The Farber Center: For Radiation Oncology

Oropharyngeal cancer is a disease in which cancer cells are found within the anatomical borders of the oropharynx. The majority of oropharyngeal cancers are squamous cell carcinomas.

The oropharynx is the middle part of the pharynx (throat). The pharynx is a hollow tube that begins behind the nose and goes down to the neck, becoming part of the tube that extends into the stomach (esophagus). The oropharynx includes the base of the tongue, the tonsils, the soft palate (back of the mouth), and the walls of the pharynx.

• Enlarged neck lymph nodes
• Sore throat
• Ear pain
• Difficulty swallowing
• Foul breath
• Voice changes
• Difficulty opening your jaw/pain in opening your jaw
• Pain

Risk Factors:

• Alcohol: Frequent and heavy consumption of alcohol increases the risk of head and neck cancer. Eighty-five percent (85%) of head and neck cancer is linked to tobacco use. Using alcohol and tobacco together increases this risk even more. Recent studies have suggested that people who have used marijuana may be at higher than average risk for head and neck cancer. Second-hand smoke may also increase a person’s risk of head and neck cancer.
• Human papillomavirus (HPV): Research indicates that infection with this virus is a risk factor for oral and oropharyngeal cancer. In fact, HPV-related oropharyngeal cancer in the tonsils and the base of the tongue have become more frequent in recent years. HPV is most commonly passed from person to person during sexual activity. There are different types, or strains, of HPV, and some strains are more.
• Tobacco use: Use of tobacco, including cigarettes, cigars, pipes, chewing tobacco, and snuff, is the single largest risk factor for head and neck cancer. Pipe smoking is particularly linked to cancer in the part of the lips that contact the pipe stem. Chewing tobacco or snuff is associated with a 50% increase in risk of cancers of the cheeks, gums, and inner surface of the lips where the tobacco has the most contact is strongly associated with certain types of cancers.

Complete history and physical examination including: a thorough history will be taken asking for some of the symptoms. Patches inside your mouth or on your lips that are white, a mixture of red and white, or red.

Physical exam of the lips and oral cavity: An exam to check the lips and oral cavity for abnormal areas. The doctor or dentist will feel the entire inside of the mouth with a gloved finger and examine the oral cavity with a small long-handled mirror and lights. This will include checking the insides of the cheeks and lips; the gums; the roof and floor of the mouth; and the top, bottom, and sides of the tongue. The neck will be felt for swollen lymph nodes. A history of the patient’s health habits and past illnesses and medical and dental treatments will also be taken.

Biopsy a small piece of tissue taken from the suspected tumor - is often advised. This tissue is sent to a pathologist to define which types of cells are making up the tumor.

Tumor HPV testing

MRI and/or CT scans of head and neck One or both of these can may be necessary at each can provide very specific information concerning the extent of disease. The physician may also order an X-ray or CT scan of the chest to see if there is any spread of disease to the lungs, the most common site of spread outside of the neck. Consider PET/CT scan A procedure to find malignant tumor cells in the body. A small amount of radionuclide glucose (sugar) is injected into a vein. The PET scanner rotates around the body and makes a picture of where glucose is being used in the body. Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells do.

T indicates the size of the main (primary) tumor and which, if any, tissues of oropharynx it has spread to.

Tis: carcinoma in situ. This means the cancer is still within the epithelium (the top layer of cells lining the oropharynx) and has not yet grown into deeper layers of oropharyngeal tissue

T1: tumor is 2 cm (about ¾ inch) across or smaller

T2: tumor is larger than 2 cm across, but smaller than 4 cm (about 1 ½ inch)

T3: tumor is larger than 4 cm across

T4a: The tumor is growing into nearby structures. This is known as moderately advanced local disease. For oropharyngeal cancers: the tumor is growing into the larynx (voicebox), the tongue muscle, or bones such as the medial pterygoid, the hard palate, and the jaw.

T4b: The tumor has grown through nearby structures and into deeper areas or tissues. This is known as very advanced local disease. Any of the following may be true:

• The tumor is growing into other bones, such as the pterygoid plates and/or the skull base
• The tumor surrounds the internal carotid artery
• For oropharyngeal cancers: the tumor is growing into a muscle called the lateral pterygoid muscle.
• For oropharyngeal cancers: the tumor is growing into the nasopharynx (the area of the throat that is behind the nose).

N stands for spread to nearby lymph nodes in the neck

N0: There is no evidence of cancer in the regional nodes.

N1: Cancer has spread to a single node on the same side as the primary tumor and the cancer found in the node is 3 cm or smaller.

N2: Describes any of the following conditions:

• N2a: Cancer has spread to a single lymph node on the same side as the primary tumor, and is larger than 3 cm, but not larger than 6 cm.
• N2b: Cancer has spread to more than one lymph node on the same side as the primary tumor, and none measure larger than 6 cm.
• N2c: Cancer has spread to more than one lymph node on either side of the body, and none measure larger than 6 cm.

N3: Cancer found in the lymph nodes is larger than 6 cm.

M is for metastasis (spread to distant organs).
M0: The cancer has not spread to distant sites.
M1: The cancer has spread to distant sites.

Stage Grouping

Stage 0 Tis, N0, M0

Stage I
T1, N0, M0

Stage II
T2, N0, M0

Stage III
T3, N0, M0, OR T1 to T3, N1, M0

Stage IVA
T4a, N0 or N1, M0, OR T1 to T4a, N2, M0

Stage IVB
T4b, Any N, M0, OR Any T, N3, M0

Stage IVC
Any T, Any N, M1

SURGERY
Surgery (removing the cancer in an operation) is a common treatment for all stages of lip and oral cavity cancer. Wide local excision: Removal of the cancer and some of the healthy tissue around it. If cancer has spread into bone, surgery may include removal of the involved bone tissue. Neck dissection: Removal of lymph nodes and other tissues in the neck. This is done when cancer may have spread from the lip and oral cavity Even if the doctor removes all the cancer that can be seen at the time of the surgery, some patients may be given chemotherapy or radiation therapy after surgery to kill any cancer cells that are left. Treatment given after the surgery, to lower the risk that the cancer will come back, is called adjuvant therapy.

RADIATION
Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated.

CHEMOTHERAPY
is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping the cells from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). The way the chemotherapy is given depends on the type and stage of the cancer being treated.

Possible Treatment Side Effects
Dr. Farber, Dr. Spierer, and their staff at The Farber Center for Radiation Oncology will discuss potential side effects with you before, during, and after treatment, and ensure that your experience is personalized.