A patient with a neck lump secondary to oropharyngeal cancer

What is Oropharyngeal Cancer?

It is a type of head and neck cancer that arises from the oropharynx, a term which refers to the middle part of the throat located just behind the mouth cavity. This area includes the back one-third of the tongue, the soft part of the palate (including the uvula), the tonsils, and the side and back walls of adjacent throat (pharynx).

Oropharyngeal cancer can originate from any of these structures.


What causes Oropharyngeal Cancer?

The majority of oropharyngeal cancers are squamous cell carcinomas, which means they originate in the thin, flat cells lining the mouth, throat and the rest of the upper airway.

The primary risk factors for oropharyngeal cancer include tobacco use (both smoking and chewing tobacco), high alcohol consumption, and infection with certain types of human papillomavirus (HPV), particularly HPV-16 or HPV-18.

HPVs have become the dominant cause of oropharyngeal cancer in recent years, which is why it is being diagnosed increasingly in younger patients who have never smoked.

Oropharyngeal cancer is a serious condition, and early detection and treatment are critical for curative treatment. Being aware of the symptoms can aid in early diagnosis.

Minimising risk factors by not smoking and limiting alcohol consumption, can help prevent oropharyngeal cancer. Vaccination against HPV is expected dramatically reduce the risk of developing this cancer in the future


What are the symptoms of oropharyngeal cancer?

The symptoms vary depending on the specific location and size of the tumour.

Common presenting complaints include:

A persistent sore throat: A sore throat that persists more than a month can be a warning sign.

Difficult or painful swallow: Experiencing discomfort or pain when swallowing, or feeling like food gets stuck in the throat.

Ear pain on one side: Persistent pain in or around the ear, which is typically worse with swallow.

A lump or ulcer in the mouth or throat: A visible lump, ulcer, or sore in the mouth, tonsil, palate or throat that does not heal (within a few weeks).

Trouble opening the mouth fully: Is a worrying sign and you should seek an urgent appointment with a Head and Neck surgeon.

A lump in the neck: Swelling or lumps in the neck could be a sign that cancer has spread to the lymph nodes of the neck. This is a common way in which HPV driven cancers present

Bad breath: Persistent bad breath that does not improve with oral hygiene practice such as brushing teeth or gargling with antiseptics.

Other symptoms that you should not ignore include:

Voice change or hoarseness: Hoarseness, that does not improve within a month.

Coughing up blood: This can occur in more advanced cases.

Unexplained weight loss with one or more of the above symptoms: For example a feeling of food stuck in the throat associated with significant weight loss in the absence of a change in diet or exercise habit.

It’s important to understand that all of these symptoms may be caused by conditions other than cancer. However, if you experience any persistent and unexplained symptoms, I would recommend you seek a consultation with a head and neck cancer specialist.

Early-stage oropharyngeal cancer can be very effectively treated and, in most cases, can be cured, so it’s important to present to a specialist early.


How do I treat Oropharyngeal Cancer?


The treatment of oropharyngeal cancer is truly multidisciplinary. The choice of treatment will depend on various factors including the specific location of the cancer, the stage of the cancer and your overall health.

Your treatment plan will be personalised and you will be treated by a team of specialists including myself (a cancer surgeon), an oncologist, specialist nurses and rehabilitation therapists.

If your cancer is caught in its early stages, then you have an option between surgical treatment and oncological therapy.

In recent years, minimally invasive techniques such as laser and robotic surgery have been developed to remove tumour through the mouth (transoral) without the need for incisions in the face/ jaw or neck. 


Transoral Robotic Surgery (TORS)

TORS has become an important surgical technique in my practice. I use it to remove tumours from the oropharynx: namely tonsil cancer, tongue base cancer, palate and other throat cancer.

This technique employs robotic arms that are controlled from a nearby console. I am provided with an amplified 3-D view and the robotic arms translate my hand movements with exceptional precision and flexibility and enable me to reach areas in the throat that I would otherwise find difficult or impossible with traditional approaches.

It should be noted that although the main tumour may be removed using TORS, I will need to perform a clearance of the draining neck lymph nodes to ensure capture of any metastatic spread. This will be performed via an external neck incision. The neck dissection usually heals relatively quickly.

The benefits of TORS are that it is minimally invasive and its precision reduces possible injury to surrounding healthy tissues, nerves and vessels. This should consequently lead to a quicker recovery (compared to an open, split-jaw approach) and very good functional outcomes with regards speech and swallow.


Other Treatment Modalities

Radiation Therapy

Is often used in conjunction with surgery, especially in cases where the cancer has spread beyond the primary tumour site into multiple lymph nodes. Focussed external radiation beams are directed into the tumour site and the neck; this is performed daily, usually for a total of 30 sessions.

Some patients with early-stage disease may opt to have this treatment as the first line, if they do not desire an operation. 



This is drug-based therapy, injected into the vein, which is usually given in combination with radiation if your overall health is good.


Targeted Therapy and Immunotherapy:

These newer forms of treatment, target cellular mutations specific to your particular cancer or enhance and focus the body’s immune response to fight the cancer.

These treatments are currently reserved for very advanced or incurable cancer