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Oropharyngeal Cancer: NCCN Guidelines for Patients

September 9, 2022 - read ≈ 7 min

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The NCCN Guidelines for Patients were developed by the National Comprehensive Cancer Network (NCCN). NCCN is an organization that unites leading cancer care centers in the United States of America. Its activities are focused on scientific research, treatment and education of patients.

Oropharyngeal cancer basics

Oropharyngeal cancer is a type of throat cancer. Read this chapter to learn where this cancer grows and what puts people at risk for this cancer.

The throat

Before learning about oropharyngeal cancer, it is helpful to know about the throat. The throat is also called the pharynx.

Pharynx

The pharynx is a tube-like structure within the head. It starts behind the nose and ends at the voice box (larynx). Food passes from the mouth through the pharynx on its way to the stomach. Air also passes from either the mouth or nose through the pharynx on its way to the lungs.

The pharynx has 3 parts, which are the:

  • nasopharynx
  • oropharynx
  • hypopharynx

The nasopharynx is behind the nose. The oropharynx is below the nasopharynx. The hypopharynx is below the oropharynx and just behind the voice box.

Lymph nodes

Throughout your body — including your throat — is a clear fluid called lymph. Lymph contains contains germ-fighting blood cells. Fluid from between cells drains into lymph. Lymph travels through channels that transport it to the bloodstream.

As lymph travels, it passes through lymph tissue. Lymph tissue removes germs from lymph.

Lymph nodes are small structures that contain lymph tissue. They are found throughout the body. There are many lymph nodes in the neck.

The tonsils are larger clusters of lymph tissue. There is a tonsil on the left and right side of the throat. There are similar clusters of lymph tissue in the nasopharynx and at the back of the tongue.

Above all, never give up. Give luck a chance to happen by doing all within your control to survive

— Mary,
Tongue cancer survivor

Head and neck cancer

Head and neck cancer is a group of cancers. It includes cancers of the inner lip, mouth, throat, voice box, nose, and sinuses. These cancers are referred to as upper aerodigestive tract cancers.

Oropharyngeal carcinoma

This book is about treatment for oropharyngeal carcinoma. Almost all cancers of the oropharynx are squamous cell carcinomas. Carcinomas are cancers of cells that line the inner or outer surfaces of the body.

Oropharyngeal carcinoma forms from cells that line the oropharynx.

The parts of the oropharynx are:

  • base of the tongue
  • tonsils
  • soft palate
  • walls of the middle part of the throat

The cancer cells can form into a tumor within the oropharynx. This is called the primary tumor. This tumor can grow into nearby tissue, such as the voice box and tongue muscle. Cancer cells from oropharynx often spread to lymph nodes in the neck.

Risk factors

A risk factor is anything that increases your chance of cancer.

Risk factors linked to oropharyngeal cancer are:

  • Tobacco use
  • Infection with human papillomavirus (HPV)

Oropharyngeal cancers that are related to HPV differ from cancers unrelated to HPV. People with HPV-related cancer tend to be younger. The outlook (prognosis) of HPV-related cancer is better. More research is needed to learn what treatments work best for each type of oropharyngeal cancer.

To take differences into account, oropharyngeal cancer is often grouped by HPV status. Cancers not related to HPV are called HPV negative. Cancers related to HPV are called HPV positive.

Treatment types

This section briefly describes treatments for oropharyngeal cancer. Not everyone receives the same treatment. Your doctors will tailor treatment to you based on tests described in Part 2.

In this book, options for initial treatment are grouped by HPV status. Options for HPV- negative cancer are listed in Part 3. Options for HPV-positive cancer are listed in Part 4. Treatment for cancer that persists or returns after initial treatment is discussed in Part 6.

Clinical trial

One treatment choice may be a clinical trial. Clinical trials are strongly supported by NCCN. NCCN believes that you will receive the best management if treated in a clinical trial.

A clinical trial is a type of research that studies a promising test or treatment in people. It gives people access to health care that otherwise couldn’t usually be received. Clinical trials often include new treatments that are added to standard treatments. Ask your treatment team if there is an open clinical trial that you can join.

Surgery

Surgery is a treatment that removes tumors or entire organs with cancer. It is a very common treatment for oropharyngeal cancers. The primary tumor, lymph nodes, or both may be removed during surgery.

The method to remove the cancer depends on where and how much the cancer has grown. The cancer may have grown near or around blood vessels and nerves. Most often, surgeons remove oropharyngeal cancers through an open mouth.

The cutting device that is used may be a surgical knife, heated device, or laser beam. A machine (“robot”) may be used to remove the cancer. Surgeries with lasers or a robot should only be performed by a surgeon with the proper training and experience.

Radiation therapy

Radiation therapy uses high-energy x-rays or particles to treat oropharyngeal cancer. It damages cancer cells. The cancer cells either die or stop making new cancer cells.

External beam radiation therapy (EBRT) is used for treatment. A large machine makes radiation beams that are shaped to the form of the tumor. The highest radiation dose is aimed at the cancer. A much lower dose is given to nearby tissue.

NCCN experts recommend the following techniques:

  • Intensity-modulated radiation therapy (IMRT) is a commonly used technique. It delivers x-ray beams that very closely match the shape of the target and spare more normal tissue.
  • Proton therapy treats cancer with proton beams. Proton beams deliver radiation mostly within the tumor. NCCN experts advise to get proton therapy only when x-ray beams would damage too much normal tissue.

A radiation oncologist is a doctor who is an expert in treating cancer with radiation. Radiation therapy to the head and neck should only be done by a radiation oncologist with the proper training and experience.

Chemotherapy

Chemotherapy is a treatment with drugs that stop the cell life cycle. As a result, cancer cells cannot make new cells. Chemotherapy can also cause cells to destroy themselves.

Cisplatin, carboplatin, 5-fluorouracil (5-FU), and docetaxel are commonly used to treat oropharyngeal cancer. There are other drugs that are less often used but can work.

Targeted therapy

Targeted therapy is a treatment with drugs that stop some of the ways by which cancer cells grow.

Cetuximab is a targeted therapy that stops growth signals from a structure called EGFR that is on cancer cells. It also allows immune cells to destroy the cancer cells.

Immunotherapy

T cells are a type of white blood cell. They help fight disease, including cancer. But, they are unable to attack cancer cells that have a protein called PD-L1.

Immune checkpoint inhibitors are a type of immunotherapy. These drugs include pembrolizumab and nivolumab. They allow T cells to attack cancer cells with PD-L1.

Review

  • The oropharynx is the middle part of the throat that is behind the mouth.
  • Most oropharyngeal cancers form from cells that line the surface of the tongue base, tonsils, soft palate, and walls of the middle throat.
  • Tobacco use and infection with HPV can increase the chance of getting oropharyngeal cancer.
  • Not everyone with oropharyngeal cancer receives the same treatment. Your doctors will tailor treatment to you.


You can read more about Oropharyngeal Cancer, its treatment methods and follow-up after treatment in the full text of the recommendations for patients by downloading it below.

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