When Should I Worry About...

What Is Oropharyngeal Cancer & Why Are Rates Rising?

April 17, 2023 - Katie McCallum

Perhaps this is your first time hearing the term "oropharyngeal," but it's important to know that the type of cancer that can develop in the back of the throat is on the rise.

"Like all cancers, the earlier oropharyngeal cancer is detected, the better," says Dr. Nadia Mohyuddin, a head and neck surgical oncologist at Houston Methodist. "It's why knowing the signs of this cancer and who's at higher risk of developing it is so important."

She adds that someone who's experiencing a constellation of nonspecific symptoms related to the throat or swallowing should have them evaluated without delay.

What is oropharyngeal cancer?

Oropharyngeal cancer is one of several types of head and neck cancer, a category that comprises a list of cancers that develop anywhere between the nasal and oral cavities down to the voice box and food pipe.

"When we talk about cancer of the oropharynx, specifically, we're talking about tumors that arise at the back of the mouth where it meets the throat, within the tonsils or at base of the tongue," explains Dr. Mohyuddin.

When cells in this region grow out of control for one reason or another, cancer develops. This most often happens in the mucosal cells that make up the lining of the oropharynx, called squamous cells.

"Historically, the most common causes of head and neck cancers, including those within the oropharynx, were smoking and excessive alcohol consumption," says Dr. Mohyuddin. If a person participates in both, she notes, the risk of cancer increases several folds more.

That said, most cases today are actually unrelated to either of these behaviors.

In fact, the incidence of oropharyngeal cancers caused by smoking or alcohol is decreasing, despite overall rates of this cancer being on the rise.

Why are oropharyngeal cancer rates rising?

"When looking at present day oropharyngeal cancer, we're actually seeing a rising rate in never-smokers and nondrinkers," says. Dr. Mohyuddin. "And it's primarily due to human papilloma virus, or HPV."

HPV is a group of viruses that can be passed between people during sex, including oral sex. HPV infection is incredibly common — according to the CDC, 85% of people will get HPV at some point in their lives.

Most HPV infections don't lead to cancer, but certain types can cause chronic infections that, over time, lead to the cellular changes that become cancer. About 75% of oropharyngeal cancers are now caused by HPV, according to the National Cancer Institute.

"These HPV-related oropharyngeal cancers tend to occur most predominantly in younger white men," adds Dr. Mohyuddin. "Primarily those in their 50s, but even as young as 30s and 40s."

Another factor that increases a person's risk of developing oropharyngeal cancer includes being immunocompromised, whether that's due to taking an immunosuppressant or having a health condition that weakens the immune system.

HPV & oropharyngeal cancer: Can vaccination help with prevention?

The good news is that there's a vaccine that can protect both women and men against the types of HPVs most likely to cause cancer, including oropharyngeal cancer.

"The vaccine is most effective before a person is ever exposed to HPV," adds Dr. Mohyuddin. "This is why it's ideal for HPV vaccination to happen prior to beginning sexual activity."

The CDC recommends all girls and boys be vaccinated between the ages of 11 and 12. But older teens and younger adults who aren't vaccinated benefit from it as well, and recent guidelines have actually increased the upper limit to 45.

"Unfortunately, if you already have one of the types of HPV most likely to cause cancer, vaccination becomes less advantageous," says Dr. Mohyuddin. "And the vaccine isn't useful for treating HPV-related oropharyngeal cancer."

Still, vaccination plays an important role the in the prevention of oropharyngeal cancer, as well as other HPV-related cancers, so talk to your doctor about whether getting vaccinated makes sense for you.

What are the symptoms of oropharyngeal cancer?

"Often, oropharyngeal cancer doesn't present with symptoms that make people immediately worried about cancer," says Dr. Mohyuddin. "Feeling as if something is stuck at the back of the throat, having to clear the back of your throat more often than usual — these are some of the nonspecific symptoms that could potentially be a sign of this cancer."

Oropharyngeal cancer symptoms include:

  • Sensitivity when swallowing
  • Irritation in the throat
  • A non-healing area in the throat or a continually raw surface within the throat
  • Pain in one ear
  • A lump in one side of the neck

"Any time you notice a symptom on only one side of your body, like a lump on one side of the neck but not the other, it should be a tipping point to think about something more serious," Dr. Mohyuddin says.

Oropharyngeal cancer symptoms can also include episodes of coughing up blood, shortness of breath, difficulty swallowing or opening the mouth and trouble lying flat — but these are often signs of more advanced disease.

"It's important to find cancer early. If you have symptoms that don't seem to go away and persist beyond six weeks, get evaluated as soon as possible," recommends Dr. Mohyuddin. "The earlier we find oropharynx cancer, the better the outcome."

Dr. Mohyuddin adds that, if you're experiencing any of the nonspecific symptoms mentioned above, it's helpful to be evaluated by a throat doctor since it's often difficult to see certain areas of the oropharynx during a routine clinical examination. A scope evaluation or sophisticated imaging may be needed to confidently rule out oropharyngeal cancer as the cause of throat or swallowing-related symptoms.

How is oropharyngeal cancer treated?

Unlike some cancers — such as those of the prostate, lung and breast — there's no screening for oropharyngeal cancer. It's why Dr. Mohyuddin says prompt evaluation is so important if symptoms are noticed.

"If an appreciable lump in the neck or a lesion in the back of the throat is detected, your doctor will biopsy the site," explains Dr. Mohyuddin. "This is the primary method of diagnosis. You have to have a biopsy to prove the cancer cells exist."

It's also how your doctor can identify whether the cancer is HPV-related. In addition, the results may be used to help in staging of the cancer and planning treatment.

"The good news is that there's been a paradigm shift in how many of these cancers are managed from a therapeutic standpoint," says Dr. Mohyuddin. "Through clinical trials, we're definitely on the frontier of advancing treatment right now."

Traditional oropharyngeal cancer treatment used to be high doses of chemotherapy and radiation therapy, often also in combination with surgery.

"Research protocols are showing promising results for what we call de-escalation of treatment," says Dr. Mohyuddin. "This is where we identify cases in which we can give lower doses of therapy. Additionally, for early stage, non-metastatic disease, we can even potentially treat with a single modality — either surgery alone or radiation alone."

Another benefit of finding oropharyngeal cancer early, when the lesion is still small, is the potential of utilizing transoral robotic surgery — a procedure in which a robot is used to visualize and assist during surgery, improving precision and reducing complications and recovery time.

"This is why we want people to come in for evaluation in a non-delayed manner, as soon as symptoms are noticed," emphasizes Dr. Mohyuddin. "The earlier we can intervene, the less aggressive we can be during treatment and the better the outcomes."

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