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<div class="pre-content"><div><div class="bk_prnt"><p class="small">NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.</p><p>StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. </p></div><div class="iconblock clearfix whole_rhythm no_top_margin bk_noprnt"><a class="img_link icnblk_img" title="Table of Contents Page" href="/books/n/statpearls/"><img class="source-thumb" src="/corehtml/pmc/pmcgifs/bookshelf/thumbs/th-statpearls-lrg.png" alt="Cover of StatPearls" height="100px" width="80px" /></a><div class="icnblk_cntnt eight_col"><h2>StatPearls [Internet].</h2><a data-jig="ncbitoggler" href="#__NBK563268_dtls__">Show details</a><div style="display:none" class="ui-widget" id="__NBK563268_dtls__"><div>Treasure Island (FL): <a href="https://www.statpearls.com/" ref="pagearea=page-banner&targetsite=external&targetcat=link&targettype=publisher">StatPearls Publishing</a>; 2025 Jan-.</div></div><div class="half_rhythm"></div><div class="bk_noprnt"><form method="get" action="/books/n/statpearls/" id="bk_srch"><div class="bk_search"><label for="bk_term" class="offscreen_noflow">Search term</label><input type="text" title="Search this book" id="bk_term" name="term" value="" data-jig="ncbiclearbutton" /> <input type="submit" class="jig-ncbibutton" value="Search this book" submit="false" style="padding: 0.1em 0.4em;" /></div></form></div></div></div></div></div>
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<div class="main-content lit-style" itemscope="itemscope" itemtype="http://schema.org/CreativeWork"><div class="meta-content fm-sec"><h1 id="_NBK563268_"><span class="title" itemprop="name">Oropharyngeal Squamous Cell Carcinoma</span></h1><p class="contrib-group"><span itemprop="author">Zohaib Jamal</span>; <span itemprop="author">Fatima Anjum</span>.</p><a data-jig="ncbitoggler" href="#__NBK563268_ai__" style="border:0;text-decoration:none">Author Information and Affiliations</a><div style="display:none" class="ui-widget" id="__NBK563268_ai__"><p class="contrib-group"><h4>Authors</h4><span itemprop="author">Zohaib Jamal</span><sup>1</sup>; <span itemprop="author">Fatima Anjum</span><sup>2</sup>.</p><h4>Affiliations</h4><div class="affiliation"><sup>1</sup> Rawalpindi Medical University, Rawalpindi</div><div class="affiliation"><sup>2</sup> Temple University, Lewis Katz School of Medicine</div></div><p class="small">Last Update: <span itemprop="dateModified">April 27, 2023</span>.</p></div><div class="jig-ncbiinpagenav body-content whole_rhythm" data-jigconfig="allHeadingLevels: ['h2'],smoothScroll: false" itemprop="text"><div id="article-113372.s1"><h2 id="_article-113372_s1_">Continuing Education Activity</h2><p>Oropharyngeal squamous cell carcinoma, commonly known as throat cancer or tonsil cancer, is a type of head and neck cancer that refers to the cancer of the base and posterior one-third of the tongue, the tonsils, soft palate, and posterior and lateral pharyngeal walls. The incidence of oropharyngeal squamous cell carcinoma is increasing in both old and young populations at an alarming level. This activity illustrates the evaluation and management of oropharyngeal squamous cell carcinoma and highlights the role of the interprofessional team in evaluating and treating patients with this condition.</p><p>
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<b>Objectives:</b>
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||
<ul><li class="half_rhythm"><div>Identify the risk factors for developing oropharyngeal squamous cell carcinoma.</div></li><li class="half_rhythm"><div>Describe the presentation of a patient with oropharyngeal squamous cell carcinoma.</div></li><li class="half_rhythm"><div>Summarize management considerations for patients with oropharyngeal squamous cell carcinoma.</div></li><li class="half_rhythm"><div>Outline the key differentials for the presentation of this condition and complications following treatments.</div></li></ul>
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|
