Oropharyngeal cancer
Oropharyngeal cancer is the most common cancer of the throat. It forms in a structure called the oropharynx.
The oropharynx starts where the back of the mouth ends. It includes the soft part of the roof of the mouth (called the soft palate), the back of the tongue (called the base of tongue), the tonsils and the back and side walls of the throat behind the tonsils.
The oropharynx is part of the pharynx. The pharynx is a tube that runs down from the back of the nasal cavity. It connects with the oral cavity (the mouth) and then with the esophagus and trachea. The pharynx is involved in both breathing and swallowing.
Almost all oropharyngeal cancers start in the structure’s lining, called mucosa, which coats the tonsils and the base of tongue. This lining is made up of thin, flat cells known as squamous cells, so most cases of oropharyngeal cancer are squamous cell carcinoma.
Oropharyngeal cancer and HPV
The number of oropharyngeal cancer cases has jumped in the past several years. This is due to an increase in infections by the human papillomavirus, or HPV.
There are more than 100 HPV subtypes. Nearly every person is infected before adulthood. Only a few subtypes can lead to cancer. HPV can be transmitted to the throat by intimate contact such as deep kissing or oral sex. The virus is most often found in tonsil tissue, so this is where HPV-related oropharyngeal cancer forms.
Like many viruses, HPV can come and go with few symptoms. There is no test for acute HPV infection and no treatment. Most cases of HPV clear up without any treatment, but in some people the virus lingers in the throat for years. This eventually causes cells in the lining of the throat to mutate and turn cancerous.
When patients are diagnosed with oropharyngeal cancer, the cancer cells should be tested for an association with HPV. Throat cancers that are caused by HPV have a different staging system and are treated differently than non-HPV throat cancers. People with HPV throat cancers also have a far better prognosis than those non-HPV throat cancers.
Finding perspective during oropharyngeal cancer treatment
Judd Woehrle has always been a firm believer in listening to your own body when something feels off. When he noticed a painless swollen gland on one side of his neck in January 2023, he wanted it checked out. He saw his primary care doctor near his home in San Antonio who referred him to an ENT for a needle biopsy.
The biopsy revealed a type of head and neck cancer called oropharyngeal cancer caused by the human papillomavirus (HPV).
“Receiving a cancer diagnosis was a surreal experience for me,” recalls Judd. “Especially since I was in the best physical shape I had been in years. I was feeling great.”
Judd immediately got online to research treatment options. Knowing MD Anderson is the top cancer hospital in the nation, he requested an appointment.
Finding care and compassion at MD Anderson
From his initial contact with MD Anderson, Judd remembers the support and compassion he received. He appreciated how appointments were scheduled for him so that he could focus on treatment and recovery.
“I was consistently amazed by the professionalism, speed and efficiency of my entire MD Anderson care team,” says Judd. “They kept me informed and I never had to worry about the planning.”
After he met with his care team, they developed his treatment plan: robotic surgery with surgical oncologist Jennifer Wang, M.D., Ph.D., followed by 30 rounds of proton therapy under the care of radiation oncologist Anna Lee, M.D.
Undergoing oropharyngeal cancer treatment
In April, Judd had TransOral Robotic Surgery (TORS) to remove the primary tumor in his tonsil. In this procedure, the surgeon uses a highly specialized robot with small and nimble arms designed specifically for operating on the mouth and throat. He also had a neck dissection to remove 38 lymph nodes. Two of the lymph nodes had cancer present.
In June, after allowing time to heal from surgery, Judd began 30 rounds of proton therapy. Because proton therapy limits the amount of radiation to normal structures, radiation did not affect the other side of his neck.
Being a cancer survivor herself, his wife was there for him every step of the way. They moved to Houston for five months, and Judd took short-term disability from work to focus on his recovery.
Managing side effects from treatment
Following surgery, Judd had difficulty eating and drinking. He underwent physical therapy for his shoulder after neck dissection during surgery.
Radiation presented a separate set of challenges for Judd. Some of his side effects during treatment included skin irritations that felt like a severe sunburn, mouth sores, a sore throat, fatigue and difficulty swallowing.
Judd credits his care team at MD Anderson’s Proton Therapy Center for managing his symptoms. “Nurse practitioner Ian Moore prescribed me liquid lidocaine to temporarily numb the sores in my mouth so I could eat,” says Judd. “My care team made pain management a priority.”
Now that he’s completed treatment, Judd says the big side effects are behind him. With diligent oral care and swallowing exercises, Judd’s sores soon healed. He still has some lymphedema in his neck and numb areas on his face from the surgery, though.
