Treating Oropharyngeal Cancer

The oropharynx is the part of the throat that includes the soft palate, tonsils, the back wall of the pharynx and the base of the tongue.

Cancer of the oropharynx is rare with an incidence of approximately 123,000 diagnosed cases and about 79,000 deaths worldwide per year. Tobacco and alcohol are the main risk factors for this type of cancer, but despite the decrease in tobacco consumption, there is an increase in the incidence of this tumor especially in young adults. This increase is related to the appearance of the human papillomavirus (HPV).

HPV-related tumors appear mainly in the tonsil and at the base of the tongue and have a better prognosis than those that are not.

The symptoms and signs that should alert of a possible oropharyngeal tumor disease are the appearance of whitish or red spots. Initially these spots are painless. If the disease progresses, pain will appear when swallowing or spontaneously. The good response to analgesic treatment should not raise suspicion because the pain may be associated with inflammation or infection produced by the cancer itself. The pain becomes more intense with the passage of time. In more advanced stages of the disease, there will be oral bleeding (bloody saliva).

How to treat oropharyngeal cancer?

Treatment in the early stages (stages I and II) of the disease is based on the use of surgery and radiotherapy. In the earlier stages of the disease, surgery or radiotherapy can be used with the same local control and survival rates. The choice between each of the treatment modalities should be based on their availability and the sequelae they produce. Radiation therapy produces mainly dryness of the treated region in addition to taste alteration. Surgical techniques can be minimally invasive such as transoral laser microsurgery (TLM), transoral robotic surgery (TdR) and conventional transoral or mandibulotomy surgery. The sequelae most frequently associated with surgical treatment are difficulty in opening the mouth or trismus, impaired swallowing (oropharyngeal dysphagia) and impaired closure of the rhinopharynx due to resection of the soft palate (velopharyngeal insufficiency). The neck nodes should be treated since cancers of this location frequently metastasize to the neck. If the primary tumor is treated with radiation therapy, both sides of the neck are also treated with radiation. If treated surgically, a neck dissection is performed on the same side of the tumor if it is lateral and bilaterally if the tumor reaches the midline.

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Care to be taken into account

It must be regular, especially during the first two years after the end of treatment. It is based on a thorough examination of the patient supported by imaging studies (CT, MRI).