||
</p></div><div id="article-113372.s2"><h2 id="_article-113372_s2_">Introduction</h2><p>Oropharyngeal squamous cell carcinoma (OPSCC), commonly known as throat cancer or tonsil cancer, refers to the cancer of the middle part of the pharynx, known as the oropharynx, which extends vertically from the soft palate to the superior area of the hyoid bone and includes the base and posterior one-third of the tongue, the tonsils, soft palate, and posterior and lateral pharyngeal walls.</p><p>More than 90% of oropharyngeal cancers are squamous cell cancers, which are the cell lining of the oropharynx <a class="bk_pop" href="#article-113372.r1">[1]</a>.</p><p>Two types of oropharyngeal cancer can be distinguished: HPV-associated, due to an oral human papillomavirus infection, and non-HPV-associated, mainly due to tobacco smoking and alcohol use.</p><p>In addition to the direct invasion of the tissues, oropharyngeal cancer can spread through blood and lymphatics. The major symptoms of oropharyngeal cancer include sore throat, odynophagia, and dysphagia. Diagnosis is made based on biopsy results of the affected tissue. Treatment involves surgery, radiotherapy, chemotherapy, or a combination of these therapies.</p></div><div id="article-113372.s3"><h2 id="_article-113372_s3_">Etiology</h2><p>The etiology of oropharyngeal carcinoma is broadly categorized into HPV-associated and non-HPV-associated carcinomas. </p><p>HPV-associated oropharyngeal squamous cell carcinoma occurs in patients who have been infected with the human papillomavirus. Among the many types of human papillomavirus, HPV16 is the most common type found in oropharyngeal cancers <a class="bk_pop" href="#article-113372.r2">[2]</a>. </p><p>Oral sex and open-mouthed kissing are the most common reasons for oral HPV infection <a class="bk_pop" href="#article-113372.r3">[3]</a>.</p><p>On the other hand, smoking tobacco and alcohol consumption have been widely identified as the major risk factors for non-HPV-associated oropharyngeal carcinomas <a class="bk_pop" href="#article-113372.r4">[4]</a>. Other less common risk factors include a diet low in vegetables and fruits, betel quid chewing, poor nutrition, marijuana smoking, asbestos exposure, and certain genetic mutations such as P53 mutation and CDKN2A (p16) mutations <a class="bk_pop" href="#article-113372.r5">[5]</a><a class="bk_pop" href="#article-113372.r6">[6]</a><a class="bk_pop" href="#article-113372.r7">[7]</a>.</p></div><div id="article-113372.s4"><h2 id="_article-113372_s4_">Epidemiology</h2><p>Oropharyngeal cancer is the sixth most common cancer worldwide <a class="bk_pop" href="#article-113372.r8">[8]</a>. HPV 16 is responsible for almost 90% of HPV-positive oropharyngeal cancers, and the prevalence is higher in males than females <a class="bk_pop" href="#article-113372.r9">[9]</a><a class="bk_pop" href="#article-113372.r10">[10]</a>. The presence of HPV-associated OPSCC is much higher in the tonsils and base of the tongue. HPV-associated OPSCC tends to occur in a younger population that smokes and drinks less; a higher percentage are males and report more oral sex partners <a class="bk_pop" href="#article-113372.r11">[11]</a>.</p></div><div id="article-113372.s5"><h2 id="_article-113372_s5_">Pathophysiology</h2><p>In the case of HPV-associated OPSCC, the oral mucosa is exposed to the HPV infection, which persists and is not cleared. This persistence can lead to a precancerous lesion that may regress or not. If it does not, it will eventually progress to invasive OPSCC. Persistent HPV infections may progress to invasive cancer within ten years. However, the majority of these infections are cleared in one to two years <a class="bk_pop" href="#article-113372.r11">[11]</a>.</p></div><div id="article-113372.s6"><h2 id="_article-113372_s6_">Histopathology</h2><p>In patients affected by oropharyngeal squamous cell carcinoma, the accumulation of genetic changes results in progression from mild and moderate dysplasia to severe dysplasia/carcinoma in situ. However, in most HPV-positive oropharyngeal cancers, the tumor originates deep inside the tonsillar crypt epithelium. This is why these cancers are neither visible on inspection nor noticeable by superficial brush biopsy <a class="bk_pop" href="#article-113372.r12">[12]</a>.