12180 Oropharyngeal Cancer

Overview

Oropharyngeal cancer is a type of head and neck cancer that starts in the oropharynx — the part of the throat behind your mouth. This area includes your tonsils, the back of your tongue, the soft roof of your mouth, and the sides and back of your throat.

It is not a common cancer, but rates have been rising in many countries over recent decades.

It most often affects adults over 50, but younger adults are increasingly affected because of HPV. It is about twice as common in men as in women.

Symptoms

Common symptoms

• A sore throat that does not go away after a few weeks
• A lump or swelling in the neck
• Difficulty or pain when swallowing
• Voice changes or hoarseness
• Pain in one ear
• A red or white patch on the inside of the throat or mouth
• A feeling that something is stuck in the throat
• Unexplained weight loss

Symptoms in children

• Oropharyngeal cancer is very rare in children, but if it occurs, symptoms may include a persistent sore throat, trouble swallowing, a neck lump, or a change in voice.
• Because children often get throat infections, doctors may first check for more common causes. Persistent symptoms should still be taken seriously.

Symptoms in older adults

• Older adults may notice a persistent sore throat, trouble swallowing, or a neck lump.
• Other warning signs include a mouth sore that does not heal, loose teeth, poorly fitting dentures, pain when chewing, blood in saliva, or unintentional weight loss.

Causes

Main causes

• Infection with human papillomavirus (HPV), a very common virus passed through skin-to-skin contact, is a leading cause, especially in younger adults.
• Long-term tobacco smoking or chewing tobacco.
• Regular heavy alcohol use, especially when combined with smoking.

Risk factors

• HPV infection
• Smoking or chewing tobacco
• Heavy alcohol use
• Being male
• Age over 50
• Poor oral hygiene
• A weakened immune system

When to see a doctor

See a doctor urgently if:

• See a doctor promptly if you have a sore throat lasting more than three weeks.
• See a doctor promptly if you notice a lump in your neck, persistent hoarseness, or one-sided ear pain.
• See a doctor promptly if swallowing becomes difficult or painful.

Book a routine appointment if:

• If you have risk factors such as smoking or heavy alcohol use and notice any persistent change in your mouth or throat, book an appointment even if you are not in pain.
• If you have had HPV-related changes in the past, ask your doctor about any new symptoms.

Diagnosis

Your GP will ask about your symptoms and examine your mouth and neck. If they suspect anything unusual, they will refer you to a specialist, usually an ear, nose, and throat (ENT) doctor at a head and neck cancer clinic.

Tests that may be done

• Nasendoscopy or panendoscopy — a thin flexible camera inserted through the nose or mouth to look at your throat.
• Biopsy — taking a small tissue sample from the suspicious area to check for cancer cells.
• Imaging scans such as MRI, CT, or PET to see the size of the cancer and whether it has spread.
• HPV testing on the biopsy sample, because HPV-related cancers may respond differently to treatment.

What to expect at your appointment

If you are referred to a specialist, you may have several tests before the diagnosis is confirmed. This can be an anxious time. Ask as many questions as you need and bring someone you trust to appointments for support.

Treatment

Treatment depends on the size and location of the cancer, whether it has spread, and your general health. Your care will be planned by a team of specialists, including surgeons, cancer doctors, nurses, dietitians, and speech and language therapists.

Self-care at home

• Keep your mouth moist with water or sugar-free ice, especially if a dry mouth is a problem.
• Eat soft, nutritious foods if swallowing is painful, and take your time at meals.
• Talk with your care team before using any mouthwashes, lozenges, or herbal products.
• Stay as physically active as your energy allows, even if it is just a short daily walk.

Medical treatments

Common treatment approaches include surgery to remove the tumor, radiotherapy (high-energy beams to kill cancer cells), chemotherapy, and targeted therapies. You may receive one treatment or a combination. Your team will explain the benefits and side effects, and clinical trials may be available for some people.

When is surgery considered?

Surgery may be used to remove the tumor and some nearby lymph nodes. Modern techniques aim to preserve swallowing and voice as much as possible. If a large area of the throat must be removed, reconstructive surgery can help restore function and appearance.

Living with this condition

After treatment, you may need swallowing therapy, speech therapy, and nutritional support. Regular follow-up appointments are important to check for side effects and to make sure the cancer has not come back. Recovery often takes time, so be kind to yourself.

Lifestyle tips

• Stop smoking — your care team can provide support and options to help you quit.
• Reduce or avoid alcohol, especially during and after treatment.
• Stay hydrated and practice good oral hygiene.
• Keep up with regular dental check-ups, as dental health is closely linked to mouth and throat health.

Diet and exercise

Eating and drinking may be difficult during treatment. Soft, moist foods, soups, and nutritious milkshakes can help. Some people need a feeding tube temporarily to get enough nutrition. Gentle exercise, such as walking, can help maintain strength, energy, and mood. Ask your team before starting any new activity.

Mental health and emotional wellbeing

A cancer diagnosis and treatment can cause anxiety, sadness, and fear. These feelings are completely normal. Tell your care team how you are feeling — they can arrange counselling or peer support. If you ever feel so overwhelmed that you might harm yourself, call your local emergency number immediately.

Prevention

Not all cases can be prevented, because HPV is very common and not everyone with HPV develops cancer. However, avoiding tobacco, limiting alcohol, and getting HPV vaccination can significantly reduce your risk.

Vaccines

HPV vaccination is offered to girls and boys in many countries. It protects against the HPV types most often linked to oropharyngeal and other HPV-related cancers.

Screening programmes

There is no routine screening test for oropharyngeal cancer for the general public. Regular dental check-ups can sometimes spot early changes in the mouth and throat, so keeping these appointments is important.

Complications

If left untreated

• The tumor may grow and make it harder to breathe, swallow, or speak.
• Cancer cells can spread to lymph nodes in the neck or other parts of the body.
• Severe weight loss and malnutrition can occur because eating becomes too painful.

Long-term outlook

When found early, oropharyngeal cancer often responds very well to treatment and many people are cured. Treatments continue to improve, and even cancers found at a later stage can be controlled effectively. Your medical team will be honest with you about what to expect and will support you through every step.

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