What Is Oropharyngeal Cancer?

The oropharynx is the part of the throat that lies just behind the oral cavity and in the back of the mouth. The tonsil, tongue-base and soft palate are the most well-known areas of this region of the throat, which can only be visualized using special endoscopes or mirrors.

Cancer in the oropharynx is called oropharyngeal cancer (OPC), and includes cancers involving:

• Tonsils
• Base of tongue
• Soft palate
• Upper part of the throat (posterior pharynx)

In 2014, an estimated 44,000 patients were estimated to be diagnosed with oral and pharyngeal cancer. More than 90% of oropharyngeal cancers are squamous cell carcinomas—so called because the tumors arise from the thin, flat "squamous" cells that cover the lining of the throat. Learn more about squamous cell carcinomas.

In the past, tumors arising in the oropharynx were uncommon and associated with heavy tobacco use. Over the past decade, there has been a dramatic change in the epidemiology of oropharyngeal cancer. A striking association has been made between oropharyngeal cancer and prior infection with the human papillomavirus (HPV).

HPV and oropharyngeal cancer

The incidence of cancer of the tonsil and base of tongue (that make up the bulk of oropharyngeal cancers) is increasing rapidly, with the expectation that by 2020 there will 50,000 new diagnoses annually in the United States. This rise is in those oropharynx tumors associated with certain strains of Human Papilloma Virus (HPV). People with these HPV-associated oropharynx cancers do very well, better than those with oropharyngeal cancers associated with other risk factors such as tobacco use.

Using the Surveillance, Epidemiology, and End Results (SEER) repository, investigators have shown that from 1988 to 2004, the incidence of HPV-positive oropharyngeal cancers increased by 225%. (doi = 10.1200/JCO.2011.36.4596)

Patients with OPC related to HPV tend to present earlier in life as compared to those with tobacco-associated OPC. The primary tumor is often difficult to see, hidden within the folds of the throat (tongue-base and tonsil.)

As a result, OPC cases typically are not diagnosed until the tumor metastasizes to the neck. Learn more about diagnosisng oropharyngeal cancer.

Numerous questions—about how to identify this disease earlier, how to prevent it, and which individuals are at greatest risk—continue to challenge researchers in the field. Yet, one thing is clear: multidisciplinary teams must transform therapy to keep pace with this “new” disease. Given these sweeping changes in the epidemiology of head and neck cancer, and in particular, the precipitous rise in HPV associated OPC, improvements in screening, prevention, and treatment must be made quickly.

Treatment for oropharyngeal cancer

The treatment of HPV+ oropharyngeal cancer is rapidly evolving. Treatment can include surgery, radiation therapy, chemotherapy, or some combination of these treatments, as we continue to seek to reduce the side effects of intervention without reducing the high likelihood of cure. Our multidisciplinary tumor board carefully evaluates the cancer as well as each patient, personalizing the approach to tailor for each patient a management strategy that both maximizes the chance of cure while minimizing morbidity of treatment. When there are equally effective treatment options, we discuss the risks and benefits of each choice with the patient to help make a decision together, including whether when eligible a patient wishes to consider participating in national studies Stanford offers to help address these choices. These studies are designed to produce the same cure rates as standard therapy, but with the least functional impact to patients' speech and swallowing.

Transoral surgical options may also be appropriate at times, such as trans-oral robotic surgery (TORS). TORS is a minimally-invasive technique that facilitates surgery in difficult access areas such as the very back of the tongue. When indicated, TORS may be able to accomplish the same or better resection by less invasive techniques and with less morbidity, resulting in faster recovery and better outcomes.

Learn more about treatment for oropharyngeal cancer.