Oropharyngeal carcinoma is a cancer of the oral pharyngeal region. The oropharynx forms the middle portion of the pharynx.
What is oropharyngeal carcinoma?
Oropharyngeal carcinoma also goes by the name oral pharyngeal cancer. This refers to a malignant mucosal tumor of the oral pharynx, which is the oropharynx or mesopharynx. Together with nasopharyngeal and hypopharyngeal carcinoma, oropharyngeal carcinoma is one of the pharyngeal cancers. The oropharynx forms the middle section of the pharynx. It includes the posterior wall of the pharynx, the soft palate, the pharyngeal tonsils, and the base of the tongue and extends to the laryngeal junction. Oral pharyngeal cancer is particularly common in older men over the age of 60. In Germany, there are about 0.5 to 2 new cases per 100,000 inhabitants per year. From a histological point of view, oropharyngeal carcinoma is mostly a squamous cell carcinoma originating from the pharyngeal mucosa. Typically, there is the development of daughter tumors (metastases) in the cervical lymph nodes.
Causes
What causes pharyngeal cancer or oropharyngeal carcinoma could not be clarified exactly. Environmental influences, genetic factors, and nutritional deficiencies are held responsible. However, certain risk factors are known to promote the occurrence of oropharyngeal carcinoma. These include high alcohol consumption, smoking, infections with the human papillomavirus (HPV), a diet low in vitamins, and the influence of harmful substances such as paints containing nickel and chromium or asbestos. However, cigarette and alcohol consumption are classified as the greatest risk factors. Especially a combination of both increases the risk of throat cancer considerably. For this reason, oral pharyngeal cancer occurs three or four times more frequently in men than in the female sex. It is not uncommon for oropharyngeal carcinoma to occur together with Epstein-Barr virus. Other risk factors include a weakened immune system and inadequate oral hygiene.
Symptoms, complaints, and signs
As a rule, oropharyngeal carcinoma does not initially present with typical symptoms. Noticeable symptoms occur only in the late stages of the insidious disease. In most cases, changes occur in the mucous membrane of the oral cavity. Changes in taste sensation and bleeding are also possible. It is not uncommon for patients to suffer from bad breath, even though their oral hygiene has not changed. When speaking and chewing, pain may also occur that radiates toward the ear. Furthermore, the affected person has problems swallowing. In most cases, oropharyngeal carcinoma forms in the region of the tonsils (palatine tonsils). Sometimes the tumor spreads to the muscles of mastication. This leads to a painful lockjaw. Patients are then unable to fully open their mouths.
Diagnosis and disease progression
If oropharyngeal carcinoma is suspected, the treating physician performs a mirror examination with a special laryngoscope. This may require the use of a very flexible endoscope to view the oropharynx more closely. When the entire pharynx is inspected, the patient receives intubation anesthesia. Imaging procedures take place to assess the extent of the tumor and to plan subsequent treatment. These are an ultrasound examination (sonography), a computer tomography (CT) as well as a magnetic resonance imaging (MRI). The ultrasound examination allows the physician to detect possible involvement of the lymph nodes. CT and MRI are used to determine the extent of the tumor. They can also be used to determine any involvement of the neck vessels. CT and X-ray images of the lungs are taken to determine whether the oropharyngeal carcinoma has caused distant metastases. The liver is also checked by sonography. Scintigraphy is considered useful to clarify metastases to the bones. The course of oropharyngeal carcinoma depends on when the tumor is discovered. Thus, late diagnosis is a common problem. In the early stage, the carcinoma turns out to be small, has not yet attacked any neighboring structures and has not caused any metastases, which means that a favorable prognosis can be given. However, if the tumor continues to grow, this often leads to a negative course of the disease.
Complications
Due to oropharyngeal carcinoma, the affected person suffers from a tumor. In this disease, the tumor can spread to other regions of the body and possibly lead to another tumor there. For this reason, life expectancy is significantly reduced with oropharyngeal carcinoma. This is especially the case if the tumor is diagnosed and treated late. In most cases, diagnosis occurs relatively late because the tumor does not initially cause symptoms. However, those affected suffer from an altered sense of taste and furthermore from changes in the oral mucosa. Furthermore, the oropharyngeal carcinoma can also cause a foul mouth odor, which cannot be defeated with the help of care products. Sufferers also suffer from ear pain. If treatment is delayed, the tumor usually spreads to the muscles of mastication as well, so patients can no longer open their mouths as usual. As a rule, the tumor must be removed. Whether this will result in a positive course of the disease cannot be predicted due to the individual characteristics. It is also possible that the affected person will die as a result of this cancer.
When should one go to the doctor?