He kept count of his daily calorie intake to keep his body strong and make sure he did not lose any weight. He ate soft foods, like pudding, broth, yogurt, smoothies and scrambled eggs. “Anything crunchy or spicy was out,” says Judd.
Judd’s takeaways from cancer treatment
Judd quickly learned how much his mindset mattered during treatment. “While it sounds cliche, time is our most precious commodity, and I want to spend it doing the things most important to me,” he says.
Here is what helped him during treatment:
- Push for definitive tests and ask questions. If something does not feel right, get it checked out.
- Trust your care team. MD Anderson moves with urgency to get you the best treatment possible.
- Keep a positive attitude. It can be tough, painful or scary, but you can do this. Find your inner strength and step up for the challenge.
- Lean on your support system. Rely on your network of friends and family for love and support.
Judd completed his last treatment in July 2023. He returns to MD Anderson for scans every three months and remains cancer-free. “Even though my diagnosis wasn’t great, I had access to the best medical team in the world at MD Anderson and a large support network to get me through,” says Judd. “Find the things you’re grateful for and let that power you through.”
Request an appointment at MD Anderson online or call 1-877-632-6789.
Oropharyngeal cancer risk factors
Oropharyngeal cancer risk factors
A risk factor is anything that increases your chance of developing a disease. Risk factors for oropharyngeal cancer include:
- HPV infection: Human papillomavirus can cause several different cancers, including oropharyngeal cancer. This is the number-one cause of throat cancer in the United States. Learn more about HPV.
- Sexual history/number of sexual partners: HPV is often spread through sexual contact, so sexual history can impact a person’s throat cancer risk.
- Age: Almost everyone is exposed to one or more subtypes of HPV before the age of 30. The virus can lie dormant for decades. Most oropharyngeal cases occur in people over age 60 but can be seen in patients in their 50s and younger.
- Gender: Oropharyngeal cancer is more common in men than in women.
- Alcohol consumption: Heavy drinkers have an increased risk of developing oropharyngeal cancer.
- Tobacco use: People who use tobacco increase their chances of developing oropharyngeal cancer.
Oropharyngeal cancer symptoms
Oropharyngeal cancer symptoms can include:
- A painless lump in the neck about two inches below the jaw line. It can often be seen and felt from the outside. This lump is a lymph node that is swollen with cancer cells. In many cases, the lymph node grows larger than the primary tumor. Doctors often misdiagnose this lump as a symptom of a common infection and prescribe antibiotics. The lump does not respond to these drugs, leading doctors to look for other causes, including oropharyngeal cancer.
- A persistent sore throat
- A dull earache on one side
- One tonsil that is larger and/or shaped differently than the other
- A red or white patch on the tonsil or palate
- Spitting up blood
- Persistent coughing
- Hoarseness or other voice changes
- Difficulty moving the tongue or opening the mouth
- Difficult and/or painful swallowing.
Oropharyngeal cancer diagnosis
Like all cancers, it is important for oropharyngeal cancer to be diagnosed as early and accurately as possible. This helps increase your chances for a successful treatment while maintaining your quality of life, including the ability to speak and swallow.
If you have symptoms that may signal oropharyngeal cancer, your doctor will examine you and ask you questions about your health and lifestyle, including smoking habits, drinking habits and family medical history.
The following tests can be used to diagnose oropharyngeal cancer and find out if it has spread. Tests also may be used to monitor the disease and how it responds to treatment.
Fiberoptic Laryngoscopy
A fiberoptic laryngoscopy is often the first test in a throat cancer diagnosis. During this procedure, a doctor passes a small camera through the nose and examines the nasopharynx, oropharynx and larynx. This allows the doctor to determine if a biopsy is needed.
Biopsy
In a biopsy, doctors retrieve suspected cancer tissue for study under a microscope. A biopsy is the only way to definitively diagnose throat cancer. Different methods are used to obtain this tissue, depending on where the tumor is located. In general, the least invasive method is preferred.
Common biopsy methods for oropharyngeal cancer include:
- Fine-needle-aspiration biopsy (FNA): This type of biopsy may be used if you have a lump in your neck that can be felt from the outside. A thin needle is inserted into the area, and cells are withdrawn and examined under a microscope. This is often coupled with an ultrasound to verify the placement of the needle. This is the most common and least invasive method.
- Direct biopsy: Since most oropharynx cancers start on the surface of the throat, a direct biopsy may be necessary for diagnosis and staging. During this procedure, the doctor surgically removes part of the suspected cancer tissue. If the suspected cancer involves a tonsil and is visible through the mouth, the procedure may be performed in an outpatient clinic. Biopsies of areas not visible through the mouth are performed in an operating room.
