Oropharyngeal Cancer Treatment in Delhi

Oropharyngeal cancer is a type of cancer that develops in the oropharynx, the middle part of the throat. This area includes the base of the tongue, tonsils, soft palate, and the walls of the throat. The most common form is squamous cell carcinoma, which begins in the thin, flat cells lining the oropharynx. Oropharyngeal cancer is often linked to two major risk factors: infection with the human papillomavirus (HPV) and prolonged tobacco or alcohol use. Early symptoms may include a persistent sore throat, difficulty swallowing, or a lump in the neck.

Oropharyngeal cancer develops when the cells in the oropharynx undergo genetic changes, leading to uncontrolled growth and tumour formation. These mutations can be triggered by various causes, with two primary factors standing out. 

One major cause is infection with the human papillomavirus (HPV), particularly the HPV-16 strain, which is linked to a growing number of oropharyngeal cancer cases. The virus infects the cells of the throat, leading to abnormal growth over time.

Another significant cause is tobacco use, including smoking cigarettes, cigars, and using smokeless tobacco, which has long been associated with cancers of the mouth and throat. 

Prolonged alcohol consumption, particularly in combination with smoking, further increases the risk by irritating and damaging the lining of the throat, promoting cancer development.

Several factors can increase the likelihood of developing oropharyngeal cancer:

• Human Papillomavirus (HPV) Infection: HPV infection, especially the HPV-16 strain, is one of the most significant risk factors. It has led to an increase in cases, particularly in younger adults who do not have a history of smoking.
• Tobacco Use: Smoking or chewing tobacco is one of the most well-established risk factors for oropharyngeal cancer. The longer and more frequently someone smokes, the higher their risk.
• Heavy Alcohol Consumption: Regular consumption of large amounts of alcohol increases the risk of oropharyngeal cancer, particularly when combined with tobacco use.
• Age and Gender: Oropharyngeal cancer is more commonly diagnosed in individuals over the age of 50, and it is more prevalent in men than in women.
• Poor Oral Hygiene: A lack of proper oral care, including untreated dental issues and chronic gum disease, has been linked to an increased risk of developing oropharyngeal cancer.
• Diet: A diet low in fruits and vegetables may contribute to a higher risk, as these foods provide essential vitamins and antioxidants that help protect cells from damage.
• Weakened Immune System: Individuals with compromised immune systems, such as those with HIV/AIDS or those on immune-suppressing medications, have an increased susceptibility to oropharyngeal cancer.

Consulting with experienced oropharyngeal cancer doctors in India can help identify and manage these risk factors effectively.

Oropharyngeal cancer may present a variety of symptoms, which can vary depending on the tumour's location and size. 

• Persistent Sore Throat: A sore throat that does not improve with standard treatment or lasts for an extended period may indicate a problem.
• Difficulty Swallowing: Known as dysphagia, this symptom can range from mild discomfort to severe pain when swallowing.
• Changes in Voice: Hoarseness or other changes in voice quality, especially if persistent, may signal irritation or involvement of the vocal cords.
• Lumps in the Neck: Swollen lymph nodes or lumps in the neck can occur if the cancer has spread to nearby lymph nodes.
• Unexplained Weight Loss: Significant weight loss without trying can be a concerning sign and may result from difficulty eating or underlying health issues.
• White or Red Patches: Lesions or patches in the mouth or throat that do not heal can be precursors to cancer.
• Ear Pain: Pain in one ear that does not resolve may also be associated with oropharyngeal cancer, particularly if accompanied by other symptoms.
• Bleeding: Unexplained bleeding from the mouth or throat can indicate a serious condition and should be evaluated promptly.

If any of these symptoms persist or worsen, it's important to consult a healthcare provider for further evaluation and potential diagnostic testing. Early diagnosis and treatment can significantly improve outcomes for those affected by oropharyngeal cancer.

