Oropharyngeal cancer

What is oropharyngeal cancer?

Oropharyngeal cancer (or oropharyngeal carcinoma) is a type of head and neck cancer that develops in the oropharynx. The oropharynx is the part of the throat directly behind the mouth. This area helps you speak and swallow. 'Oro' means mouth and the 'pharynx' is the throat.

The most common type of oropharyngeal cancer is squamous cell cancer. Squamous cell cancer of the oropharynx is one of the most common types of head and neck cancer.

We have separate information about cancer that develops in other areas of the throat such as the nasopharynx (nasopharyngeal) or hypopharynx.

Symptoms of oropharyngeal cancer

Often the first symptom or oropharyngeal cancer is a painless swelling or lump in the neck.

If you are worried about oropharyngeal cancer, we have more information about the signs and symptoms.

Causes of oropharyngeal cancer

Doctors do not know the exact causes of oropharyngeal cancer. But there are risk factors that can increase your chance of developing it.

Your risk of oropharyngeal cancer is increased if you:

smoke or chew tobacco, for example, betel nut
drink large amounts of alcohol.

Your risk of developing oropharyngeal cancer is higher if you do both. Having one or more risk factors does not mean you will get oropharyngeal cancer. Also, having no risk factors does not mean you will not develop oropharyngeal cancer.

Many cases of oropharyngeal cancer are linked to an infection called human papilloma virus (HPV). HPV is a common virus that spreads through skin contact, often during sex. Most people who are sexually active have HPV at some time during their life.

Most people with HPV in the mouth do not develop oropharyngeal cancer.

We have more information about the causes and risk factors of head and neck cancer.

Diagnosis of oropharyngeal cancer

If you have symptoms, you usually begin by seeing your GP or dentist. They will examine your mouth closely.

They will refer you to a specialist doctor if:

they think that your symptoms could be caused by cancer
they are not sure what the problem is.

The specialist doctor will ask about your symptoms and general health. They will examine your mouth and throat using a bright light.

If your only symptom is a lump in your neck, you may be referred to a hospital that has a neck lump clinic.

You may have some of the following tests:

Nasendoscopy

A nasendoscopy is used to look at the inside of your nose and throat.
Biopsy

The doctor collects samples (biopsies) of cells or tissue from the area that looks abnormal. A doctor who specialises in analysing cells (called a pathologist) looks at the sample under a microscope for cancer cells. Your doctor may take a biopsy while they are examining you with the nasendoscope. Or they might arrange for you to have a general anaesthetic to take the biopsy.
Ultrasound scan of the neck

An ultrasound scan of the neck uses soundwaves to produce a picture of your neck and lymph nodes on a computer screen.
Fine needle aspiration (FNA) of the lymph nodes

You may have a fine needle aspiration (FNA) of the lymph nodes if the lymph nodes in your neck do not feel or look normal on a scan. It is done to see whether there are any cancer cells in the lymph nodes.

Waiting for test results can be a difficult time, we have more information that can help.

Further tests for oropharyngeal cancer

Your specialist may arrange further tests. These may help diagnose oropharyngeal cancer or be used to check whether it has spread:

CT scan

A CT scan takes a series of x-rays, which build up a three-dimensional picture of the inside of your body.
MRI scan

An MRI scan uses magnetism to build up a detailed picture of areas of your body.
PET-CT scan

A PET-CT scan gives more detailed information about the part of the body being scanned.
Testing for viruses

If you have oropharyngeal cancer, your doctor may do a test to see if it is linked to the human papilloma virus (HPV).

Staging and grading of oropharyngeal cancer

The results of your tests help your doctors find out more about the size and position of the cancer and whether it has spread. This is called staging.

A doctor decides the grade of the cancer by how the cancer cells look under the microscope. This gives an idea of how quickly the cancer might grow or spread.

Knowing the stage and grade helps your doctors plan the best treatment for you.

Treatment for oropharyngeal cancer

A team of specialists will meet to discuss the best possible treatment for you. This is called a multidisciplinary team (MDT).

