Oropharyngeal Cancer

Oropharyngeal Cancer and HPV
The most prevalent cause of oropharyngeal cancer is human papillomavirus (HPV), which accounts for about 70% of cases. Also the leading cause of cervical cancer in women, HPV is a common sexually transmitted infection that can spread to the mouth and throat through oral sexual contact. Most HPV infections don’t cause symptoms, so people often contract HPV in early adulthood and don’t know it. HPV infections usually go away without treatment, but if the virus lingers, infected cells can mutate into precancerous and cancerous cells.

Tobacco and/or alcohol use account for the other 30% or so of oropharyngeal cancers.

Oropharyngeal Cancer Symptoms
The most common symptom of oropharyngeal cancer is a lump in your neck. Although this can be a symptom of many conditions, most of which are not cancerous, if your notice a lump, it is important to quickly see a doctor for evaluation. Oropharyngeal cancer symptoms can also include a long-lasting sore throat, hoarseness, difficulty swallowing, ear pain, and bloody spit.

Physical Exam
An otolaryngologist asks questions about your symptoms and medical and family history and examines your head, neck, mouth, tongue, and tonsils.

Flexible Fiberoptic Laryngoscopy
An otolaryngologist places an endoscope (a flexible tube with a camera on its end) through a nostril and into your throat to inspect your anatomy. Beforehand, a topical anesthesia is sprayed into your nose to numb the area. This quick procedure is usually done in your doctor’s office after your physical exam.

Imaging Scans
A contrast-enhanced CT scan, sometimes combined with a PET scan (PET-CT), of your neck and chest will help determine the stage (how advanced the cancer is and whether it has spread) of your cancer and guide treatment recommendations.

Biopsy
A sample of tissue is removed and tested in a laboratory for the presence of cancer.

• Needle Biopsy: A doctor uses a syringe to collect cells from a tumor or enlarged lymph node. A needle biopsy may be done in your doctor’s office, or it can be performed by a radiologist in a procedure room using imaging guidance for increased accuracy.
• Biopsy Under Anesthesia: If the area in question is difficult to reach while you are awake, or if the tumor is near the back of your tongue or deep in your tonsils, you will need to have general anesthesia so doctors can collect a tissue sample to test. This is usually an outpatient procedure. Some people may require a tonsillectomy (surgically removing the tonsils) to get a sample large enough for diagnosis.  

HPV Testing
It is critical to determine whether your oropharyngeal cancer is caused by HPV, as this may affect treatment strategy and prognosis. Biopsied tissue is used for HPV testing, but sometimes a biopsy procedure will need to be repeated to get enough tissue to test.

Like many other types of cancer, oropharyngeal cancer treatment is based on your cancer location and stage.

Radiation Therapy
Beams of high-energy X-rays are aimed at the tumor to destroy cancer cells. Duke is conducting an innovative clinical trial studying PET-CT imaging to identify candidates who could benefit from reduced doses of radiation to reduce side effects.

Chemotherapy
Your doctors may recommend chemotherapy along with radiation. Chemotherapy medicines kill cancer cells or stop them from growing.

Surgery 
Surgery removes the tumor and other tissues affected by the cancer. Our head and neck surgeons use a wide range of surgical approaches, including transoral laser surgery (TLS) and transoral robotic surgery (TORS), which can reduce bleeding, increase precision, and improve visualization to remove hard-to-reach tumors.

Leading Cancer Center
As a National Cancer Institute-designated Comprehensive Cancer Center, Duke provides a level of cancer expertise and experience only found in the top U.S. centers. We are also part of the National Comprehensive Cancer Network (NCCN), an alliance of the nation’s leading cancer centers dedicated to improving patient care.

Team Approach to Care
Oropharyngeal cancer treatment is managed by experienced and highly trained surgical oncologists, radiation oncologists, and medical oncologists who routinely treat oropharyngeal cancer and other head and neck cancers. Your care team also includes pathologists, radiologists, and oral medicine specialists, plus speech-language pathologists, physical therapists, nutritionists, and social workers.

Nurse Navigator Support
Our nurse navigators help gather your previous medical records, schedule and coordinate appointments, and answer your questions.

Clinical Trials
As a Duke patient, you may be eligible to participate in clinical trials studying new diagnostic or treatment options, including reduced doses of radiation.