Changes in the area of the mouth or throat are often signs of disease. If there is swelling, a tight feeling, or pain in the mouth or throat, a doctor is needed. Irregularities in chewing or phonation should be investigated and treated. If complaints occur with existing dentures or braces, a visit to the doctor is necessary. If the complaints spread or increase in intensity, a clarification of the impairments is advisable. An investigation into the cause must be initiated so that a treatment plan can be drawn up. Since oropharyngeal carcinoma can have a fatal course without medical care, a physician should be consulted at the first sign of disagreement. A loss of appetite, sensory disturbances, or a decrease in body weight are other signs of disease. Earaches and headaches, a tilted head or tension are cause for concern. Action is required as soon as there are changes in the appearance of the skin or mucous membranes. If the jaws can no longer be moved as usual, if there is a loss of well-being or if participation in social life declines, the observations should be discussed with a doctor. A general feeling of malaise, listlessness or sleep disturbances are secondary disorders that can occur as a result of oropharyngeal carcinoma. A visit to a physician is advised so that a diagnosis can be made.
Treatment and therapy
If the discovery of oropharyngeal carcinoma takes place at an early stage and the tumor is still small, the cancer can even be cured. Carcinomas of the tonsils are usually operated out. If the tumor is larger, radiation therapy is also necessary. If the carcinoma is on the tongue or palate, high-dose radiation therapy is usually administered. If the carcinoma has also affected neighboring structures such as the esophagus or thyroid gland, the affected areas are also surgically removed. However, complete removal of the tumor is considered problematic in such cases. In most patients, the complete removal of the cervical lymph nodes also takes place, which is considered an advantage because settlements of the tumor in the cervical lymph nodes cannot always be made visible. If the patient is in an advanced stage of oropharyngeal carcinoma, a combination of radiation therapy and chemotherapy is administered. Doctors refer to this mixture as radiochemotherapy. The additional chemotherapy ensures that the treatment is more effective. The survival rate of patients older than 70 years is considered higher than that of young patients.
Outlook and prognosis
The prognosis for oropharyngeal cancer is quite variable. Essentially, the outlook in each case depends on the stage, form, and cause, as well as the metastatic nature of the cancer. The most favorable prognosis is for patients whose oropharyngeal carcinoma was caused by HP viruses. In these cases, both chemotherapy and radiation have proven to be extremely effective. Often, surgery is not necessary in these cases. Smokers, on the other hand, have significantly poorer prospects.With early treatment, the five-year survival rate is 90 percent. In the second stage of the disease, it is 75 percent. The best prospects are for patients who have had the oropharyngeal carcinoma surgically removed. In patients who have already developed further distant metastases, the five-year survival rate is between 35 and 75 percent. Affected patients who are treated very late have very poor prospects. In these cases, only a combination of different therapeutic approaches has proven successful. A decisive factor is also the age of the patient. Younger patients have significantly higher survival rates than older patients. In particular, the outlook for oropharyngeal carcinoma is very poor for sufferers over the age of 70. Nevertheless, compared with other cancers, the prognosis is relatively good in most cases.
Prevention
There are definitely ways to prevent oropharyngeal carcinoma. For example, it is advisable to avoid excessive consumption of cigarettes and alcohol. Even after many years of consumption, the risk of cancer can still be reduced. Complete abstinence from nicotine and alcohol is even better. Consistent oral hygiene and a healthy diet also play an important role. However, there is no specific vaccination against viruses that promote oropharyngeal carcinoma.
Aftercare
Because oropharyngeal carcinoma is detected relatively late in many cases, there are few and usually limited aftercare measures and options available to the affected person with this disease. For this reason, the person affected by this disease should ideally see a doctor at a very early stage so that other complications or complaints do not arise. The treatment itself is usually carried out by means of a surgical intervention, during which the tumor is removed. Regular checks and examinations by a doctor are also very important after such an operation in order to detect and remove further tumors at an early stage. Due to the lengthy treatment, those affected are sometimes dependent on psychological support, which can alleviate and prevent depression in particular. In general, a healthy lifestyle should be strived for, whereby attention should also be paid to a balanced diet. At the same time, the affected person should avoid alcohol and cigarettes. Possibly, oropharyngeal carcinoma reduces the life expectancy of the patient, although the further course depends very much on the time of diagnosis.
What you can do yourself
To strengthen the organism, pay attention to a healthy and balanced diet. Harmful substances such as alcohol, nicotine or the consumption of drugs should be refrained from. In particular, a renunciation of alcohol should be observed by the affected person. Since in severe cases the course of the disease is fatal, early medical consultation is necessary even at the first irregularities. During the treatment process, the instructions and guidelines of the attending physician must be followed in order to avoid complications. Mental strength is important for coping with the overall situation. The psyche should be supported by relaxation and mental techniques. Yoga, meditation or autogenic training are helpful. In addition, psychotherapeutic treatment can be used. In order to strengthen the immune system, sleep hygiene and an adequate supply of oxygen are important in addition to an optimized food intake. The body must be able to regenerate well to absorb the effects of oropharyngeal cancer. Walks and exercise within the limits of physical possibilities are recommended. Many patients find an exchange with like-minded people helpful. Contacts with other affected persons can be established and maintained in self-help groups or Internet forums. Tips for dealing with the adversities of everyday life or mutual motivation take place through these channels.
