What is Oropharyngeal Squamous Cell Carcinoma (throat cancer, tonsil cancer)?
Oropharyngeal squamous cell carcinoma (OPSCC), also known as throat cancer or tonsil cancer, refers to cancer that occurs in the middle part of your throat, also known as the oropharynx. This area spans from the soft part at the roof of your mouth (soft palate) to the area above a small bone in your neck (hyoid bone). It includes the back part of the tongue, tonsils, soft palate, and the back and sides of the throat.
More than 90% of cancers in this area are squamous cell cancers, which is a type of skin cancer that develops in the lining of the oropharynx.
There are two types of this throat cancer. The first is HPV-associated, which means it happens due to an oral infection with the human papillomavirus (HPV). The other is non-HPV-associated, which is mainly caused by smoking tobacco and drinking alcohol.
Throat cancer can spread in two ways: by directly invading the nearby tissues or by spreading through the blood and lymphatic system, which carries the body’s infection-fighting cells. The main symptoms include a sore throat, pain when swallowing (odynophagia), and difficulty swallowing (dysphagia). Doctors diagnose this cancer by taking a small sample of the affected tissue (biopsy) and examining it for cancer cells. Treatment for throat cancer includes surgery, radiation therapy, chemotherapy, or a combination of these treatments.
What Causes Oropharyngeal Squamous Cell Carcinoma (throat cancer, tonsil cancer)?
The cause of oropharyngeal carcinoma, or throat cancer, is generally divided into two categories: those linked with HPV and those not linked with HPV.
Throat cancer that is linked with HPV, or human papillomavirus, usually happens in individuals who have been infected with this virus. Among the many kinds of human papillomavirus, HPV16 is the type found most often in throat cancers.
Behaviors like oral sex and open-mouth kissing are usually the main ways someone gets oral HPV infection.
On the other hand, for throat cancers not linked with HPV, the biggest risks are smoking tobacco and alcohol use. Additional risks, though less common, include eating a diet low in fruits and vegetables, chewing betel quid (a type of plant), poor nutrition, smoking marijuana, exposure to asbestos, and having certain gene changes like P53 mutation and CDKN2A (p16) mutations.
Risk Factors and Frequency for Oropharyngeal Squamous Cell Carcinoma (throat cancer, tonsil cancer)
Oropharyngeal cancer, which primarily affects the tonsils and the base of the tongue, is the sixth most common type of cancer globally. Most cases of this cancer, almost 90%, are associated with a specific virus, HPV 16. Furthermore, this type of cancer is more prevalent in males than in females, and it often occurs in younger individuals who smoke and drink less but report having more oral sex partners.
- Oropharyngeal cancer ranks as the sixth most common cancer worldwide.
- 90% of these cancers are linked to the HPV 16 virus.
- This cancer is more common in males than in females.
- It commonly affects the tonsils and the base of the tongue.
- The main risk factors include being younger, smoking and drinking less, and having more oral sex partners.
Signs and Symptoms of Oropharyngeal Squamous Cell Carcinoma (throat cancer, tonsil cancer)
Oropharyngeal cancer is a type of cancer that affects part of the throat called the oropharynx. People with this condition may have a variety of symptoms, which can depend on exactly where the cancer is. For instance, some common symptoms are:
- A persistent sore throat
- Difficulty swallowing, which is medically known as dysphagia
- Painful swallowing, or odynophagia
- Difficulty speaking, or dysarthria
- A noticeable lump in the neck
- Ear pain, or otalgia
- Changes in voice, such as hoarseness
- Unexplained weight loss
- Vomiting blood, which is known as hematemesis
In a physical examination, doctors might find an ulcer or a patch of red or white skin. These can be found on various parts of the throat like the base or back of the tongue, the posterior and lateral pharyngeal walls, soft palate, or tonsils.
Testing for Oropharyngeal Squamous Cell Carcinoma (throat cancer, tonsil cancer)
If your doctor suspects you might have oropharyngeal cancer, which is cancer located in the back part of your throat, there are several types of investigations that will be done. These include:
X-Rays
Initially, the doctor might take an X-ray to check your teeth and to see if the cancer has spread to the bone. But this method is limited in its capacity to provide a clearer vision of the condition.
Ultrasonography
If you have noticed a lump in your neck, an ultrasound might be performed. This can provide an excellent assessment of how this lump, or what doctors call a “nodal disease”, has progressed. Sometimes, the doctor might take a small tissue sample from the lump during the ultrasound, to examine it more closely in the lab.
Magnetic Resonance Imaging (MRI)
An MRI scan gives a clear picture of the tumor, especially how much it has spread into the surrounding soft tissues. Unlike the X-rays, the accuracy of MRIs, do not get affected by dental fillings or other metallic dental restorations. For this reason, they are often the best choice to understand the stage, or severity, of your tumor.
Computed Tomography (CT) Scan
The CT scan is another valuable tool to measure the size of your tumor and see if it has spread to your neck’s lymph nodes or lower jawbone. This information helps doctors decide whether surgery to remove the tumor is an option.