Diagnosing oropharyngeal cancer involves several steps, to identify cancer early and determine how advanced it may be. This process typically begins with a detailed evaluation of symptoms and a physical examination, followed by more specialised tests to confirm the presence of cancerous cells and assess the extent of the disease. Below are the main diagnostic methods used:

Physical Examination

A healthcare provider will start by performing a thorough physical examination, checking the throat, mouth, and neck for lumps, sores, or any unusual changes in tissue. This can include feeling for swollen lymph nodes, inspecting the inside of the mouth, and using a light and mirror to look at the oropharynx. Often, early symptoms like persistent throat pain, difficulty swallowing, or changes in the voice lead to this initial exam, prompting further tests if abnormalities are detected.

Endoscopy

If there are any concerns during the physical examination, an endoscopy is typically the next step. A thin, flexible tube with a light and camera, called an endoscope, is inserted through the nose or mouth to provide a detailed view of the oropharynx and nearby structures. This procedure helps doctors closely examine hard-to-see areas of the throat and can detect small lesions or growths that might not be visible during a routine exam. The procedure is often done under local anaesthesia, and in some cases, a biopsy may be taken during the endoscopy if suspicious areas are found.

Biopsy

A biopsy is a crucial step in diagnosing oropharyngeal cancer, as it provides definitive evidence of cancerous cells. During a biopsy, a small sample of tissue is removed from the affected area, either with a fine needle, through an endoscopic procedure, or surgically. The tissue sample is then analysed under a microscope by a pathologist to identify the presence of cancer cells and determine their type and grade. This is essential for planning appropriate treatment. If the biopsy confirms cancer, further tests may be needed to assess its stage and whether it has spread.

Imaging Tests

Imaging tests play a vital role in understanding the size, location, and spread of the cancer. CT scans (Computed Tomography), MRIs (Magnetic Resonance Imaging), and PET scans (Positron Emission Tomography) are commonly used to create detailed images of the throat, head, neck, and surrounding areas. These scans can detect tumours that may not be visible with physical examination alone, and they help determine if the cancer has spread to nearby lymph nodes or distant parts of the body. This information is crucial for staging the cancer, which influences the treatment plan. X-rays may also be used to check for cancer spread to the chest, while a barium swallow test can evaluate swallowing issues and any blockages in the oesophagus.

HPV Testing

Since oropharyngeal cancer is increasingly linked to human papillomavirus (HPV) infection, especially the HPV-16 strain, HPV testing is often done as part of the diagnostic process. If a biopsy confirms cancer, the tissue sample may be tested for the presence of HPV. HPV-positive oropharyngeal cancers tend to respond better to treatment and may have a better prognosis than HPV-negative cancers. Testing for HPV can guide treatment decisions and help predict outcomes.

X-rays and Barium Swallow Test

In some cases, additional imaging tests such as X-rays or a barium swallow test may be recommended. An X-ray can reveal abnormalities in the bones or detect whether the cancer has spread to the chest area. A barium swallow test involves drinking a barium-containing liquid that coats the lining of the throat and oesophagus, making it easier to see blockages or irregularities during an X-ray. This test is particularly useful for assessing swallowing difficulties, which are common in oropharyngeal cancer patients.

Oropharyngeal cancer is classified into stages to describe the severity and spread of the disease. This staging system helps guide treatment decisions and offers a general outlook for recovery. The stages are based on the TNM system: Tumour (T), Node (N), and Metastasis (M). This system evaluates the size of the tumour, the involvement of nearby lymph nodes, and whether the cancer has spread to distant parts of the body. Here’s a breakdown of the stages:

Stage 0 (Carcinoma in Situ)

At this stage, abnormal cells are found in the lining of the oropharynx but have not yet invaded deeper tissues or spread to other parts of the body. Though these cells are not fully cancerous yet, they have the potential to become malignant. Stage 0 is highly treatable, often involving local procedures to remove the abnormal tissue.

Stage I

In this stage, the cancer is still small and localised. The tumour is 2 centimetres or smaller and has not spread to nearby lymph nodes or distant organs. Because the cancer is confined to the oropharynx, treatment is generally effective, and the prognosis is good.

Stage II

At Stage II, the tumour has grown to between 2 and 4 centimetres but is still limited to the oropharynx. The cancer has not spread to nearby lymph nodes or other organs at this point. Treatment typically involves a combination of surgery and radiation therapy, and the outlook is still positive with proper intervention.

