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Tumors of the Oropharynx

Cancer of the oropharynx is expected to occur in approximately 4000 individuals per year. It is seen in men five to eight times more often than in women, and typically develops during the 50th to 70th year. Risk factors for the development of the disease include smoking and alcohol use.

Base of tongue tumors are less frequent than other cancers of the tongue, and pathologically are made up predominantly of squamous cell cancers. These cancers have a high propensity to spread to lymph nodes and can grow in either an exophytic or infiltrating pattern. Presenting symptoms often include pain and difficulty swallowing.

Tumors of the tonsil, tonsillar pillar and soft palate, although anatomically located close to one another, behave quite differently from each other. Tumors of the tonsillar pillar tend to be more superficial and tend to spread over a broad region. By comparison, tonsillar fossa cancers often present with advanced, bulky tumors. Tumors of the soft palate often are less aggressive. Soft palate tumors linger in early stages and remain superficial for longer periods.

Tumors of the pharyngeal walls often are found at advanced stages. Presenting symptoms often include pain, bleeding, weight loss and occasionally a mass in the neck. These tumors have a propensity to spread to lymph nodes of the neck. Bilateral (both sides) involvement is often seen. Pathologically, the majority of these cancers are squamous cell carcinomas.

Staging
See Staging for general staging rules. Specific tumor stages for the oropharynx region are as follows:

TX	Primary tumor cannot be assessed
T0	No existence of primary tumor
Tis	Carcinoma in situ
T1	Tumor 2 cm or less in greatest dimension
T2	Tumor more than 2 cm but not more than 4 cm in greatest dimension.
T3	Tumor more than 4 cm in greatest dimension.
T4	Tumor invades adjacent structures (e.g. through cortical bone, soft tissues of the neck, and deep muscles of the tongue).

Treatment

• Base of Tongue
  For early stage tumors of the base of tongue, either surgery or radiation may be used as primary therapy with equally good results. Treatment of the neck should be performed in patients with clinically positive necks regardless of the size of the primary tumor. For more advanced (T3) disease, radiation therapy may be considered. With T4 lesions, surgical therapy is probably more advantageous.

• Tonsil, Tonsillar Pillar and Soft Palate
  Like most other areas already discussed, treatment of this area for early stage disease can be adequately performed using either surgery or radiation. Due to the high risk of the disease spreading to nearby lymph nodes, treatment of the neck should be considered in all such patients. Advanced disease usually requires surgical intervention followed by postoperative radiation therapy. However, treatment primarily with radiation followed by surgical treatment of the neck also may be an option. Therapy should be tailored to the exact tumor (T) and node (N) stage of the patient.

• Pharyngeal Wall
  For early stage disease, either radiation or surgery may be contemplated. However, even early stage disease typically calls for bilateral (both sides) neck dissections. In advanced disease multimodality therapy should be considered.

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