Oropharyngeal cancer

What is it?

This disease originates in the tonsils, the back of the tongue (base of the tongue) and the soft palate; it should not be confused with tumours of the remainder of the tongue, which is part of the oral cavity. It is a rare tumour, but compared to other tumours of the head and neck areas it is one of the most frequent. In Italy, it affects 2.6/100000 inhabitants, mostly middle-aged people, mainly between 50 and 70 years old, with an incidence 6 times higher in men than in women.

The known causes are smoking and/or alcohol abuse and/or infection with the Papilloma Virus (HPV). The latter cause is related to the occurrence of spinocellular carcinomas of the oropharynx (especially of the palatine and lingual tonsils) favourably affects their prognosis. The main prognostic factors are as follows:

·         tumour size (T)

·         size and number of lymph nodes involved (N)

·         type of carcinoma.

·         presence or absence of HPV and p16

·         Number of cigarettes smoked per day

·         how many years you have smoked

Which are the symptoms?

·         Difficulty and pain in swallowing

·         Enlarged lymph nodes in the neck

·         earache

How is it diagnosed?

A rapid specialist otolaryngological evaluation is essential, supported by an endoscopic examination called fibroscopy and associated, if suspected, with radiological investigations such as: magnetic resonance imaging (MRI) of the face and neck with and without contrast medium (mdc) and, if necessary, positron emission tomography (PET).
The diagnosis of a tumour should be confirmed by a biopsy of the site of origin or, if impossible, by a biopsy of the suspected lymph node, with an additional search for HBV or the p16 protein in the tumour.
Treatment of early-stage disease consists of radiotherapy alone or surgery alone; in locally advanced disease, a combined approach involving simultaneous chemotherapy and radiotherapy or, in selected cases, chemotherapy followed by simultaneous radiochemotherapy to achieve a cure is required.
In individual cases, reirradiation may be considered.
In advanced forms of the disease, the aim is to chronicise the disease with chemotherapy, possibly in combination with biological therapy, and secondarily, for patients in good general condition, immunotherapy as recently approved, or further chemotherapy.
These treatments can be combined with radiotherapy for symptomatic areas or areas at risk of bleeding/fracture, and with surgical treatment of individual metastases.

Suggested exams

How is it treated?

Treatment of early stages consists of radiotherapy alone or surgery alone; a combined approach involving simultaneous chemotherapy and radiotherapy or, in some cases, chemotherapy followed by simultaneous radiochemotherapy to achieve a cure is required in locally advanced disease.

In individual cases, reirradiation may be considered.

In advanced forms, the aim is to chronicle the disease with chemotherapy, possibly in combination with biological therapy, and subsequently, for patients in good general condition, immunotherapy +/- chemotherapy.

These treatments can be combined with radiotherapy for symptomatic areas or areas at risk of bleeding/fracture and surgical treatment of individual metastases.

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