Oropharyngeal or throat cancer
How common is it?
Cancers of the oropharynx (a muscular tube that connects the back of the nose and mouth with the upper end of the food pipe) account for 3-5% of all new cancers in India. An exact estimate is difficult as large tumours may involve both the oral cavity and the oropharynx, and it is unclear where the tumour arises. These cancers are found more commonly in men and may involve the tonsil, base of tongue (the back of the tongue), soft palate or posterior pharyngeal wall (the back of the throat).
What are the symptoms?
Some of the common symptoms are a lump in the throat, painful or difficult swallowing, a lump in the neck, choking sensation or cough while eating or oral bleeding. If you have any of these symptoms beyond two weeks, they need evaluation by a doctor.
What causes it?
In India the majority of these cancers are associated with tobacco used, either smoked or chewed. In a smaller percentage of patients, these cancers are associated with the human papillomavirus (HPV) which is a sexually transmitted virus typically resulting in development of cancer decades after infection. Differentiating between tobacco and virus related cancers is important as the behaviour of the cancers and the way they are treated may differ.
How do you diagnose it?
Tonsil and soft palate cancers may be readily visible in the mouth, however base of tongue and posterior pharyngeal wall cancers may be visible only with laryngoscopy, which is an endoscopy that looks at the upper airway and throat. The diagnosis involves two parts. The first is a biopsy of the tumour (generally done in the clinic after an injection of local anaesthetic, however deep seated tumours may require short general anaesthesia for visualization and biopsy), which determines which type of cancer you have. The second is imaging, either CT scan, MRI, PET or a chest X-ray in various combinations to determine the stage of the tumour and how far it has spread. Both of these will help determine what the best treatment plan is for you.
How do you treat it?
Most of these cancers are treated with radiotherapy. Early tumours can be treated with radiotherapy alone while advanced tumours require a combination of radiotherapy and chemotherapy. However certain early tumours can be treated with surgery, where the goal of surgery is to completely remove the cancer with a rim of uninvolved tissue (known as a ‘margin’), and remove the draining lymph nodes in the neck. Transoral robotic surgery (TORS) is helpful in some of these patients as it gives good visualization and access to the back of the throat. Surgery is also the best option when the patient has previously received radiotherapy. Except for very small tumours, reconstructive surgery after removing the tumour is vital; this helps restore swallowing and speech.
Is it curable?
For early tumours (<4 cm with no lymph nodes involved) the response to either radiotherapy or surgery alone is excellent, with around 80% of patients alive at 5 years. For late stage tumours, which are extensive or have spread to multiple lymph nodes in the neck, around 35% of patients are alive at 5 years. However each patient is different; it does not mean that patients with advanced disease do not survive. To maximize chances of survival, early diagnosis and appropriate and complete treatment from qualified specialists are of vital importance. HPV-associated cancers are associated with a better survival and response to treatment than tobacco related cancers.
What does the road to recovery look like?
The extent of your treatment will determine how long it takes you to recover. Radiotherapy for an early tumour may take two weeks to recover from while a major surgery following by radiotherapy and chemotherapy may take months to completely recover from. It is important to think of your treatment as a marathon rather than a sprint, and take help from those around you, whether they are medical professionals, or friends and family. The team involved in your rehabilitation may include the speech and swallowing therapist, the dental team, the physical therapist and the pain specialists. Follow-up after treatment is crucial – this is to not only assess your recovery, but also to check for recurrence or to identify new tumours (this can happen in 5-15% of patients).