</p></div><div id="article-113372.s7"><h2 id="_article-113372_s7_">History and Physical</h2><p>Patients with oropharyngeal cancer can present with a variety of symptoms depending on the location of the tumor. The most common presentations include persistent sore throat, dysphagia, odynophagia, dysarthria, presence of a lump in the neck, and otalgia. In addition, the patients may also complain of voice changes (hoarseness), unexplained weight loss, and hematemesis.</p><p>Physical examination of the oropharynx may reveal either an ulcer or a red or white patch on the base or posterior one-third of the tongue, posterior and lateral pharyngeal walls, soft palate, or tonsils.</p></div><div id="article-113372.s8"><h2 id="_article-113372_s8_">Evaluation</h2><p>A comprehensive protocol of investigations should be employed if there is a clinical suspicion of oropharyngeal cancer. These include:</p><p>
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<b>Radiography</b>
|
||
</p><p>Plain radiography is done for dental assessment and bony invasion, but it is of limited value.</p><p>
|
||
<b>Ultrasonography</b>
|
||
</p><p>It is recommended to perform ultrasound with or without needle biopsy in all the patients reporting a neck lump because of its excellent accuracy of staging the nodal disease if employed by an experienced operator <a class="bk_pop" href="#article-113372.r13">[13]</a>.</p><p>
|
||
<b>Magnetic Resonance Imaging (MRI)</b>
|
||
</p><p>MRI provides excellent visualization of the tumor infiltrating the soft tissue, is not distorted by the metallic dental restorations, and is considered optimal for the staging of the primary tumor <a class="bk_pop" href="#article-113372.r13">[13]</a>.</p><p>
|
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<b>Computed Tomography (CT)</b>
|
||
</p><p>A CT scan can not only be utilized to estimate the size of the tumor but also assist in deciding on surgical removal of the tumor and its spread to the lymph nodes in the neck or lower mandible.</p><p>
|
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<b>Positron Emission Tomography (PET)</b>
|
||
</p><p>PET combined with CT-scan should be employed in cases where conventional cross-sectional imaging fails to identify primary tumors <a class="bk_pop" href="#article-113372.r13">[13]</a>. PET scan is also employed for the assessment and detection of the recurrence of the primary tumors <a class="bk_pop" href="#article-113372.r13">[13]</a>.</p><p>
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<b>Endoscopy and Laryngoscopy</b>
|
||
</p><p>Endoscopy and laryngoscopy are performed after using an anesthetic spray or general anesthesia to visualize and examine the suspicious sites in detail and take the biopsy sample.</p><p>
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<b>Biopsy</b>
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||
</p><p>A biopsy of the suspicious area is performed to make a definitive diagnosis. The type of biopsy i.e., a fine-needle aspiration biopsy using a fine needle to collect a sample or oral brush biopsy, which is a newer, simpler, and more convenient method employing a small brush to collect the sample during routine dental examinations, depends upon the location of the cancer.</p><p>
|
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<b>Human Papillomavirus Testing (HPV testing)</b>
|
||
