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Overview

The pharynx is the part of your throat behind your nose and mouth. It’s a 5-inch hollow tube that transports air through the trachea (also known as the “wind pipe”), and food and liquid through your esophagus. There are three parts of the pharynx: the uppermost section behind your nose called the nasopharynx, the lowermost section behind your voice box called the hypopharynx, and the middle section called the oropharynx. The oropharynx includes the back one-third of the tongue, tonsils, soft palate and the side and back walls of the throat. 

Cancer in any part of the pharynx is known as pharyngeal cancer, and cancer specific to the oropharynx is called oropharyngeal cancer. Oropharyngeal cancer is a type of head and neck cancer that accounts for about 18,000 newly diagnosed cases in the U.S. every year.

The leading cause of head and neck cancers is smoking tobacco, and as smoking has become less common in recent years, so has the occurrence for most head and neck cancers. The exception to this is oropharyngeal cancer, which is drastically increasing, especially in the younger population. The cause of this steady rise is human papillomavirus (HPV) infection, a common sexually transmitted disease and a leading risk factor for oropharyngeal cancer. About 70% of all oropharyngeal cancers in the U.S. are caused by HPV. Tobacco and alcohol are still important factors for developing oropharyngeal cancers, but doctors now distinguish between HPV-related oropharyngeal cancers and HPV-negative oropharyngeal cancers; the good news is, HPV-related oropharyngeal cancers tend to be much more responsive to treatment.

“Cure rates are high for HPV-driven oropharynx cancer, particularly when the tumors are small and occur in non-smokers,” says Barbara Burtness, MD, a Yale Medicine medical oncologist. “In fact, treatments developed in an era of predominantly tobacco-initiated cancers may be more intensive than is necessary for patients with HPV-driven cancers.”

Clinical trials are now studying ways to reduce the toxicity of treatment for patients with HPV-driven oropharynx cancer, she says.

What is oropharyngeal cancer?

Oropharyngeal cancer is a type of head and neck cancer that affects the middle part of the pharynx called the oropharynx. Cancer of the oropharynx can occur on the back one-third of your tongue, soft palate, tonsils, and side and back walls of the throat. 

How many kinds of oropharyngeal cancer are there?

Most oropharyngeal cancers are squamous cell carcinomas, meaning that the cancer is affecting your squamous cells, which are thin flat cells found in the lining of most of your organs. And although rare, lymphoma, or cancer affecting cells in the lymphatic system, can also occur at the base of the tongue and tonsils, which are made up of lymph tissue.

Who is at risk for developing oropharyngeal cancer?

The leading risk factors for developing oropharyngeal cancer are smoking tobacco, heavy alcohol consumption, and HPV infection, especially a specific type known as HPV-16. The fact that fewer U.S. residents now smoke has resulted in a decline in smoking-related oropharyngeal cancers. However, because HPV infection is exceedingly common, HPV-related oropharyngeal cancers have increased by more than 200 percent since the 1980’s. 

What are the symptoms of oropharyngeal cancer?

Symptoms of oropharyngeal cancer can be very similar to the symptoms of other types of throat and oral cancer. Here is a list of symptoms you should see your doctor about:

  • A sore throat that doesn’t get better over time
  • Difficulty swallowing, opening the mouth fully or moving the tongue
  • Weight loss for no reason
  • Ear pain
  • A lump in the back of the mouth, throat or neck
  • A white patch on the tongue or in the mouth that doesn’t go away
  • Coughing up blood

How is oropharyngeal cancer diagnosed?

Oropharyngeal cancer diagnosis often begins with a physical exam conducted by your doctor, or sometimes your dentist, to check for any signs of abnormality such as a sore or lump in your mouth or swollen lymph nodes in your neck. If an abnormality is spotted, your doctor will recommend imaging tests (X-rays, MRI, CT and PET scans) and likely a biopsy of the tissue to confirm the presence of cancer. 

What are the treatments for oropharyngeal cancer?

Treatment for oropharyngeal cancer will depend on the stage of your cancer, your overall health and age. Surgery to remove the cancer is the preferred method of treating all people with oropharyngeal cancer. This is especially true for those with HPV, because this particular population is younger and otherwise healthy, and improved efforts are being made to spare patients the toxicity of chemotherapy, if possible. Other treatments include the following:

  • Radiation therapy, used for all stages of oropharyngeal cancer, employs high-energy rays to kill cancer cells and prevent new cancer cells from growing.
  • Chemotherapy uses anticancer drugs taken as a pill or intravenously (through an IV) to kill cancer cells in the body. Chemotherapy may be recommended as the only treatment for your oropharyngeal cancer, in combination with radiation therapy, before surgery to shrink a tumor, or after surgery to kill any remaining cancer cells left in the body post-operation.
  • Targeted therapy uses drugs to kill rapidly producing cancer cells without harming normal cells.
  • Immunotherapy activates the immune system to specifically kill cancer cells.

What makes Yale Medicine’s approach to treating oropharyngeal cancers unique?

Yale is an NCI-designated cancer center. Our head and neck team has decades of experience in treating this complex disease, and our experts contribute to national guidelines for head and neck cancer treatment. Our doctors lead national and international studies that seek to improve the outcome for head and neck cancer.

“For some patients with oropharynx cancer,” Dr. Burtness says, “the expectation of cure is very high, above 90%.”

Some patients with oropharynx cancer are at high risk of recurrence. Our team has the expertise to accurately identify patients who are at a high risk of recurrence, and, in many cases, we may be able to offer a clinical trial that includes immunotherapy or genome profiling as part of the care plan, explains Dr. Burtness.