The pharynx is a hollow tube in the neck about 5 inches long that is made up of three parts:
When we breathe or swallow, the pharynx acts as a passageway for air to reach the lungs and food to reach the stomach. Oropharyngeal cancer commonly begins in the squamous cells that line the oropharynx.
The oropharynx includes the:
Sometimes, a person can have more than one cancer at the same time in the oropharynx and mouth, nose, throat, voice box (larynx), windpipe (trachea), or esophagus.
Oropharyngeal cancer is caused by certain changes in how oropharyngeal cells function, especially how they grow and divide into new cells. There are many risk factors for oropharyngeal cancer, but many do not directly cause cancer. Instead, they increase the chance of DNA damage in cells that may lead to oropharyngeal cancer. Learn more about how cancer develops at What Is Cancer?
A risk factor is anything that increases a person's chance of getting a disease. Some risk factors for oropharyngeal cancer, like tobacco use, can be changed. Risk factors also include things you cannot change, like your family history. Learning about risk factors for oropharyngeal cancer can help you make choices that might prevent or lower your risk of getting it.
The most common risk factors for oropharyngeal cancer include:
The number of cases of oropharyngeal cancers linked to HPV infection is increasing. Learn more about HPV and Cancer.
Sometimes oropharyngeal cancer does not cause early signs and symptoms. When signs and symptoms occur, they may include:
These problems may be caused by conditions other than oropharyngeal cancer. Check with your doctor if you have any of these problems to find out the cause and begin treatment, if needed.
If you have symptoms that suggest oropharyngeal cancer, your doctor will need to find out if these are due to cancer or another problem. They will ask when the symptoms started and how often you have been having them. They will also ask about your personal and family health history and do a physical exam. Based on these results, the doctor may recommend other tests. If you are diagnosed with oropharyngeal cancer, the results of these tests will help you and your doctor plan treatment.
The following tests and procedures are used to diagnose and stage oropharyngeal cancer:
The following procedures may be used to remove samples of cells or tissue:
If cancer is found, the following test may be done to study the cancer cells:
Learn about the type of information that can be found in a pathologist's report about the cells or tissue removed during a biopsy at Pathology Reports.
You may want to get a second opinion to confirm your oropharyngeal cancer diagnosis and treatment plan. If you seek a second opinion, you will need to get medical test results and reports from the first doctor to share with the second doctor. The second doctor will review the pathology report, slides, and scans. They may agree with the first doctor, suggest changes or another treatment approach, or provide more information about your cancer.
Learn more about choosing a doctor and getting a second opinion at Finding Cancer Care. You can contact NCI's Cancer Information Service via chat, email, or phone (both in English and Spanish) for help finding a doctor, hospital, or getting a second opinion. For questions you might want to ask at your appointments, visit Questions to Ask Your Doctor About Cancer.
The prognosis depends on:
Oropharyngeal tumors related to HPV infection have a better prognosis and are less likely to recur than tumors not linked to HPV infection.
Treatment options depend on:
People with oropharyngeal cancer have an increased risk of another cancer in the head or neck. This risk is increased if a person continues to smoke or drink alcohol after treatment.
For more information, visit Cigarette Smoking: Health Risks and How to Quit.
Cancer stage describes the extent of cancer in the body, such as the size of the tumor, whether it has spread, and how far it has spread from where it first formed. Knowing the cancer stage helps plan treatment.
There are several staging systems for cancer that describe the extent of the cancer. Oropharyngeal cancer staging usually uses the TNM staging system. The cancer may be described by this staging system in your pathology report. Based on the TNM results, a stage (I, II, III, or IV, also written as 1, 2, 3, or 4) is assigned to the cancer. When talking to you about your diagnosis, your doctor may describe the cancer as one of these stages.
Learn more about Cancer Staging.
In stage I, one of the following is true:
In stage II, one of the following is true:
In stage III, one of the following is true:
In stage IV, cancer has spread to other parts of the body, such as the lung or bone.