</p><p>The American Society of Clinical Oncology recommends that HPV testing should be done on all newly diagnosed oropharyngeal cancers. This is done by polymerase chain reaction, which detects the HPV DNA.</p></div><div id="article-113372.s9"><h2 id="_article-113372_s9_">Treatment / Management</h2><p>Surgery and radiotherapy are the two principle modalities used in the treatment of patients suffering from oropharyngeal cancers. Surgery or radiotherapy can be used primarily if the tumor is small and has not advanced. However, if the disease has advanced or the tumor is larger, then a combination of surgery and radiotherapy is used. Implementing minimally invasive procedures, such as transoral laser microsurgery (TLM), as a first-line treatment modality for oropharyngeal carcinomas have been found safe and efficacious <a class="bk_pop" href="#article-113372.r14">[14]</a>.</p><p>Other resection methods include transoral robotic surgery, transoral video laryngoscopic surgery, transoral ultrasound surgery, and endoscopic laryngopharyngeal surgery <a class="bk_pop" href="#article-113372.r15">[15]</a>.</p><p>Following surgery, survival is increased in patients undergoing induction chemotherapy or concomitant chemoradiotherapy. In the case of unresectable tumors, concomitant cisplatin-based chemotherapy, along with radiotherapy, is considered the gold standard and has shown to be better in terms of improving survival as compared to radiotherapy alone <a class="bk_pop" href="#article-113372.r16">[16]</a>. However, some studies have shown a parallel prognostic profile of concomitant use of carboplatin/paclitaxel in stage III and IV non-metastatic oropharyngeal carcinomas but with fewer adverse effects <a class="bk_pop" href="#article-113372.r17">[17]</a>.</p></div><div id="article-113372.s10"><h2 id="_article-113372_s10_">Differential Diagnosis</h2><p>The conditions with presentations similar to oropharyngeal squamous cell carcinoma and which need to be excluded include:</p><ul><li class="half_rhythm"><div>Actinic keratosis</div></li><li class="half_rhythm"><div>Erythroplasia</div></li><li class="half_rhythm"><div>Lichen planus</div></li><li class="half_rhythm"><div>Leukoplakias</div></li><li class="half_rhythm"><div>Lichenoid lesions</div></li><li class="half_rhythm"><div>Oral candidiasis</div></li><li class="half_rhythm"><div>Tonsillitis</div></li><li class="half_rhythm"><div>Traumatic lesions</div></li></ul></div><div id="article-113372.s11"><h2 id="_article-113372_s11_">Staging</h2><p>The American Joint Committee on Cancer (AJCC) has defined the staging of oropharyngeal cancer. This follows a TNM staging system where T relates to the extent of the primary tumor, N indicates the involvement of regional lymph nodes, and M specifies the distant metastasis. In their 8th edition of the staging manual, AJCC has modified the staging system being used for staging oropharyngeal cancer with the addition of depth of invasion (DOI) of the primary tumor as a modification to the T category and extranodal extension (ENE) to upstage node-positive oropharyngeal squamous cell carcinoma <a class="bk_pop" href="#article-113372.r18">[18]</a>. The new version of classification is more complex than its previous one, but it is better in terms of stratifying survival of oropharyngeal squamous cell carcinoma patients by stage <a class="bk_pop" href="#article-113372.r19">[19]</a>.</p><p>
|
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<b>Staging of Human Papillomavirus-Associated (p16-Positive) Oropharyngeal Cancer</b>
|
||
</p><p>
|
||
<b>Primary Tumor (T)</b>
|
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</p><ul><li class="half_rhythm"><div>T0-Primary tumor cannot be assessed</div></li><li class="half_rhythm"><div>T1-Tumor smaller than 2cm in greatest dimension</div></li><li class="half_rhythm"><div>T2-Tumor larger than 2cm but smaller than 4cm in greatest dimension</div></li><li class="half_rhythm"><div>T3-Tumor larger than 4cm or extension to the lingual surface of epiglottis</div></li><li class="half_rhythm"><div>T4-Moderately advanced local disease; tumor invades the larynx, extrinsic muscle of tongue, medial pterygoid, hard palate, or mandible or beyond</div></li><li class="half_rhythm"><div>T4a-Moderately advanced local disease; tumor invades the larynx, extrinsic muscle of tongue, medial pterygoid, hard palate, or mandible</div></li><li class="half_rhythm"><div>T4b-Very advanced local disease; tumor invades lateral pterygoid muscle, pterygoid plates, lateral nasopharynx, or skull base or encases carotid artery</div></li></ul><p>
