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Cancer of the Oropharynx

HomeKnow about CancerCancer of the Oropharynx
HomeKnow about CancerCancer of the Oropharynx

Oropharyngeal Cancer Treatment

Sight:- Oropharynx- Anatomically, the oropharynx is located between the soft palate superiorly and the hyoid bone inferiorly

It is continuous with the oral cavity anteriorly and communicates with the nasopharynx superiorly and the supraglottic larynx and hypopharynx inferiorly. The oropharynx is divided into the following sites.

  • 1. Base of the tongue, which includes the pharyngoepiglottic folds and the glossoepiglottic folds.
  • 2. Tonsillar region, which includes the fossa and the anterior and posterior pillars.
  • 2. Soft palate, which includes the uvula.
  • 3. Pharyngeal walls, that is, posterior and lateral.
Sex Prediction:- Men are afflicted three to five times more often than women.
Age:- Typically involves patients who are between 50-70 years
Risk Factors: Apart from tobacco and alcohol abuse, some other risk factors include:

A diet poor in fruits and vegetables.

The consumption of mate, a stimulant beverage commonly consumed in South America.

The chewing of betel quid, a stimulant preparation commonly used in parts of Asia.

Infection with the human papillomavirus (HPV), especially HPV-type-16, also known as HPV-16.

Diagnosis of Oropharyngeal Cancer:-

A doctor can diagnose oropharyngeal cancer by examining the throat. The doctor will use a mirror and lights, and/or a fiber optic scope, to look at the throat and will feel the neck for masses. If the doctor finds abnormal tissue, he or she will obtain a piece of tissue in a procedure called a biopsy. The tissue will be checked for cancer cells.

Other examinations and tests to find this cancer are:

Medical history and physical exam Complete head and neck exam

Indirect laryngoscopy: A small mirror with handle is used to see the patient’s throat and larynx. It is reviewed whether the vocal cords can move normally while making sounds.

Direct laryngoscopy: A lighted tube (laryngoscope) is used to see your throat and larynx. The lighted tube can be flexible or rigid.

Using of biopsies

In a biopsy, a sample of tissue is removed so that it can be observed at under a microscope. Several types of biopsies can be done, depending on each case.

Exfoliative cytology

In this method, the doctor scrapes a doubtful area and smears the accumulated tissue onto a glass slide so that it can be stained with a dye for observing under the microscope. If the cells look anomalous, the area can be biopsied. The benefit of this technique is that it is easy, and even minor unusual-looking areas can be examined. However, this technique is unable to detect all cancers. On many occasions, it is not possible to distinguish between cancerous cells and irregular but non-cancerous cells (dysplasia).

Incisional biopsy

In this technique, the doctor cuts a small piece of abnormal tissue for examination. If the tumor is deep, the biopsy is performed in the operating room with the patient under general anesthesia. The surgeon uses an endoscope to take out tissue samples.

Fine needle aspiration (FNA) biopsy

This test uses a very thin, hollow needle to take out some cells from a tumor or lump so that they can be examined.FNA biopsy is not used to deal with anomalous areas in the mouth or throat, but can be used when a patient has a neck mass.

HPV testing

The biopsy samples are tested to check if HPV infection is the possible cause. This information helps the medical professionals to predict the apparent course of the cancer.This testing is not regularly used to direct treatment now, but in the future it can help to decide which patients may need less aggressive treatment.

Symptoms of Cancer of the oropharynx:-
  • 1. A sore in the mouth that does not heal (most common symptom)
  • 2. Pain in the mouth that doesn’t go away (also very common)
  • 3. A lump or thickening in the cheek
  • 4. A white or red patch on the gums, tongue, tonsil, or lining of the mouth
  • 5. A sore throat or a feeling that something is caught in the throat that doesn’t go away
  • 6. Trouble chewing or swallowing
  • 7. Trouble moving the jaw or tongue
  • 8. Trouble moving the jaw or tongue
  • 9. Numbness of the tongue or other area of the mouth
  • 10. Swelling of the jaw that causes dentures to fit poorly or become uncomfortable
  • 11. Loosening of the teeth or pain around the teeth or jaw
  • 12. Voice changes
  • 13. A lump or mass in the neck
  • 14. Weight loss
  • 15. Constant bad breath
Oropharyngeal Cancer Treatment:-
Surgery for oral cavity and oropharyngeal cancer

Several types of surgeries can be used to treat oropharyngeal cancers. After surgery, reconstructive surgery can be performed to restore the look and function of the affected areas.

  • 1. Tumor resection
  • 2. Mohs micrographic surgery (for some cancers of the lip)
  • 3. Glossectomy (removal of the tongue)
  • 4. Mandibulectomy (removal of the jaw bone)
  • 5. Maxillectomy
  • 6. Robotic surgery
  • 7. Laryngectomy (removal of the voice box)
Radiation Therapy:

Radiation therapy may be used before or after surgery. Or it may be used instead of surgery. Radiation therapy is usually given with chemotherapy to treat cancer.
Doctors use two types of radiation therapy to treat cancer. Some people receive both types:

External radiation therapy: The radiation comes from a large machine outside the body. The machine aims radiation at your cancer. Treatments are usually 5 days a week for several weeks. New advanced technologies like image guided radiotherapy (IGRT) are now available which delivers radiation to the target tumor sparing normal surrounding organs.

Internal radiation therapy Brachytherapy: The doctor numbs your throat with an anesthetic spray and puts a tube inside so that it can be used to give radiation.

Chemotherapy:

Chemotherapy (chemo) is the use of drugs to stop the growth of cancer cells by either killing it or preventing it from dividing. It may be used in several different situations:

  • 1. Chemo along with radiation can be used as an alternative to surgery in some cancers.
  • 2. Chemo along with radiation therapy can be given after surgery to kill the cancerous cells left behind. This is known as adjuvant chemotherapy.
  • 3. Chemo in conjunction with radiation can shrink some large cancer cells before surgery. This is called neoadjuvant or induction chemotherapy. This helps to experience less side effects from surgery.
  • 4. Chemo can be used to treat cancer cells that are too big or have spread throughout the body. This slows the growth of the cancer as long as possible.

The chemo drugs used most often for cancers of the oral cavity and oropharynx are:

  • 1. Cisplatin
  • 2. 5-fluorouracil (5-FU)
  • 3. Carboplatin
  • 4. Paclitaxel (Taxol®)
  • 5. Docetaxel (Taxotere®)
  • 6. Methotrexate
  • 7. Ifosfamide (Ifex®)
  • 8. Bleomycin

Doctors usually give chemotherapy in fixed cycles, and each treatment is followed by a rest period of few weeks.

Targeted Drug Therapy:

Targeted drugs work differently from standard chemotherapy drugs. They often have different (and less severe) side effects. Cetuximab (Erbitux) is a monoclonal antibody that targets epidermal growth factor receptor (EGFR), a protein that helps them grow and divide. Oral cavity and oropharyngeal cancer cells often have more than normal amounts of EGFR. By blocking EGFR, cetuximab can slow or stop cell growth.

Cetuximab is often given in combination with radiation therapy for intial stage cancers. For advanced stage cancers, it can be given in conjunction with standard chemo drugs such as cisplatin. Several other drugs that target EGFR are now being studied as well, some of which are already being used to treat other cancers.

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