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Oropharynx tumors (throat including tonsils and base of tongue)

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oropharynx anatomy: tonsils, base of tongue, etc.

The oropharynx is the part of the throat directly behind the oral cavity. The base of the tongue and the tonsils (palatine tonsils), are part of the oropharynx. View the anatomy here.

hpv and p16

The Human Papilloma Virus (HPV) is a common cause of squamous cell carcinoma (a type of cancer) of the tonsils or base of tongue. It also causes cancer in the female cervix. Several different strains of this virus exist, and are numbered from one to over one hundred at last count, named in order of their identification. Some of the strains, such as HPV-16 and HPV-18, are the types more likely to cause cancer, whereas other strains may cause warts on the skin (such as HPV-1) or benign genital warts (such as HPV-6 and HPV-11). HPV is spread by contact, as opposed to aerosols, but this could be any type of contact in which live virus particles are physically transferred to a tissue in which it can grow.

p16 is different from HPV-16. p16 is a protein that is present in high amounts in cancers involved with HPV, and so it is used as an indicator of HPV presence. p16 is produced in high quantity by HPV infected cells. The presence of p16 does not indicate which strain of HPV is present. The fact that the number 16 is associated with the protein p16 and the 16th strain of HPV is just coincidence. A squamous cell carcinoma of the tonsils or base of tongue may be tested for the protein p16. When p16 is present, it is thought that the cancer is caused by HPV. When p16 is not present, another cause, such as tobacco, is the reason for the cancer.

While squamous cell carcinoma may be caused by smoking or by HPV, the type caused by HPV tends to respond somewhat better to treatment and has a better prognosis overall. Smoking (especially when combined with drinking) is another cause of squamous cell carcinoma of the tonsils and base of tongue, and this type is typically p16 negative. Not uncommonly, a cancer in this area has HPV present in an individual with a smoking history. In this case, whether the smoking or the virus caused the cancer in this scenario is not always obvious. When someone has smoked more than 10 pack years of cigarettes and has a p16 positive oropharyngeal squamous cell carcinoma, the statistical outcome is somewhere between that of the nonsmokers with p16 positive oropharynx squamous cell carcinoma and the smokers with p16 negative oropharynx squamous cell carcinoma.

• Link to a slide presentation on the the American Head and Neck Society website with information for the patient on human papilloma virus (HPV) and head and neck cancers.

• Link to an article on HPV in throat cancer on the ENTHealth website.

• YouTube video explaining why HPV vaccination is needed for boys (as well as girls!) Please vaccinate!

Laryngoscopy and pharyngoscopy

• Link to a page on the American Cancer Society site describing use of a scope in the office to examine the throat. This procedure is done to look at both the larynx and pharynx (laryngoscopy and pharyngoscopy, respectively) and it takes about 30-60 seconds, typically. Performing laryngoscopy and/or pharyngoscopy in the operating room may be necessary to get an better examination and to obtain biopsy material; this is done under general anesthesia and takes about 30 minutes.

Imaging

Imaging is an important component in the assessment of an oropharyngeal tumor for assessing size, anatomic characteristics, spread of the disease, and response to treatment. Among the options for imaging modalities are plain x-ray, ultrasound, CT, MRI, and PET-CT scanning.

Swallowing

Swallowing well is essential for maintaining nutrition as well as keeping the lungs free of infection. A decision faced commonly in the treatment of throat cancer is whether to place a gastric feeding tube (G tube).

Survival

Kaplan-Meier Survival Curves for Oropharyngeal Squamous Cell Carcinoma. These graphs are for all stages grouped together. Overall survival includes patients who are alive, even if cancer is present and growing or spreading. Disease free survival includes patients who are alive and have no evidence that cancer is growing or spreading. Reference: Ang KK, Harris J, Wheeler R, Weber R, Rosenthal DI, Nguyen-Tân PF, Westra WH, Chung CH, Jordan RC, Lu C, Kim H, Axelrod R, Silverman CC, Redmond KP, Gillison ML. Human papillomavirus and survival of patients with oropharyngeal cancer. N Engl J Med. 2010 Jul 1;363(1):24-35. doi: 10.1056/NEJMoa0912217. Epub 2010 Jun 7. PMID: 20530316; PMCID: PMC2943767.

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