|
||
<b>Regional Lymph Nodes (N)</b>
|
||
</p><ul><li class="half_rhythm"><div>NX-Regional lymph nodes cannot be assessed</div></li><li class="half_rhythm"><div>pN0-No regional lymph node metastasis</div></li><li class="half_rhythm"><div>pN1-Metastasis in 4 or fewer lymph nodes</div></li><li class="half_rhythm"><div>pN2-Metastasis in more than four lymph nodes</div></li></ul><p>
|
||
<b>Metastasis (M)</b>
|
||
</p><ul><li class="half_rhythm"><div>M0-No distant metastasis</div></li><li class="half_rhythm"><div>M1-Distant metastasis</div></li></ul><p>
|
||
<b>Clinical Prognostic Groups for HPV-Mediated (p16+) Oropharyngeal Cancer (cTNM):</b>
|
||
</p><p>
|
||
<b>Stage I</b>
|
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</p><ul><li class="half_rhythm"><div>T0–T2N0M0</div></li><li class="half_rhythm"><div>T0–T2N1M0</div></li></ul><p>
|
||
<b>Stage II</b>
|
||
</p><ul><li class="half_rhythm"><div>T0–T2N2M0</div></li><li class="half_rhythm"><div>T3N0–N2M0</div></li></ul><p>
|
||
<b>Stage III</b>
|
||
</p><ul><li class="half_rhythm"><div>T0–T3N3M0</div></li><li class="half_rhythm"><div>T4N0–N3M0</div></li></ul><p>
|
||
<b>Stage IV</b>
|
||
</p><ul><li class="half_rhythm"><div>Any T/Any N M1</div></li></ul><p>
|
||
<b>Pathological Prognostic Groups for HPV-Mediated (p16+) Oropharyngeal Cancer (pTNM):</b>
|
||
</p><p>
|
||
<b>Stage I</b>
|
||
</p><ul><li class="half_rhythm"><div>T0–T2N0M0</div></li><li class="half_rhythm"><div>T0–T2N1M0</div></li></ul><p>
|
||
<b>Stage II</b>
|
||
</p><ul><li class="half_rhythm"><div>T0–T2N2M0</div></li><li class="half_rhythm"><div>T3–T4N0M0</div></li><li class="half_rhythm"><div>T3–T4N1M0</div></li></ul><p>
|
||
<b>Stage III</b>
|
||
</p><ul><li class="half_rhythm"><div>T3–T4N2M0</div></li></ul><p>
|
||
<b>Stage IV</b>
|
||
</p><ul><li class="half_rhythm"><div>Any T/Any N M1</div></li></ul><p>
|
||
<b>Non-Human Papillomavirus-Associated (p16-Negative) Oropharyngeal Cancer</b>
|
||
</p><p>
|
||
<b>Primary tumor (T)</b>
|
||
</p><ul><li class="half_rhythm"><div>Tx-Primary tumor cannot be assessed</div></li><li class="half_rhythm"><div>Tis-Carcinoma in situ</div></li><li class="half_rhythm"><div>T1-Tumor 2 cm or smaller in greatest dimension</div></li><li class="half_rhythm"><div>T2-Tumor larger than 2 cm but not larger than 4 cm in greatest dimension</div></li><li class="half_rhythm"><div>T3-Tumor larger than 4 cm in greatest dimension or extension to the lingual surface of epiglottis</div></li><li class="half_rhythm"><div>T4-Moderately advanced or very advanced local disease</div></li><li class="half_rhythm"><div>T4a-Moderately advanced local disease; tumor invades the larynx, extrinsic muscle of tongue, medial pterygoid, hard palate, or mandible</div></li><li class="half_rhythm"><div>T4b-Very advanced local disease; tumor invades lateral pterygoid muscle, pterygoid plates, lateral nasopharynx, or skull base or encases carotid artery</div></li></ul><p>
|
||
<b>Regional lymph nodes (N)</b>
|
||
</p><ul><li class="half_rhythm"><div>N0-No regional lymph node metastasis</div></li><li class="half_rhythm"><div>N1-Metastasis in a single ipsilateral lymph node, 3 cm or smaller in greatest dimension and ENE-negative</div></li><li class="half_rhythm"><div>N2-Metastasis in a single ipsilateral lymph node larger than 3 cm but not larger than 6 cm in greatest dimension and ENE-negative; or metastases in multiple ipsilateral lymph nodes, none larger than 6 cm in greatest dimension and ENE-negative; or metastasis in bilateral or contralateral lymph nodes, none larger than 6 cm in greatest dimension and ENE-negative</div></li><li class="half_rhythm"><div>N2a-Metastasis in a single ipsilateral lymph node larger than 3 cm but not larger than 6 cm in greatest dimension and ENE-negative</div></li><li class="half_rhythm"><div>N2b-Metastasis in multiple ipsilateral lymph nodes, none larger than 6 