Stage IV oropharyngeal cancer is also called metastatic oropharyngeal cancer. Metastatic cancer happens when cancer cells travel through the lymphatic system or blood and form tumors in other parts of the body. The metastatic tumor is the same type of cancer as the primary tumor. For example, if oropharyngeal cancer spreads to the lung, the cancer cells in the lung are actually oropharyngeal cancer cells. The disease is called metastatic oropharyngeal cancer, not lung cancer. Learn more in Metastatic Cancer: When Cancer Spreads.
In stage 0, abnormal cells are found in the lining of the oropharynx (throat). These abnormal cells may become cancer and spread into nearby normal tissue.
In stage I, cancer has formed. The tumor is 2 centimeters or smaller.
In stage II, the tumor is larger than 2 centimeters but not larger than 4 centimeters.
In stage III, the cancer:
Stage IV is divided into stages IVA, IVB, and IVC.
Stage IV oropharyngeal cancer is also called metastatic oropharyngeal cancer. Metastatic cancer happens when cancer cells travel through the lymphatic system or blood and form tumors in other parts of the body. The metastatic tumor is the same type of cancer as the primary tumor. For example, if oropharyngeal cancer spreads to the lung, the cancer cells in the lung are actually oropharyngeal cancer cells. The disease is called metastatic oropharyngeal cancer, not lung cancer. Learn more in Metastatic Cancer: When Cancer Spreads.
Recurrent oropharyngeal cancer is cancer that has come back after it has been treated. If oropharyngeal cancer comes back, it may come back in the oropharynx, lymph nodes, or other parts of the body, such as the lungs, bone, or liver. Tests will help determine where in the body the cancer has returned. The type of treatment that you have for recurrent oropharyngeal cancer will depend on where it has come back.
Learn more in Recurrent Cancer: When Cancer Comes Back. Information to help you cope and talk with your health care team can be found in the booklet When Cancer Returns.
Different types of treatments are available for oropharyngeal cancer. You and your cancer care team will work together to decide your treatment plan, which may include more than one type of treatment. Many factors will be considered, such as the stage of the cancer, your overall health, and your preferences. Your plan will include information about your cancer, the goals of treatment, your treatment options and the possible side effects, and the expected length of treatment.
Talking with your cancer care team before treatment begins about what to expect will be helpful. You'll want to learn what you need to do before treatment begins, how you'll feel while going through it, and what kind of help you will need. Learn more at Questions to Ask Your Doctor About Your Treatment.
An oncologist, a doctor who specializes in treating people with cancer, oversees treatment for oropharyngeal cancer. Because the oropharynx helps in breathing, eating, and talking, you may need help adjusting to the side effects of the cancer and its treatment. The oncologist may refer you to other health care providers who are experts in treating head and neck cancer and also specialize in other areas of medicine. Other specialists may include:
Surgery to remove the tumor is a common treatment for all stages of oropharyngeal cancer. A surgeon may remove the cancer and some of the healthy tissue around the cancer. After the surgeon removes all the cancer that can be seen at the time of the surgery, some people may be given chemotherapy or radiation therapy after surgery to kill any cancer cells that are left. Treatment given after the surgery, to lower the risk that the cancer will come back, is called adjuvant therapy.
New types of surgery, including transoral robotic surgery, are being studied for the treatment of oropharyngeal cancer. Transoral robotic surgery may be used to remove cancer from hard-to-reach areas of the mouth and throat. Cameras attached to a robot give a 3-dimensional (3D) image that a surgeon can see. Using a computer, the surgeon guides very small tools at the ends of the robot arms to remove the cancer. This procedure may also be done using an endoscope.
Learn more about Surgery to Treat Cancer.
Radiation therapy uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing by damaging their DNA. External radiation therapy uses a machine outside the body to send radiation toward the area of the body with cancer.
Certain ways of giving radiation therapy can help keep radiation from damaging nearby healthy tissue. These types of radiation therapy include:
In advanced oropharyngeal cancer, dividing the daily dose of radiation into smaller-dose treatments improves the way the tumor responds to treatment. This is called hyperfractionated radiation therapy.
