Oropharyngeal cancer: current understanding and management

Squamous cell carcinoma of the oropharynx (OPSCC) occurs with an age-adjusted incidence rate of 2.2/ 100,000 per year, and makes up one of the largest growing subsets of head and neck cancer. Traditional risk factors include alcohol and tobacco exposure, however, the demographics have changed significantly over the past 2-3 decades, with human papillomavirus (HPV) infection now considered one of the most important risk factors. As our understanding of HPV-related OPSCC has developed, there has been increasing evidence that this new tumor subtype has a better overall prognosis and response to therapies. This review focuses on OPSCC from a surgical perspective. We review the relevant anatomy, diagnosis and workup, and discuss several different surgical approaches for management of this disease, including transoral robotic surgery, lateral oropharyngectomy and tonsillectomy, base of tongue resection, and neck dissection. In addition, the common complications associated with these treatment options are discussed.

show abstract

“…When taking a history, it is also important to ask about hemoptysis, weight loss, trismus, limited tongue mobility and odynophagia [16].…”

Section: Clinical Presentation and Initial Evaluationmentioning

confidence: 99%

Surgical Management of Oropharyngeal Squamous Cell Carcinoma

Abel

Moore

2013

Curr Otorhinolaryngol Rep

View full text Add to dashboard Cite

show abstract

“…Mucosal or submucosal disease spread to the hypopharynx and nasopharynx also occurs. SCC of the tonsillar complex is commonly (66-76 %) associated with positive lymph nodes at the time of diagnosis: the levels II, III and IV ipsilateral nodes are most commonly affected [7][8][9][10].…”

Section: Pattern Of Tumor Spreadmentioning

confidence: 99%

“…4). If the tumor extends laterally, the pterygomandibular raphe and anterior tonsillar pillar can be reached; from there the tumor can spread in a predictable fashion along those tissue planes [7][8][9][10].…”

Section: Pattern Of Tumor Spreadmentioning

confidence: 99%

Radiographic Imaging of Human Papillomavirus Related Carcinomas of the Oropharynx

Corey

Hudgins

2012

Head and Neck Pathol

View full text Add to dashboard Cite

Imaging, especially contrast-enhanced computed tomography (CECT) for anatomy and positron emission tomography (PET) with labeled 18 F fluorodeoxyglucose for physiologic detail, is critical for staging carcinomas of the oropharynx. As the incidence of human papillomavirus (HPV) infection and related carcinomas of the tonsil and base of tongue (BOT) increases, experience with CECT and PET for staging HPV? tumors is growing. No imaging modality, however, can determine whether the tumor is HPV?. There are some unique challenges posed by HPV? oropharyngeal squamous cell carcinoma (SCC). In most locations of the head and neck, a malignancy enhances more than surrounding normal structures, which facilitates tumor mapping. Unfortunately, normal lymphoid tissue of the oropharynx, in the BOT and palatine tonsillar fossa, enhances on CECT and gadolinium enhanced magnetic resonance imaging in a manner similar to SCC. The primary tumor may be small or even occult at presentation, and easily over-looked on CECT. PET coupled with CECT has made a true ''unknown primary'' very rare, as the metabolically active tumor is almost always detectable on PET. The nodal metastases, so common with HPV? SCC, can be truly cystic; and as such, can be misdiagnosed as a second branchial cleft cyst, a congenital benign lesion. These pitfalls, coupled with the complex anatomy of the upper aerodigestive tract, make staging these tumors difficult. In this monograph we describe the anatomy of the oropharynx and review the imaging modalities available for staging. Figures highlight the points raised in the text.

show abstract

“…Cancer of the soft palate accounts for approximately 2% of head and neck mucosal malignancies and most cancer of the palates are squamous cell carcinoma (SCC). 1 Human soft palate cancers are characterized by a high degree of local invasion and a high rate of metastases to the cervical lymph nodes. Moreover, human soft palate cancer frequently shows local recurrence after initial treatment, probably due to micro invasion and/or metastasis of tumor cells at the primary site.…”

Section: Research Reportmentioning

confidence: 99%