal cancer treatment

Based on the patient’s cancer stage and general health, multiple treatment options may be used for oropharyngeal cancer. Doctors may suggest one or several, either at the same time or in succession.

A surgical intervention is reserved for early stage oropharyngeal cancer (Stage 1 or Stage 2). Otherwise, concurrent chemotherapy and radiation therapy is them most commonly used treatment modality. 

Additionally, targeted therapies may be used against oropharyngeal cancer. These are drugs that specifically attack cancer cells based on their characteristics. These include Erbitux® (cetuximab), a monoclonal antibody treatment that binds to the cancer cell and stops it from growing.

Immunotherapies that turn the body’s immune system against cancer are also being tested against oropharyngeal cancers in clinical trials. These include PD-1 checkpoint inhibitors like Keytruda® (pembrolizumab) and Opdivo® (nivolumab).

Oropharyngeal cancer survival rate

Cancer survival rates are determined by the National Cancer Institute Surveillance, Epidemiology, and End Results (SEER) Program. This database uses three stages for determining cancer outcomes. The three stages are based on how far the cancer has spread when it’s discovered.

  • Localized: The cancer is located in the tissue where it originated.
  • Regional: The cancer has spread to nearby tissues.
  • Distant: The cancer has spread to faraway organs.

Of patients diagnosed with localized oropharyngeal cancer, the five-year relative survival rate is 59 percent, according to the American Cancer Society. For regional-stage oropharyngeal cancers, the rate is 62 percent. For those staged as distant, it’s 29 percent. The average five-year relative survival rate across all of these groups for oropharyngeal cancer is 52 percent.

As with all cancer survival rates, these numbers are derived from patients first diagnosed more than five years before this article was written, so in 2018. Many treatments are advancing, and new approaches are being tested in clinical trials. The survival rates now may be better than they were when these patients were first diagnosed.

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