Oropharynx Cancer

You may need to undergo a number of tests for the screening and diagnosis, which will help your team to assess the stage, or severity of the cancer. Your head and neck specialist will first perform a physical examination to look for signs and symptoms of cancer, and then may order one or more of the most commonly used tests such endoscopy, panendoscopy, and x-rays.

Learn about some of the other tests commonly used for head and neck cancers

Cancers of the hypopharynx are biologically aggressive and have more ability to spread than other types of head and neck cancer. Because most hypopharyngeal tumors grow in a silent fashion without presenting noticeable symptoms, they are often quite large by the time the patient is first seen.

Radiation
The frontline treatment for cancers of the oropharynx is radiation. Because surgery on the oropharynx can result in significant problems with swallowing and speech, it is generally only used as a first line treatment for small tumors or for patients who cannot undergo or choose not to undergo radiation. Radiation effectively kills small tumors while preserving the swallowing and speaking functions of the oropharynx. The radiation schedule most often used is called ‘altered fraction radiation’ where radiation is given twice daily.

Cancers of the oropharynx often spread to the local lymph nodes. In such cases, the preferred treatment is a single treatment that can attack the primary cancer as well as the diseased lymph nodes. Radiation is the treatment that fulfills those requirements and also preserves the critical function of the oropharynx in speaking and swallowing.

For large tumors and very advanced cases, the preferred treatment is radiation and/or chemotherapy. If the tumor doesn’t completely disappear following radiation or chemotherapy, then surgical removal would be offered.

If oropharyngeal cancer returns, patients are offered a therapy other than the primary treatment they received. For example, if patients had radiation initially, then they may be offered surgery as a treatment. Patients may also be interested in participating in clinical trials that are using chemotherapy therapy combined with radiation to treat recurrent oropharyngeal cancer.

Surgery
The surgical approaches to treating oropharyngeal cancer will depend on the whether the cancer is at an early or late stage of development.

Early-Stage Oropharynx Cancer
The early stage tumors that are less than 4 cm can be reached through the mouth and removed by surgical excision or laser.

Larger tumors that occur during later stages or oropharyngeal cancer have to be removed by radical surgery. In such cases, the surgeon will need to make an incision on the face in the middle of the chin, and split the lip and jaw to reach the tumor to remove it. In these cases, the incision usually heals without much in the way of scarring but the surgeon will need to reconstruct the oropharynx to put the jaw and tissues back together.

Late Stage Oropharyngeal Cancer
Late stage oropharyngeal cancer may also require neck dissection surgery where the lymph nodes close to the cancer are removed and then assessed by a pathologist. In cases where multiple lymph nodes test positive or where the cancer is growing along nearby nerves, patients are treated with radiation and/or chemotherapy after surgery.

Complications
The complications that may arise from lip and mouth cancer treatment include:

• Delayed wound healing, infections
• Difficulty with swallowing, eating or speaking

Preparing for Your Surgery
Prior to surgery, all patients will have an appointment at the pre-admission clinic located at the Toronto General Hospital. You must bring all the information about recent medical tests, as well as the names and phone numbers of physicians you have seen in the past. A pre-admission nurse will perform the admission, assessment and blood work, usually 2-3 weeks before the surgery. A clinical nurse coordinator will supervise the preadmission appointment, explain the information about your surgery, introduce you to the staff and take you on a tour of the surgical inpatient unit if you request it. The pre-admission clinic is responsible for providing all tests, assessments and educational information to patients and family members before the scheduled surgery.

Starting at midnight on the night before your surgery, you must not eat, drink, chew or suck on candies as it is of the utmost importance that your stomach be empty when you have your surgery. On the morning of your surgery, you must arrive at the hospital 2 hours before the scheduled surgery time. The preadmission nurse and nursing staff will prepare you for surgery, and insert an intravenous (IV) needle that will allow fluids, antibiotics and pain medications to be injected into your blood during the surgery.

Follow-up care for oropharyngeal cancer is critical and you will need to see your physician on a regular basis. You may also need ongoing therapy for speaking and swallowing problems.

Many members of the multidisciplinary treatment team will work with you through this challenging process, and can offer continuing care and guidance about the services and resources that may be of assistance during your recovery or palliative care.