Your cancer doctor or specialist nurse will explain the different treatments and their side effects. They will also talk to you about things to consider when making treatment decisions.

Treatment for oropharyngeal cancer may include:

Surgery

Surgery can be used to remove the cancer or lymph nodes in the neck.
Radiotherapy

Radiotherapy uses high-energy rays to destroy cancer cells. It can be given on its own, but it is often given in combination with chemotherapy. This is called chemoradiation.
Chemoradiation

Chemoradiation is often used as the main treatment for locally advanced oropharyngeal cancer. It may also be given after surgery.
Chemotherapy

Chemotherapy uses anti-cancer (cytotoxic) drugs to destroy cancer cells. For oropharyngeal cancer, it is usually given in combination with radiotherapy. Chemotherapy may also be given if cancer has come back or spread to other parts of the body.
Targeted therapy

Targeted therapy drugs work by targeting something in or around the cancer cell that is helping it grow and survive. Cetuximab is the most commonly used targeted therapy to treat oropharyngeal cancer.

We have more information about:

how different treatments are used to treat oropharyngeal cancer
what will happen before your treatment and how to prepare.

You may have some treatments as part of a clinical trial.

After oropharyngeal cancer treatment

You will have regular follow-up appointments after treatment. These may continue for several years. You may also have regular follow-up appointments with a speech and language therapist (SLT), dietitian, restorative dentist and dental hygienist.

If you have any problems or notice new symptoms between appointments, let your doctor know as soon as possible.

Sex life and fertility

Head and neck cancer and its treatment can sometimes affect your sex life and fertility.

If you are worried about this, it is important to talk with your doctor before you start treatment.

We have more information about:

Late effects

Some side effects that develop during treatment may take a long time to improve, or may sometimes become permanent. These are called long-term effects. Other effects can develop months or even years after treatment has finished. These are known as late effects. We have more information about long-term and late effects of head and neck cancer treatment.

Well-being and recovery

Even if you already have a healthy lifestyle, you may choose to make some positive lifestyle changes after treatment.

Making small changes to the way you live such as eating well and keeping active can improve your health and well-being and help your body recover.

It can be difficult to eat well after treatment for head and neck cancer, but your dietitian can help you.

Your feelings after oropharyngeal cancer treatment

For some people, it takes several months to recover from treatment. It can be hard to cope if treatment has changed your appearance, voice or how you eat and drink. It is common to feel overwhelmed by different feelings.

There are national support groups that you may find helpful:

The Mouth Cancer Foundation

The Mouth Cancer Foundation gives information and support to people affected by head and neck cancers.
Changing Faces

Changing Faces offers advice and information to anyone who is affected by a change in their appearance.

Macmillan is also here to support you. If you would like to talk, you can:

Call the Macmillan Support Line on 0808 808 00 00.
Chat to our specialists online.
Visit our head and neck cancer forum to talk with people who have been affected by head and neck cancer, share your experience, and ask an expert your questions.

About our information

References

Below is a sample of the sources used in our oropharyngeal cancer information. If you would like more information about the sources we use, please contact us at cancerinformationteam@macmillan.org.uk

British Association of Head and Neck Oncologists. Head and Neck Cancer: United Kingdom National Multidisciplinary Guidelines. 2016. Available from: https://www.bahno.org.uk/_userfiles/pages/files/ukheadandcancerguidelines2016.pdf (accessed September 2018).

Mehanna H, Evans M, Beasley M et al. Oropharyngeal cancer: United Kingdom National Multidisciplinary Guidelines. The Journal of Laryngology and Otology, 2016: 130 (Suppl 2): S90-S96, Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4873902/ (accessed September 2018)

Reviewers

This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert medical and health professionals and people living with cancer. It has been approved by Senior Medical Editor, Dr Chris Alcock, Consultant Clinical Oncologist.

Our cancer information has been awarded the PIF TICK. Created by the Patient Information Forum, this quality mark shows we meet PIF’s 10 criteria for trustworthy health information.