General Information About Oropharyngeal Cancer

Oropharyngeal cancer is a type of head and neck cancer that starts in the tissues of the oropharynx.

The pharynx is a hollow tube in the neck about 5 inches long that is made up of three parts:

• The nasopharynx is the upper part of the pharynx, located behind the nose. The nostrils are connected to the nasopharynx. Openings on each side of the nasopharynx lead to the ears.
• The oropharynx is the middle part, located beneath the nasopharynx.
• The hypopharynx is the lowermost part of the pharynx, opening up to both the trachea (windpipe) and esophagus.

When we breathe or swallow, the pharynx acts as a passageway for air to reach the lungs and food to reach the stomach. Oropharyngeal cancer commonly begins in the squamous cells that line the oropharynx.

The oropharynx includes the:

• soft palate
• side and back walls of the throat
• tonsils
• back one-third of the tongue

Sometimes, a person can have more than one cancer at the same time in the oropharynx and mouth, nose, throat, voice box (larynx), windpipe (trachea), or esophagus.

Smoking or being infected with human papillomavirus (HPV) can increase the risk of oropharyngeal cancer.

Oropharyngeal cancer is caused by certain changes in how oropharyngeal cells function, especially how they grow and divide into new cells. There are many risk factors for oropharyngeal cancer, but many do not directly cause cancer. Instead, they increase the chance of DNA damage in cells that may lead to oropharyngeal cancer. Learn more about how cancer develops at What Is Cancer?

A risk factor is anything that increases a person's chance of getting a disease. Some risk factors for oropharyngeal cancer, like tobacco use, can be changed. Risk factors also include things you cannot change, like your family history. Learning about risk factors for oropharyngeal cancer can help you make choices that might prevent or lower your risk of getting it.

The most common risk factors for oropharyngeal cancer include:

• a history of smoking cigarettes for more than 10 pack years and other tobacco use
• heavy alcohol use
• being infected with human papillomavirus (HPV), especially HPV type 16
• a personal history of head and neck cancer
• chewing betel quid, a stimulant commonly used in parts of Asia

The number of cases of oropharyngeal cancers linked to HPV infection is increasing. Learn more about HPV and Cancer.

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

Sometimes oropharyngeal cancer does not cause early signs and symptoms. When signs and symptoms occur, they may include:

• a sore throat that does not go away
• trouble swallowing
• trouble opening the mouth fully
• trouble moving the tongue
• weight loss for no known reason
• ear pain
• a lump in the back of the mouth, throat, or neck
• a white patch on the tongue or lining of the mouth that does not go away
• coughing up blood

These problems may be caused by conditions other than oropharyngeal cancer. Check with your doctor if you have any of these problems to find out the cause and begin treatment, if needed.

Tests that examine the mouth and throat are used to diagnose and stage oropharyngeal cancer.

If you have symptoms that suggest oropharyngeal cancer, your doctor will need to find out if these are due to cancer or another problem. They will ask when the symptoms started and how often you have been having them. They will also ask about your personal and family health history and do a physical exam. Based on these results, the doctor may recommend other tests. If you are diagnosed with oropharyngeal cancer, the results of these tests will help you and your doctor plan treatment.

The following tests and procedures are used to diagnose and stage oropharyngeal cancer:

• During a physical exam of the mouth and neck, the doctor or dentist looks at the mouth and neck, under the tongue, and down the throat with a small, long-handled mirror to check for abnormal areas.
• A neurological exam uses a series of questions and tests to check the brain, spinal cord, and nerve function. The exam checks your mental status, coordination, and ability to walk normally, and how well the muscles, senses, and reflexes work. This may also be called a neuro exam or a neurologic exam.
• PET-CT scan combines the pictures from a positron emission tomography (PET) scan and a computed tomography (CT) scan. The PET and CT scans are done at the same time with the same machine. The combined scans give more detailed pictures of areas inside the body than either scan gives by itself.
  • For the PET scan, a small amount of radioactive glucose (sugar) is injected into a vein. The scanner rotates around the body and makes a picture of where glucose is being used in the body. Because cancer cells often take up more glucose than normal cells, the pictures can be used to find cancer cells in the body.
  • For the CT scan, a series of detailed pictures of areas inside the body, such as the head, neck, chest, and lymph nodes, is taken from different angles. A dye is injected into a vein or swallowed to help the organs or tissues show up more clearly.
• MRI (magnetic resonance imaging) 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).
• Biopsy is the removal of cells or tissues so they can be viewed under a microscope by a pathologist to check for signs of cancer. A fine-needle biopsy is usually done to remove a sample of tissue using a thin needle.

  The following procedures may be used to remove samples of cells or tissue:

  • Endoscopy is a procedure to look at organs and tissues inside the body to check for abnormal areas. An endoscope is inserted through an incision (cut) in the skin or opening in the body, such as the mouth or nose. An endoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove abnormal tissue or lymph node samples, which are checked under a microscope for signs of disease. The nose, throat, back of the tongue, esophagus, stomach, larynx, windpipe, and large airways will be checked. The type of endoscopy is named for the part of the body that is being examined. For example, pharyngoscopy is an exam to check the pharynx.
  • Laryngoscopy is a procedure in which the doctor checks the larynx (voice box) with a mirror or a laryngoscope to check for abnormal areas. A laryngoscope is a thin, tube-like instrument with a light and a lens for viewing the inside of the throat and voice box. It may also have a tool to remove tissue samples, which are checked under a microscope for signs of cancer.

  If cancer is found, the following test may be done to study the cancer cells:

  • HPV test (human papillomavirus test) is a laboratory test used to check the sample of tissue for certain types of HPV infection, such as HPV type 16. This test is done because oropharyngeal cancer can be caused by HPV infection. This is important because HPV-positive oropharyngeal cancer has a better prognosis and is treated differently than HPV-negative oropharyngeal cancer.

  Learn about the type of information that can be found in a pathologist's report about the cells or tissue removed during a biopsy at Pathology Reports.

Some people may decide to get a second opinion.

You may want to get a second opinion to confirm your oropharyngeal cancer diagnosis and treatment plan. If you seek a second opinion, you will need to get medical test results and reports from the first doctor to share with the second doctor. The second doctor will review the pathology report, slides, and scans. They may agree with the first doctor, suggest changes or another treatment approach, or provide more information about your cancer.

Learn more about choosing a doctor and getting a second opinion at Finding Cancer Care. You can contact NCI's Cancer Information Service via chat, email, or phone (both in English and Spanish) for help finding a doctor, hospital, or getting a second opinion. For questions you might want to ask at your appointments, visit Questions to Ask Your Doctor About Cancer.

Certain factors affect prognosis (chance of recovery) and treatment options.

The prognosis depends on:

• whether the person has HPV infection of the oropharynx
• whether the person has a history of smoking cigarettes for 10 or more pack years
• the stage of the cancer
• the number and size of lymph nodes with cancer

Oropharyngeal tumors related to HPV infection have a better prognosis and are less likely to recur than tumors not linked to HPV infection.

Treatment options depend on:

• the stage of the cancer
• keeping the person's ability to speak and swallow as normal as possible
• the person's general health

People with oropharyngeal cancer have an increased risk of another cancer in the head or neck. This risk is increased if a person continues to smoke or drink alcohol after treatment.

For more information, visit Cigarette Smoking: Health Risks and How to Quit.