- Incisional/excisional biopsy: A type of biopsy that removes part (incisional) or all (excisional) of the suspected cancer tissue. These are performed in the operating room. This procedures can be used to test suspected cancer tissue in the throat or a lymph node where cancer may have spread.
Imaging exams
Imaging exams can help locate the suspected cancer and show whether it has spread. They can also be used to monitor the disease’s progression and how it is responding to treatment.
Throat cancer imaging exams may include:
- CT or CAT (computed axial tomography) scans
- PET (positron emission tomography) scans
- MRI (magnetic resonance imaging) scans
- Ultrasound
- Chest and dental X-rays
Learn more about imaging exams.
Swallowing tests
Doctors use swallowing tests to understand how the patient’s throat is performing and help them plan treatment. There are different types of swallowing tests.
Modified barium swallow: During a modified barium swallow, the patient ingests liquid, pudding and solid food, all containing barium. A speech pathologist and radiologist observe the swallowing in real time using a specialized X-ray exam, called a fluoroscopy. They then evaluate the structures and movements associated with swallowing.
Fiberoptic endoscopic examination of swallowing (FEES): FEES relies on a small, flexible endoscope that is inserted through the nose. It allows the doctor or speech pathologist to examine swallowing.
Oropharyngeal cancer staging
Staging is a way of determining how much disease is in the body and where it has spread. This information helps your doctors decide the best type of treatment for you and the outlook for your recovery.
There are separate staging systems for oropharyngeal cancer, depending on whether it is HPV-positive or HPV-negative.
HPV-positive oropharyngeal cancer stages
Source: National Cancer Institute
Stage I
In stage I, one of the following is true:
- one or more lymph nodes with cancer that is HPV p16-positive are found but the place where the cancer began is not known. The lymph nodes with cancer are 6 centimeters or smaller, on one side of the neck; or
- cancer is found in the oropharynx (throat) and the tumor is 4 centimeters or smaller. Cancer may have spread to one or more lymph nodes that are 6 centimeters or smaller, on the same side of the neck as the primary tumor.
Stage II
In stage II, one of the following is true:
- one or more lymph nodes with cancer that is HPV p16-positive are found but the place where the cancer began is not known. The lymph nodes with cancer are 6 centimeters or smaller, on one or both sides of the neck; or
- the tumor is 4 centimeters or smaller. Cancer has spread to lymph nodes that are 6 centimeters or smaller, on the opposite side of the neck as the primary tumor or on both sides of the neck; or
- the tumor is larger than 4 centimeters or cancer has spread to the top of the epiglottis (the flap that covers the trachea during swallowing). Cancer may have spread to one or more lymph nodes that are 6 centimeters or smaller, anywhere in the neck.
Stage III
In stage III, one of the following is true:
- cancer has spread to the larynx (voice box), front part of the roof of the mouth, lower jaw, muscles that move the tongue, or to other parts of the head or neck. Cancer may have spread to lymph nodes in the neck; or
- the tumor is any size and cancer may have spread to the larynx, front part of the roof of the mouth, lower jaw, muscles that move the tongue, or to other parts of the head or neck. Cancer has spread to one or more lymph nodes that are larger than 6 centimeters, anywhere in the neck.
Stage IV
In stage IV, cancer has spread to other parts of the body, such as the lung or bone.
HPV-negative oropharyngeal cancer stages
Stage 0 (Carcinoma in Situ)
In stage 0, abnormal cells are found in the lining of the oropharynx (throat). These abnormal cells may become cancer and spread into nearby normal tissue. Stage 0 is also called carcinoma in situ.
Stage I
In stage I, cancer has formed. The tumor is 2 centimeters or smaller.
Stage II
In stage II, the tumor is larger than 2 centimeters but not larger than 4 centimeters.
Stage III
In stage III, the cancer:
is either larger than 4 centimeters or has spread to the top of the epiglottis (the flap that covers the trachea during swallowing); or
is any size. Cancer has spread to one lymph node that is 3 centimeters or smaller, on the same side of the neck as the primary tumor.
Stage IV
Stage IV is divided into stages IVA, IVB, and IVC.
- Any evidence of an extranodal extension in a lymph node elevates the cancer to stage IV, regardless of the lymph node’s size.