Stage III

In Stage III, the tumour is larger than 4 centimetres, or the cancer has spread to a nearby lymph node, which is no more than 3 centimetres in size. The cancer may begin to invade surrounding tissues but has not reached distant organs. Treatment at this stage becomes more complex and usually involves surgery, radiation therapy, and possibly chemotherapy. While more advanced than earlier stages, treatment can still be effective.

Stage IV

Stage IV oropharyngeal cancer is the most advanced and is further divided into three subcategories:

• Stage IVA: The tumour may have spread to nearby structures such as the voice box, jaw, or muscles, and may involve one or more lymph nodes larger than 3 centimetres. The cancer has not yet metastasized to distant parts of the body.
• Stage IVB: The cancer has spread extensively to surrounding tissues or lymph nodes. It may involve larger lymph nodes or have grown into nearby structures, such as bones or large blood vessels, but there is still no distant spread.
• Stage IVC: In this final stage, the cancer has metastasized to distant organs, such as the lungs, liver, or bones. Treatment at this point focuses on controlling symptoms and managing the disease rather than curing it.

Treatment for oropharyngeal cancer depends on the stage of the cancer, its location, and whether it has spread to nearby tissues or distant parts of the body. The goal of treatment is to remove or destroy the cancer while preserving the function of the affected areas, such as speech and swallowing. 

Surgery

Surgery is often the first line of treatment for oropharyngeal cancer, especially for early-stage tumours. The goal of surgery is to remove the tumour and, in some cases, the surrounding lymph nodes to prevent the cancer from spreading. Depending on the tumour's size and location, minimally invasive techniques such as transoral robotic surgery (TORS) may be used, which helps reduce recovery time and preserve functions like swallowing and speaking. In more advanced cases, a more extensive surgery may be required, possibly involving reconstruction of affected tissues to maintain essential functions.

Radiation Therapy

Radiation therapy uses high-energy rays to target and destroy cancer cells. For oropharyngeal cancer, this treatment is commonly used either alone for early-stage cancers or in combination with surgery or chemotherapy for more advanced stages. In some cases, radiation therapy may be used after surgery to eliminate any remaining cancer cells and reduce the risk of recurrence. Modern techniques, like intensity-modulated radiation therapy (IMRT), allow for precise targeting of the tumour while minimising damage to surrounding healthy tissues.

Chemotherapy

Chemotherapy involves the use of drugs to kill cancer cells or stop them from growing. It is often used in combination with radiation therapy (chemoradiation) to enhance the effectiveness of both treatments, particularly for more advanced cancers. Chemotherapy may also be used before surgery to shrink tumours, making them easier to remove, or after surgery to help prevent the cancer from coming back. Common side effects include fatigue, nausea, and an increased risk of infection, but these can be managed with supportive care.

Targeted Therapy

Targeted therapies are drugs designed to specifically attack cancer cells by targeting certain proteins or genes that are involved in the growth and spread of cancer. For oropharyngeal cancer, targeted therapies such as cetuximab may be used, especially if the cancer is linked to human papillomavirus (HPV). These therapies are often combined with radiation or chemotherapy to improve outcomes, particularly in cases where traditional treatments are less effective.

Immunotherapy

In some cases, immunotherapy may be used to treat advanced or recurrent oropharyngeal cancer. Immunotherapy works by stimulating the body’s own immune system to recognize and attack cancer cells more effectively. This form of treatment is typically used when other options, such as surgery or chemotherapy, have not been successful or are not viable. Immunotherapy can provide long-term control of the disease for some patients.

Rehabilitation and Supportive Care

Treatment for oropharyngeal cancer can sometimes lead to side effects that affect speaking, swallowing, and eating. After treatment, patients may need rehabilitation to regain these functions, including speech therapy and nutritional support. Supportive care, such as pain management and addressing emotional and psychological impacts, is also an important part of the overall treatment plan, helping patients cope with the effects of cancer and its treatment.