cm in greatest dimension and ENE-negative</div></li><li class="half_rhythm"><div>N2c-Metastasis in bilateral or contralateral lymph nodes, none larger than 6 cm in greatest dimension and ENE-negative</div></li><li class="half_rhythm"><div>N3-Metastasis in a lymph node larger than 6 cm in greatest dimension and ENE-negative; or metastasis in any lymph node(s) and clinically overt ENE-positive</div></li><li class="half_rhythm"><div>N3a-Metastasis in a lymph node larger than 6 cm in greatest dimension and ENE-negative</div></li><li class="half_rhythm"><div>N3b-Metastasis in any node(s) and clinically overt ENE-positive</div></li></ul><p>
|
||
<b>Metastasis </b>
|
||
</p><ul><li class="half_rhythm"><div>M0-No distant metastasis</div></li><li class="half_rhythm"><div>M1-Distant metastasis</div></li></ul><p>
|
||
<b>Prognostic Stage Groups for Clinical and Pathologic Non–HPV-Mediated (p16 -) Oropharyngeal Cancer</b>
|
||
</p><p>
|
||
<b>Stage 0</b>
|
||
</p><ul><li class="half_rhythm"><div>TisN0M0</div></li></ul><p>
|
||
<b>Stage I</b>
|
||
</p><ul><li class="half_rhythm"><div>T1N0M0</div></li></ul><p>
|
||
<b>Stage II</b>
|
||
</p><ul><li class="half_rhythm"><div>T2N0M0</div></li></ul><p>
|
||
<b>Stage III</b>
|
||
</p><ul><li class="half_rhythm"><div>T3N0M0</div></li><li class="half_rhythm"><div>T1N1M0</div></li><li class="half_rhythm"><div>T2N1M0</div></li><li class="half_rhythm"><div>T3N1M0</div></li></ul><p>
|
||
<b>Stage IVA</b>
|
||
</p><ul><li class="half_rhythm"><div>T4aN0M0</div></li><li class="half_rhythm"><div>T4aN1M0</div></li><li class="half_rhythm"><div>T1N2M0</div></li><li class="half_rhythm"><div>T2N2M0</div></li><li class="half_rhythm"><div>T3N2M0</div></li><li class="half_rhythm"><div>T4aN2M0</div></li></ul><p>
|
||
<b>Stage IVB</b>
|
||
</p><ul><li class="half_rhythm"><div>AnyTN3M0</div></li><li class="half_rhythm"><div>T4bAnyNM0</div></li></ul><p>
|
||
<b>Stage IVC</b>
|
||
</p><ul><li class="half_rhythm"><div>AnyTAnyNM1</div></li></ul></div><div id="article-113372.s12"><h2 id="_article-113372_s12_">Prognosis</h2><p>The overall five-year survival rate in oropharyngeal carcinoma is around 60%. However, the prognosis varies depending on the etiology. In comparison to HPV-negative oropharyngeal squamous cell carcinoma, HPV-positive oropharyngeal carcinoma shows a better prognosis and increased response to the treatment.<a class="bk_pop" href="#article-113372.r20">[20]</a> The higher survival with HPV-associated cancer is because of favorable tumor biology and a healthier and younger patient population.</p></div><div id="article-113372.s13"><h2 id="_article-113372_s13_">Complications</h2><p>Treatment modalities employed in oropharyngeal cancers can result in several complications, such as:</p><ul><li class="half_rhythm"><div>Oral mucositis</div></li><li class="half_rhythm"><div>Tissue fibrosis</div></li><li class="half_rhythm"><div>Hyposalivation</div></li><li class="half_rhythm"><div>Infection</div></li><li class="half_rhythm"><div>Osteoradionecrosis</div></li><li class="half_rhythm"><div>Morbidity from jaw resection, disfigurement, and loss of function can further reduce quality of life.<a class="bk_pop" href="#article-113372.r21">[21]</a></div></li></ul></div><div id="article-113372.s14"><h2 id="_article-113372_s14_">Deterrence and Patient Education</h2><p>Regarding primary prevention of HPV-related OPSCC, HPV vaccines are more than 90% effective in preventing vaccine-type HPV infections and their correlated anogenital precancerous lesions. Pinto et al. demonstrated that vaccination induces HPV antibody levels in the oral cavity that correlate with circulating levels <a class="bk_pop" href="#article-113372.r11">[11]</a>. A screening tool useful in the early detection of HPV-DNA in oral rinses is promising, but very little data is available <a class="bk_pop" href="#article-113372.r11">[11]</a>.</p><p>Safe oral sex habits should be advised. Educating the patients on the risks of betel quid chewing, alcohol use, and tobacco smoking is of prime importance in controlling and preventing oropharyngeal cancers.