- In stage IVA, cancer:
- has spread to the larynx (voice box), front part of the roof of the mouth, lower jaw, or muscles that move the tongue. Cancer may have spread to one lymph node that is 3 centimeters or smaller, on the same side of the neck as the primary tumor; or
- is any size and may have spread to the top of the epiglottis, larynx, front part of the roof of the mouth, lower jaw, or muscles that move the tongue. Cancer has spread to one of the following:
- one lymph node that is larger than 3 centimeters but not larger than 6 centimeters, on the same side of the neck as the primary tumor; or
- more than one lymph node that is 6 centimeters or smaller, anywhere in the neck.
- one lymph node that is larger than 3 centimeters but not larger than 6 centimeters, on the same side of the neck as the primary tumor; or
- has spread to the larynx (voice box), front part of the roof of the mouth, lower jaw, or muscles that move the tongue. Cancer may have spread to one lymph node that is 3 centimeters or smaller, on the same side of the neck as the primary tumor; or
- In stage IVB, cancer:
- has spread to the muscle that moves the lower jaw, the bone attached to the muscle that moves the lower jaw, the base of the skull, or to the area behind the nose or around the carotid artery. Cancer may have spread to lymph nodes in the neck; or
- may be any size and may have spread to other parts of the head or neck. Cancer has spread to a lymph node that is larger than 6 centimeters or has spread through the outside covering of a lymph node into nearby connective tissue.
- has spread to the muscle that moves the lower jaw, the bone attached to the muscle that moves the lower jaw, the base of the skull, or to the area behind the nose or around the carotid artery. Cancer may have spread to lymph nodes in the neck; or
- In stage IVC, cancer has spread to other parts of the body, such as the lung, liver, or bone.
Oropharyngeal cancer treatment
MD Anderson customizes your oropharyngeal cancer treatment to maximize the chances of cure while also paying special attention to your quality of life. Because the oropharynx plays a critical role in speaking, breathing and swallowing, treatment for oropharyngeal cancer often focuses on preserving these functions along with eliminating the cancer. To achieve these goals, treatment plans are customized to each individual patient.
Surgery
Surgery is a common treatment for early-stage oropharyngeal cancer. These procedures used to be highly invasive. Today, new technologies and tools allow doctors to perform oropharyngeal cancer surgery with less invasive approaches and much shorter recovery times. The surgeries for oropharyngeal cancer include:
- Transoral robotic surgery: This is the most common surgery for oropharyngeal cancer. It is a minimally invasive surgery that allows doctors to completely remove a tumor with robotic tools. These specialized instruments and advanced three-dimensional imaging have made it possible to perform complex procedures in small areas such as the oropharynx without the need for large incisions in the mouth and jaw area.
- Transoral laser microsurgery: This procedure lets surgeons reach tumors in tight locations that were previously not accessible. Surgeons remove these tumors using a flexible, hollow-core fiber that transmits CO2 laser energy. Damage to nearby tissue is minimal.
Radiation therapy
Radiation therapy uses powerful, focused beams of energy to kill cancer cells. There are several different radiation therapy techniques. Doctors can use these to accurately target a tumor while minimizing damage to healthy tissue.
Learn more about radiation therapy.
The types of radiation therapy used to treat oropharyngeal cancer include:
- Intensity modulated radiation therapy (IMRT): This treatment focuses multiple radiation beams of different intensities directly on the tumor for the highest possible dose. One type of IMRT is Volumetric modulated arc therapy (VMAT), which uses a rotating treatment machine to deliver radiation at multiple angles.
- Proton therapy: Proton therapy is similar to standard radiation therapy, but it uses a different type of particle that may allow doctors to reduce the radiation dose and limit damage to healthy nearby tissue. Learn more about proton therapy.
- MR LINAC radiotherapy: This approach uses a specialized device to adjust treatment on a daily basis. These adjustments can reduce side effects and effectively treat changing tumors.
- Stereotactic body radiation therapy (SBRT): SBRT, also known as stereotactic ablative radiotherapy and stereotactic ablative body radiation, precisely targets tumors with very high doses of radiation. SBRT achieves this by using several radiation beams of various intensities aimed at the tumor from different angles. Learn more about SBRT.
Chemotherapy
Chemotherapy drugs kill cancer cells, control their growth or relieve disease-related symptoms. Chemotherapy may involve a single drug or a combination of two or more drugs, depending on the type of cancer and how fast it is growing.
Chemotherapy is often given with radiation to oropharyngeal cancer patients who do not undergo surgery. Chemotherapy may also be given to patients whose cancer cannot be cured.
Learn more about chemotherapy.
Targeted therapy
Targeted therapy drugs are designed to stop or slow the growth or spread of cancer. This happens on a cellular level. Cancer cells need specific molecules (often in the form of proteins) to survive, multiply and spread. These molecules are usually made by the genes that cause cancer, as well as the cells themselves. Targeted therapies are designed to interfere with, or target, these molecules or the cancer-causing genes that create them. Targeted therapy is sometimes offered to patients who cannot be treated with chemotherapy.