The choice of treatment depends on various factors, including the size and stage of the cancer, whether it is HPV-related, and the patient’s overall health. In many cases, a combination of treatments is used to maximise effectiveness while minimising side effects.

Oropharyngeal cancer and its treatments can lead to a variety of complications, both immediate and long-term. Below are some of the common complications associated with oropharyngeal cancer:

• Difficulty Swallowing: Treatment, especially surgery or radiation, can lead to long-term swallowing issues.
• Speech Problems: Tumour location or treatment may affect speech clarity or voice quality.
• Infection Risk: Surgery or radiation can increase susceptibility to infections in the throat or mouth.
• Nutritional Deficiencies: Difficulty eating and swallowing can lead to weight loss and malnutrition.
• Cancer Recurrence: Even after successful treatment, there's a risk of the cancer returning, particularly in advanced cases.

While not all cases of oropharyngeal cancer can be prevented, there are steps that can significantly reduce the risk of developing this disease. Here are some preventive measures:

• Avoid Tobacco: Quitting smoking and avoiding tobacco products can significantly lower risk.
• Limit Alcohol Consumption: Reducing heavy alcohol intake helps reduce the likelihood of developing cancer.
• HPV Vaccination: Getting vaccinated against HPV can lower the risk of HPV-related oropharyngeal cancer.
• Maintain Oral Hygiene: Regular dental check-ups and good oral hygiene reduce the risk of infections and cancers in the mouth and throat.
• Healthy Lifestyle: A balanced diet, regular exercise, and avoiding known carcinogens contribute to overall cancer prevention.

By following these preventive measures, individuals can lower their chances of developing throat cancer and improve overall health.

Can oropharyngeal cancer be hereditary?

Oropharyngeal cancer is generally not considered hereditary in the same way that some cancers are linked to inherited genetic mutations. However, certain genetic factors may increase susceptibility to the disease. For instance, individuals with a family history of cancers linked to tobacco use or human papillomavirus (HPV) infections might have a higher risk. It is essential to discuss personal and family medical history with a healthcare provider to understand any potential genetic risks.

What is the recovery process like after treatment for oropharyngeal cancer?

The recovery process after oropharyngeal cancer treatment varies depending on the type of treatment and individual health. Generally, patients may experience fatigue and discomfort in the treated area. Recovery often involves managing side effects such as pain, difficulty swallowing, and changes in speech. Physical and speech therapy may be needed to help regain normal function. 

Can oropharyngeal cancer spread to other parts of the body?

Yes, oropharyngeal cancer can spread beyond its original site. It may metastasize to nearby lymph nodes in the neck and, in more advanced stages, to distant organs such as the lungs, liver, or bones. The extent of spread is assessed through imaging tests and is an important factor in determining the treatment approach and prognosis.

What are the long-term effects of radiation therapy for oropharyngeal cancer?

Long-term effects of radiation therapy for oropharyngeal cancer can include dry mouth (xerostomia), difficulty swallowing (dysphagia), and changes in taste. Other possible effects are changes in the texture and appearance of the skin in the treated area, and an increased risk of dental issues. These effects can be managed with supportive care, including saliva substitutes, swallowing therapy, and regular dental check-ups.

How can I manage side effects like dry mouth or difficulty swallowing after treatment?

To manage dry mouth, consider using saliva substitutes, staying hydrated, and using a humidifier. Chewing sugar-free gum or candies may also help stimulate saliva production. For difficulty swallowing, work with a speech therapist to develop strategies and exercises to improve swallowing function. Soft, moist foods and avoiding irritants like spicy or acidic foods can also make eating easier.

What are the chances of recurrence after successful treatment?

The chances of recurrence after successful treatment vary based on factors such as the stage of the cancer at diagnosis, the type of treatment received, and individual patient factors. Generally, the risk of recurrence is higher in advanced stages of cancer. Regular follow-up visits and monitoring are crucial to detect any signs of recurrence early and manage them promptly.

Reviewed By Dr. Meenu Walia, Vice Chairman - Medical Oncology (Breast, Gynaecology, Thoracic) Cancer Care / Oncology, Gynecologic Oncology on 19 Dec 2024.