Facing Pain and Difficulties in Swallowing? Check if it is a Sign of Oropharyngeal cancer

By: Dr. Rajeev Sharan, Senior Consultant Head and Neck Oncologist, HCG EKO Cancer Centre, Kolkata

Pharynx generally known as the throat, that helps in passage of fluid, food, and air into the food pipe or windpipe respectively. Problems with the throat is only realised when it hurts while swallowing food. There are many other complications that can plague our throat, one of them being Oropharyngeal cancer.

Oropharyngeal cancer is a form of head and neck cancer in which cancer cells are discovered in the oropharynx, a part of your throat. There are different types of oropharyngeal cancer. The majority is squamous cell carcinoma, which can be classified into two kinds based on HPV testing. Oropharyngeal cancer associated with human papilloma virus is the most common form and accounts for more than 70% of all oropharyngeal cancer in USA and Western countries. In India, majority of oropharyngeal cancer is due to tobacco use or alcohol use and around 20% cases are due to HPV.

Symptoms

Oropharyngeal malignancies are frequently asymptomatic in early stages and causes difficulty or pain in swallowing in advanced stages. The first sign  may be usually a lump in the neck. Other signs and symptoms may include:

• Neck mass
• Difficulty or pain in swallowing
• Sore throat
• A lump or mass in the back of the throat
• Ear pain

Causes

Factors that increase your chances of developing oropharyngeal cancers include:

• A history of smoking
• Heavy alcohol use
• History of head and neck cancer
• History of radiation therapy to the head and neck
• Being infected with Human Papillomavirus (HPV), especially type 16.

Can oropharyngeal cancers be found early?

For oral cavity and oropharyngeal cancers, there is no routine screening test or program. Nonetheless, many pre-cancers and cancers in these areas can be detected early during routine oral check-ups performed by a dentist, doctor, dental hygienist, or self-exam.

• Self-examination: Some dentists and doctors recommend that you inspect your mouth in the mirror once a month for changes such as white patches, ulcers, or lumps. This is especially crucial if you use or have used tobacco, or if you consume alcohol on a regular basis, as you are at a significantly increased risk of developing certain malignancies.
• Regular dental check-ups: Regular dental exams that involve an examination of the entire mouth are critical for detecting oral and oropharyngeal cancers early.
• Use of special dyes or lights: In addition to a clinical examination of the mouth and throat, certain dentists and doctors may employ special dyes or lights to look for abnormal areas, especially if you are at a higher risk of these cancers. One method uses a dye called Toluidine blue. If the dye is applied to an abnormal location, it will turn a darker blue than the surrounding areas. Another method is to use fluorescent light. Light reflected off diseased tissue appears different from light reflected off normal tissue.
• Exfoliated Cytology: If an abnormal region is discovered, it may be evaluated using exfoliative cytology. The abnormal area is scraped using a harsh brush which is called brush biopsy. The scraped cells are transported to a lab to discover if they include pre-cancer or cancer cells.

Treatment

Treatment for oropharyngeal cancer is determined on the basis of various factors, including, but not limited to: the kind of cancer, tumor size and location, lymph nodes, speech and swallow function, and the patient’s overall medical state. The treatment options include:

• Surgery- minimally invasive robotic surgery (Transoral robotic surgery or TORS) and neck dissection
• Radiation
• Chemotherapy

For early-stage oropharyngeal cancer, the major treatment options are transoral robotic surgery (TORS) to remove the main tumor as well as the lymph nodes in the neck.

radiation therapy aimed at cancer and the lymph nodes in the neck, or

Chemoradiation is frequently performed after surgery if any cancer persists or if there is a high risk of the cancer returning. If imaging or a biopsy reveals that the lymph nodes in the neck have malignancy, chemoradiation may be used as the first treatment.

Oropharyngeal cancer that may have spread to other parts of the body, for example, the lungs ,is treated with chemotherapy. Immunotherapy, either alone or in combination with chemotherapy, could be another possibility. Treatments such as radiation may also be used to ease cancer symptoms or avoid future complications.

Quitting tobacco and consumption of alcohol is the best way to limit the risk of getting these cancers. If you need help to reduce your risk of this cancer by quitting alcohol and tobacco, you can consult a healthcare professional.