An Overview of Oropharyngeal Cancer

Oropharyngeal cancer is a type of head and neck cancer where cancerous cells take over a part of the oropharynx—that is, the soft palate, tonsils, and tissue in the very back of the throat and tongue. Signs typically include a lump in the throat that is sometimes painful and can make it hard to swallow or open the mouth. Most oropharyngeal cancers are associated with human papillomavirus (HPV), tobacco, alcohol, and they are diagnosed primarily through imagining tests and removing a small piece of the affected area to check for cancerous cells. Treatment options vary by stage and can include surgery, radiation, chemotherapy, and targeted therapy. 

Types of Oropharyngeal Cancer 

Three primary types of cancer begin in the oropharynx: squamous cell carcinoma, minor salivary gland carcinoma, and lymphomas. 

• Squamous cell carcinoma: A type of cancer that affects the thin, flat cells lining the mouth and throat (called squamous cells). The overwhelming majority (about nine in 10) cases of cancer in the oropharynx are squamous cell carcinomas. 
• Minor salivary gland carcinoma: A type of cancer that starts in the roof of the mouth or in the salivary glands lining the mouth and throat
• Lymphomas: A type of cancer that originates in the lymphoid tissue in the tonsils or base of the tongue

Symptoms

The most obvious symptom of oropharyngeal cancer is a lump in or around the back of the throat, which can lead to pain or discomfort. But symptoms can vary depending on whether the cancer is positive for HPV. The most common signs and symptoms of oropharyngeal cancer are: 

• A lump or mass in the neck or back of the throat
• Unexplained weight loss
• Long-lasting sore throat
• A white patch on the back of the tongue or throat that doesn’t go away
• Swollen lymph nodes
• Trouble swallowing
• Pain in the mouth, throat, or ear
• Difficulty opening the mouth or moving the tongue normally
• Hoarseness
• Coughing up blood

Some people with early stages of oropharyngeal cancer don’t have any symptoms at all, and others might have cases that develop slightly differently, depending on the potential cause of the cancer. For example, individuals with oropharyngeal cancer linked to HPV are more likely to notice a neck mass as the first sign of cancer, whereas those with cases linked to carcinogens like tobacco are more likely to first experience a sore throat, trouble swallowing, or unexplained weight loss. 

Causes

It’s difficult to say why some people develop cancer and others don’t, but there are certain things that can increase a person’s chances of getting oropharyngeal cancer. The biggest known drivers of oropharyngeal cancers are HPV infection, smoking, and heavy alcohol use.

HPV infection

HPV is a common sexually transmitted infection linked to several cancers, including oropharyngeal cancer. Roughly 70% of oropharyngeal cancers are caused by HPV, resulting in about 13,500 cases a year in the United States, mostly in men. Rates of HPV-associated oropharyngeal cancers have gone up substantially in recent decades. They increased by 225% from 1988 to 2004, with no signs of trends reversing.

There are dozens of HPV subtypes, and not all of them lead to cancer. The kind of HPV most likely to cause oropharyngeal cancer is oral HPV 16, a high-risk subtype found in about 1% of Americans. Oral HPV infections occur in men more often than in women, which could help explain why oropharyngeal cancers are more common in men. While most new HPV infections happen during adolescence or early adulthood, it can take years or even decades for cancer to develop. 

Oropharyngeal cancers caused by HPV look and act differently than other types. Cases tend to be in younger people (in their 40s and 50s) who don’t smoke. They generally have smaller tumors without many other symptoms, which can lead some doctors to misdiagnose the lumps as benign cysts at first. Even so, those with HPV-associated oropharyngeal cancers are more likely to survive than those with other types of oropharyngeal cancers. 

Smoking or Tobacco Use 

Prior to the rise of HPV-associated oropharyngeal cancer cases, the biggest suspected cause was smoking. There are over a dozen different cancers linked to smoking, and oropharyngeal cancer is one of them. Those who smoke more than a pack a day for 10 years are at the greatest risk for head and neck cancers.

Heavy Alcohol Consumption

Like smoking, heavy alcohol use can also increase your chances of developing head and neck cancers like in the oropharynx. And the more you drink, the greater the risk. Research has found that those who drink four or more alcoholic drinks per day are over five times more likely to develop oropharyngeal cancers than those who drink less or not at all.

Other Risk Factors 

In addition to HPV, smoking, and alcohol, other things can increase your chances of getting oropharyngeal cancers. These include: 

• Poor oral hygiene (such as not brushing your teeth regularly)
• Unhealthy diet
• Chewing betel nuts (a stimulant used in some developing countries particularly in Asia) 

Diagnosis

Diagnostic tests can help doctors confirm oropharyngeal cancer and, if found, determine how advanced and aggressive it is—both of which can impact treatment decisions. Tools to diagnose oropharyngeal cancer include taking a closer look in and around the back of the throat, imaging tests, biopsies, and an HPV test. 

Physical Exam and Health History 

The first step a doctor will take when diagnosing oropharyngeal cancer is a physical exam. They’ll likely ask questions about your health history—such as the number of sexual partners or smoking status—and look at the throat and inside the mouth for suspicious lumps that could be cancer. To see the hard-to-reach places deep inside the back of the throat, doctors might use special tools like a thin scope or long-handled mirror. 

Biopsy 

If doctors do see potential signs of oropharyngeal cancer, they might cut out a small piece of the affected area to test it for cancer cells. This is often done through a process called fine needle cytology (FNAC).