Learn more about targeted therapy.
Immune checkpoint inhibitors
Immune checkpoint inhibitors are a type of immunotherapy. They stop the immune system from turning off before cancer is eliminated.
For oropharyngeal cancer, immune checkpoint inhibitors are currently approved only for stage IV cancer. They can be used alone or with other treatments, including surgery, radiation therapy and other cancer drugs.
Learn more about immune checkpoint inhibitors.
Clinical Trials
As one of the world’s premier cancer centers, MD Anderson develops and participates in clinical trials of new therapies for throat cancer. Sometimes they are your best option for treatment. They can also help researchers learn how to treat cancer more effectively and improve the future of cancer care.
Learn more about clinical trials.
Specialized care for oropharyngeal cancer patients
Throat cancer and its treatments can impact a person’s ability to eat, drink and speak, as well as their appearance. MD Anderson offers therapies and services to help throat cancer patients adjust to and overcome these challenges as much as possible.
Speech therapy: MD Anderson speech pathologists and audiologists offer patients the most advanced techniques for restoring speech after throat cancer and its treatment.
Swallowing therapy: Experts in MD Anderson’s Speech Pathology and Audiology Section are dedicated to evaluating and treating patients who have difficulty eating, drinking and swallowing after treatment. MD Anderson’s swallowing service is one of the leaders in this field and serves as a model for the management of patients treated for throat cancers.
Reconstructive surgery: Throat cancer treatment can impact a patient’s appearance. MD Anderson is home to renowned reconstructive surgeons who can perform procedures to help restore appearance.
Dental care: The teeth and jaw of throat cancer patients can be damaged by the disease and its treatments. MD Anderson dentists specialize in designing implants and performing procedures to help throat cancer patients restore appearance and function.
Survivorship: MD Anderson has a survivorship clinic dedicated to the needs of head and neck cancer patients.
Regular follow-up and screenings are vital due to the high risk of throat cancer returning to the throat or other areas in the head and neck region. Patients need to see their doctors every three to six months for the first two years after treatment, since most cancers that recur, or come back, do so within that time.
Throat cancer patients are also strongly urged not to smoke or drink alcohol during and after treatment. Drinking and smoking can make treatments less successful and worsen side effects during treatment. They can also greatly increase the chance of the cancer returning.
Why choose MD Anderson for your oropharyngeal cancer treatment?
Choosing where to go for cancer treatment is one of the most important decisions a patient can make.
Every patient with oropharyngeal cancer is different. Treatment plans for oropharyngeal cancer can change drastically based on the cancer’s exact location. Just a few millimeters can make a huge difference. The right treatment plan can greatly reduce the chance of recurrence and help maintain your quality of life, including your ability to speak, chew and swallow.
At MD Anderson, you will get care from a multidisciplinary team of throat cancer specialists, including a medical oncologist, radiation oncologist and surgical oncologist. Their focus on throat cancer allows them to recognize the small differences among oropharyngeal cancers and develop treatment plans tailored to each individual patient. These plans can offer the most effective treatments while minimizing side effects. Treatments can include many cutting-edge interventions, such as proton therapy, targeted therapy and advanced robotic surgeries.
As a leading cancer center, MD Anderson is also developing new oropharyngeal cancer treatments, including less invasive and less toxic approaches to treatment. Since HPV-positive throat cancer is highly curable, our doctors are conducting de-intensification clinical trials. These trials are designed to minimize treatment side effects by using therapies that are less intense but just as effective at fighting cancer.
Care for oropharyngeal patients at MD Anderson goes far beyond these therapies. Oropharyngeal cancer and its treatment may affect eating, hearing, speaking and appearance. At MD Anderson you will be offered a full range of treatments and therapies to help you overcome these challenges.
These include occupational, physical and speech therapy. If needed, you will have access to MD Anderson’s renowned reconstructive surgeons, as well as expert dental surgeons who can design and place and custom-made dental implants. You can also work closely with speech pathologists and audiologists who have special expertise in restoring speech and swallowing after surgery.
MD Anderson also offers dedicated survivorship care for oropharyngeal cancer patients. This care can help monitor for the disease’s return and offer interventions to help maximize your quality of life.
And at MD Anderson you will also be surrounded by the strength of one of the nation's largest and most experienced cancer centers. From support groups to counseling to integrative medicine care, we have all the services needed to treat not just the disease, but the whole person.