Positron Emission Tomography (PET) Scan
In cases where the doctor can’t locate the primary tumor using other imaging tests, a combination of PET and CT might be used. PET scans are also used to check for any recurrence, or return of primary tumors, after the treatment is complete.
Endoscopy and Laryngoscopy
Sometimes, doctors need a closer look at the suspicious areas in your throat. So they might use an endoscope and laryngoscope to examine those sites. This process usually involves an anesthetic spray or general anesthesia to make it as comfortable as possible for you.
Biopsy
A biopsy involves taking a small sample of tissue from the suspicious area for closer lab examination, which helps doctors conclusively determine if you have cancer. Depending on where the cancer is located, this can be done either with a fine needle or a special small brush during a routine dental examination. The latter method is relatively new, simpler, and more convenient.
Human Papillomavirus Testing (HPV testing)
The American Society of Clinical Oncology advises testing all newly diagnosed oropharyngeal cancers for the presence of the human papillomavirus (HPV). This test is done using a method called a polymerase chain reaction, which tests for the presence of HPV DNA.
Treatment Options for Oropharyngeal Squamous Cell Carcinoma (throat cancer, tonsil cancer)
Surgery and radiation therapy are the two main forms of treatment for patients with oropharyngeal cancers, which affect the middle part of the throat. If the cancer is small and has not spread significantly, either surgery or radiation therapy can be used by itself. But if the cancer has spread or is larger, then both surgery and radiation therapy are usually employed to tackle it.
Surgeons have started using less invasive methods to treat oropharyngeal cancers. One technique is called transoral laser microsurgery (TLM), which involves using a laser to remove the cancer through the mouth. This method has proven to be safe and successful.
Other ways of removing cancer cells include transoral robotic surgery, where robots assist surgeons in performing precise operations. There’s also transoral video laryngoscopic surgery and transoral ultrasound surgery, which use camera and ultrasound technology respectively to guide the surgical procedure, and endoscopic laryngopharyngeal surgery, which involves using a flexible tube called an endoscope to inspect the throat and carry out surgery.
After surgery, patients can increase their chances of survival by undergoing extra treatments known as induction chemotherapy or chemoradiotherapy, which involves using drugs and radiation together to kill cancer cells. If the tumor cannot be removed with surgery, a combination of a drug called cisplatin and radiation therapy is considered the best option. This combination has proven more successful in improving survival rates compared to using radiation therapy alone. However, some studies show that using a combination of two other drugs, carboplatin and paclitaxel, can also be effective in treating stage III and IV non-metastatic oropharyngeal cancers, and may cause fewer side effects.
What else can Oropharyngeal Squamous Cell Carcinoma (throat cancer, tonsil cancer) be?
When a person shows symptoms that might indicate oropharyngeal squamous cell carcinoma, a type of throat cancer, there are other conditions doctors need to rule out because they can cause similar symptoms. These include:
- Actinic keratosis (skin condition with scaly patches)
- Erythroplasia (a red patch in the mouth that could indicate pre-cancer)
- Lichen planus (a rash inside the mouth)
- Leukoplakias (white patches in the mouth)
- Lichenoid lesions (a type of skin rash)
- Oral candidiasis (a yeast infection in the mouth)
- Tonsillitis (inflammation and infection of the tonsils)
- Traumatic lesions (injuries to the mouth)
What to expect with Oropharyngeal Squamous Cell Carcinoma (throat cancer, tonsil cancer)
The overall survival rate for oropharyngeal carcinoma, a type of throat cancer, is generally around 60% after five years. However, this can change depending on the cause of the cancer. For instance, if the cancer is caused by the Human Papillomavirus (HPV), the outlook tends to be more favorable and the response to treatment is usually better.
This higher survival rate in HPV-related cases seems to be due to two main factors: the nature of the tumor itself, which reacts more positively to treatment, and the general health and younger age of these patients.
Possible Complications When Diagnosed with Oropharyngeal Squamous Cell Carcinoma (throat cancer, tonsil cancer)
Treatments for cancers of the throat and mouth can lead to various problematic side effects. These include:
- Mouth sores
- Thickening and scarring of tissue
- Reduced saliva production
- Infections
- Severe bone damage due to radiation
- Issues related to the jawbone removal, such as changes in appearance and function, which can lower the quality of life
Preventing Oropharyngeal Squamous Cell Carcinoma (throat cancer, tonsil cancer)
When it comes to stopping HPV-related throat cancer (OPSCC) before it starts, HPV vaccines are very effective. They can prevent more than 90% of HPV infections that the vaccine covers, and can stop abnormal cells (anogenital precancerous lesions) in the genital area from forming. A study by Pinto and team showed that getting vaccinated makes the body produce HPV antibodies in the mouth which correspond to the levels in the bloodstream. Additionally, there’s a screening tool that could potentially detect HPV DNA in mouth rinses early on, however, more research is needed as there isn’t much data available at the moment.
Safe oral sex practices are also advised as a preventive measure. It’s important to educate people about the risks of harmful habits when it comes to oral health and throat cancer. Chewing betel quid, using alcohol, and smoking tobacco all significantly increase the risk of throat cancer, so understanding these risks is essential to prevent it.