FNAC is when a doctor uses a very small needle (often guided by an ultrasound) to take a piece of the tumor or tissue so that it can be looked at under a microscope.

Imaging Tests 

Because oropharyngeal cancer happens in the back of the throat, where lumps or issues are hard to see with the naked eye, doctors will often rely on imaging tests to help make their diagnosis. These tests typically involve a PET-CT scan and/or an MRI. 

PET-CT Scan

A PET-CT is when two imaging tests—a positron emission tomography (PET) scan and a computerized tomography (CT) scan—are done simultaneously. The PET scan can check the body for cancerous cells by using a tiny amount of radioactive glucose (a simple sugar) liquid and then scanning around the body to see where the fluid is being used. Cancer cells look brighter in the PET scan images because they use more glucose than healthy cells. In some cases, a doctor might choose to use only a PET scan to look for signs of cancer, rather than combining it with a CT scan.  

A CT scan works in a similar way to a PET scan: A dye is injected into a vein, and then a large machine takes pictures of the head, neck, and other areas of the body from different angles. The pictures taken are X-rays, and the dye helps the tissue and organs show up more clearly in the images. 

MRI 

Similar to a PET or CT scan, a magnetic resonance imaging (MRI) scan takes images of what’s happening inside the body. The machine uses a combination of a magnet, radio waves, and a computer to take a series of images that can help doctors see signs of cancer. 

HPV Test 

Oropharyngeal cancer caused by HPV is often treated differently than other kinds. So if doctors find cancer using other diagnostic tests, they might want to test the cancer cells for HPV, particularly the subtype HPV16. 

Treatment

Treatment options for cancers of the oropharynx can vary depending on how aggressive the cancer cells are, where and how far they’ve spread, HPV status, smoking history, and overall health. Generally speaking, HPV-positive oropharyngeal cancers are treated differently than HPV-negative cancers, though many of the same techniques are used. 

Treatment Methods

Oropharyngeal cancer is typically treated using some combination of the following treatment strategies: 

• Surgery: Removing the cancerous cells from the oropharynx. 
• Radiation therapy: Using radiation (such as high-energy X-rays) to kill cancer cells and stop them from spreading or growing. This can sometimes damage nearby healthy tissue. 
• Chemotherapy: Using medications to kill or stop cancer cells. It can sometimes be taken by mouth or injected into the body.
• Targeted therapy: Using medications or other substances to fight specific cancer cells, which can reduce the potential harm to healthy cells. One type of targeted therapy used are monoclonal antibodies—immune system cells that attach themselves to the cancer cells (or other substances in the body that can help the cells grow) to kill them and stop them from growing. 
• Immunotherapy: Leveraging the body’s own immune system to attack the cancer cells. Some proteins latch onto cancer cells and protect them from the body’s defenses. Immunotherapy blocks those proteins, making it easier for the immune system to identify and kill the cancer cells. This type of therapy is still being tested in clinical trials.  

When and what treatments you receive can depend a lot on how far along the cancer is. Someone in the early stages of oropharyngeal cancer, for example, might receive only surgery and radiation therapy, while more advanced cancers might be treated with multiple strategies given at the same time (such as radiation and chemotherapy). 

Clinical Trials 

Clinical trials are research studies. They test different medications or treatment options to see if they work better or have fewer side effects compared to the standard treatment. Individuals with cancer can enroll in the studies if they meet certain criteria. They’re then given either the new treatment being tested or the standard treatment. 

For some people, participating in a clinical trial might be the best treatment option. Those interested should ask their doctors about ongoing or upcoming clinical trials that might be a good fit for their specific type and stage of cancer. 

Side Effects

Some of the methods used to treat cancers of the oropharynx can cause side effects. Not everyone will have the same responses to treatments, and some might have more severe reactions than others. 

Some common side effects of cancer treatment include:  

• Loss of appetite
• Fatigue
• Constipation 
• Nausea or vomiting
• Swelling
• Hair loss
• Bleeding or bruising 
• Fertility issues

Prevention

There’s no sure-fire way to prevent oropharyngeal cancer, but you can lower your chances of developing it by steering clear of certain risk factors, like HPV, smoking, and alcohol. 

• HPV vaccination: Because so many cases of HPV don’t have any symptoms at all, the best way to prevent HPV infection is through vaccination. The Advisory Committee on Immunization Practices recommends that kids be vaccinated against HPV by age 13 to reduce their risks of oropharyngeal cancer and other cancers linked to HPV. Those who missed the age window can still be vaccinated up to age 45 in the United States, though research shows vaccination is more effective when given during early adolescence.  
• Quit smoking (or never start): If you don’t smoke, you can reduce your risk of a variety of cancers (including in the oropharynx) by avoiding smoking or smoke of any kind. And if you’re a current smoker, you can still lower your chances of getting cancer by quitting smoking for good.
• Reduce your alcohol intake. Whether you smoke or not, avoiding heavy or prolonged drinking can reduce your chances of getting several cancers, including oropharyngeal cancer. 

A Word From Verywell

HPV-positive cancers in the oropharynx are on the rise, but they are largely preventable by getting vaccinated against HPV, and by practicing healthy behaviors like limiting how much you smoke or drink. 

Those in need of help quitting smoking or alcohol should talk to their primary care provider, or call SAMHSA’s National Helpline at 1-800-662-HELP (4357) or TTY: 1-800-487-4889. You can also find treatment options through SAMHSA’s Behavioral Health Treatment Services Locator.