Radiation therapy may work better in people who have stopped smoking before beginning treatment.
If the thyroid or pituitary gland are part of the radiation treatment area, the person has an increased risk of hypothyroidism (too little thyroid hormone). A blood test to check the thyroid hormone level in the body should be done before and after treatment.
Chemotherapy uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. Chemotherapy for oropharyngeal cancer is usually systemic, meaning it is taken by mouth or injected into a vein or muscle. When given this way, the drugs enter the bloodstream and can reach cancer cells throughout the body.
Chemotherapy drugs used to treat oropharyngeal cancer include:
Combinations of these drugs may be used. Other chemotherapy drugs not listed here may also be used.
Chemotherapy may be combined with other types of treatment, such as radiation therapy.
To learn more about how chemotherapy works, how it is given, common side effects, and more, visit Chemotherapy to Treat Cancer and Chemotherapy and You: Support for People With Cancer.
Targeted therapy uses drugs or other substances to identify and attack specific cancer cells. Cetuximab is a type of targeted therapy used to treat recurrent and metastatic oropharyngeal cancer.
Learn more about Targeted Therapy to Treat Cancer.
Immunotherapy is a treatment that uses a person's immune system to fight cancer. Your doctor may suggest biomarker tests to help predict your response to certain immunotherapy drugs. Learn more about Biomarker Testing for Cancer Treatment.
Pembrolizumab and nivolumab are types of immunotherapy used to treat metastatic or recurrent oropharyngeal cancer.
Learn more about Immunotherapy to Treat Cancer.
For some people, joining a clinical trial may be an option. There are different types of clinical trials for people with cancer. For example, a treatment trial tests new treatments or new ways of using current treatments. Supportive care and palliative care trials look at ways to improve quality of life, especially for those who have side effects from cancer and its treatment.
You can use the clinical trial search to find NCI-supported cancer clinical trials accepting participants. The search allows you to filter trials based on the type of cancer, your age, and where the trials are being done. Clinical trials supported by other organizations can be found on the ClinicalTrials.gov website.
Learn more about clinical trials, including how to find and join one, at Clinical Trials Information for Patients and Caregivers.
For information about side effects caused by treatment for cancer, visit our Side Effects page.
As you go through treatment, you will have follow-up tests or check-ups. Some tests that were done to diagnose or stage the cancer may be repeated to see how well the treatment is working. Decisions about whether to continue, change, or stop treatment may be based on the results of these tests.
Some of the tests will continue to be done from time to time after treatment has ended. The results of these tests can show if your condition has changed or if the cancer has recurred (come back).
After treatment is complete, it is important to have head and neck exams to look for signs that the cancer has come back. Check-ups will be done every 6 to 12 weeks in the first year, every 3 months in the second year, every 3 to 4 months in the third year, and every 6 months thereafter.
For information about the treatments listed below, see the Treatment Option Overview section.
Treatment of newly diagnosed stage I and stage II oropharyngeal cancer may include:
Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. General information about clinical trials is also available.
For information about the treatments listed below, see the Treatment Option Overview section.
Treatment of newly diagnosed stage III oropharyngeal cancer and stage IV oropharyngeal cancer may include:
Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. General information about clinical trials is also available.
For information about the treatments listed below, see the Treatment Option Overview section.
Treatment of oropharyngeal cancer that has metastasized or recurred in the oropharynx may include:
Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. General information about clinical trials is also available.
For more information from the National Cancer Institute about oropharyngeal cancer, visit:
For general cancer information and other resources from the National Cancer Institute, visit:
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PDQ® Adult Treatment Editorial Board. PDQ Oropharyngeal Cancer Treatment. Bethesda, MD: National Cancer Institute. Updated <MM/DD/YYYY>. Available at: https://www.cancer.gov/types/head-and-neck/patient/adult/oropharyngeal-treatment-pdq. Accessed <MM/DD/YYYY>. [PMID: 26389310]
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