Highlights & Basics
- Human papillomavirus (HPV) infection is strongly implicated in the majority of oropharyngeal carcinomas in developed countries. Tobacco and alcohol use are known risk factors in cases not driven by HPV. In medium and low human development index countries, betel nut chewing is also associated with oropharyngeal cancer.
- Signs of oropharyngeal cancer at the primary site in the oropharynx include sore throat, referred oral pain, dysphagia, and trismus. Unintentional weight loss and neck mass can be the first signs of otherwise asymptomatic oropharyngeal cancer. In HPV-associated oropharyngeal cancer, patients are often asymptomatic at the primary site, and a neck mass is the most common presenting symptom.
- Patients should be referred to an ear, nose, and throat surgeon for biopsy and histologic diagnosis.
- Diagnosis is made through biopsy of the primary tumor or ultrasound-guided fine needle aspiration cytology of a metastatic lymph node. Staging is through computed tomography (CT) scan or magnetic resonance imaging of the head and neck with contrast, positron emission tomography (PET) or PET-CT, and nasolaryngoscopy. Triple endoscopy with the addition of esophagoscopy and bronchoscopy is reserved only for patients with active risk factors such as tobacco and alcohol use, as the risk of a synchronous second primary cancer in HPV-associated oropharyngeal cancer is very low.
- Treatment regimens vary depending on the stage of the cancer and may involve surgery, radiation, chemotherapy, and/or immunotherapy. Employment of multimodality therapy is common in the treatment of oropharyngeal cancer. Patients should be managed in specialized head and neck centers by a multidisciplinary team to optimize oncologic and functional outcomes.
Quick Reference
History & Exam
Key Factors
Other Factors
Diagnostics Tests
Treatment Options
Definition
Epidemiology
Etiology
Pathophysiology
Images
Large base of tongue tumor seen on axial CT scan
74-year-old man with squamous cell carcinoma of the left tongue base extending into the hypopharynx. Fluorodeoxyglucose PET/CT images demonstrate focal increased metabolic activity in the left hypopharynx/tongue base (arrows)
60-year-old man with squamous cell carcinoma of the right tongue base. Fluorodeoxyglucose PET/CT images demonstrate focal increased metabolic activity in the right tongue base, which extends inferior to the hypopharynx (arrows) and across the midline. On the CT images (top row), soft-tissue irregularity can be seen, but the margins of the tumor are difficult to define
74-year-old man with squamous cell carcinoma of the left tongue base extending into the hypopharynx. Images after chemoradiation therapy, showing complete resolution of metabolic foci. Mild diffuse increased metabolism in the oropharyngeal region consistent with mild post-therapy inflammation
60-year-old man with squamous cell carcinoma of the right tongue base. PET/CT images show mild increased metabolism in a mid right neck lymph node, of concern for metastatic involvement (arrows)
60-year-old man with squamous cell carcinoma of the right tongue base. Axial images further caudally show extent of tumor involvement in the hypopharynx including invasion through the hyoid bone
Large base of tongue tumor not amenable to transoral robotic surgery, required open transhyoid approach to the base of tongue
Transhyoid open approach to a large base of tongue tumor
Robotic wide-field tonsillectomy using the Da Vinci SP robot
Robotic base of tongue resection using the Da Vinci SP robot
Citations
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