</p></div><div id="article-113372.s15"><h2 id="_article-113372_s15_">Pearls and Other Issues</h2><p>New and remarkable achievements have been developed regarding the strategies employed in oropharyngeal cancer diagnosis and treatment. These include the use of LASER-based technology to detect oropharyngeal squamous cell carcinoma at the early stages, especially in limited-resource settings, and targeted therapy, which detects the mutations in genes that result in cancer and correct them, either inhibiting the growth of the tumor, its metastasis or target vascularity, cell signaling or transduction pathways <a class="bk_pop" href="#article-113372.r22">[22]</a>.</p><p>In addition, the Food and Drug Administration (FDA) has approved vaccination against HPV to prevent HPV-related infections, reducing the incidence of oropharyngeal cancers.</p></div><div id="article-113372.s16"><h2 id="_article-113372_s16_">Enhancing Healthcare Team Outcomes </h2><p>An interprofessional team consisting of an oncologist, psychotherapist, dentist, dietitian, histopathologist, surgeon, radiation oncologist, otorhinolaryngologist, clinical speech pathologist, a dental hygienist, and a chemotherapy nurse should work in collaboration to arrive at the best possible outcomes regarding the diagnosis and management of such patients <a class="bk_pop" href="#article-113372.r23">[23]</a>.</p><p>These professionals are also in an optimal position to influence and advise patients on quitting smoking and limiting alcohol in addition to maintaining healthy lifestyle habits such as eating fruits and vegetables, observing dental hygiene, and having safe sex, which may contribute to preventing the increasing incidence of oropharyngeal squamous cell carcinoma.</p></div><div id="article-113372.s17"><h2 id="_article-113372_s17_">Review Questions</h2><ul><li class="half_rhythm"><div>
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</div></li></ul></div><div id="article-113372.s18"><h2 id="_article-113372_s18_">References</h2><dl class="temp-labeled-list"><dt>1.</dt><dd><div class="bk_ref" id="article-113372.r1">Shibahara T. [Oral cancer -diagnosis and therapy-.]. <span><span class="ref-journal">Clin Calcium. </span>2017;<span class="ref-vol">27</span>(10):1427-1433.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/28947694" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 28947694</span></a>]</div></dd><dt>2.</dt><dd><div class="bk_ref" id="article-113372.r2">Isayeva T, Li Y, Maswahu D, Brandwein-Gensler M. Human papillomavirus in non-oropharyngeal head and neck cancers: a systematic literature review. <span><span class="ref-journal">Head Neck Pathol. </span>2012 Jul;<span class="ref-vol">6 Suppl 1</span>(Suppl 1):S104-20.</span> [<a href="/pmc/articles/PMC3394168/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC3394168</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/22782230" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 22782230</span></a>]</div></dd><dt>3.</dt><dd><div class="bk_ref" id="article-113372.r3">Shah A, Malik A, Garg A, Mair M, Nair S, Chaturvedi P. Oral sex and human papilloma virus-related head and neck squamous cell cancer: a review of the literature. <span><span class="ref-journal">Postgrad Med J. </span>2017 Nov;<span class="ref-vol">93</span>(1105):704-709.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/28778951" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 28778951</span></a>]</div></dd><dt>4.</dt><dd><div class="bk_ref" id="article-113372.r4">Barón AE, Franceschi S, Barra S, Talamini R, La Vecchia C. A comparison of the joint effects of alcohol and smoking on the risk of cancer across sites in the upper aerodigestive tract. <span><span class="ref-journal">Cancer Epidemiol Biomarkers Prev. </span>1993 Nov-Dec;<span class="ref-vol">2</span>(6):519-23.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/8268767" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 8268767</span></a>]</div></dd><dt>5.</dt><dd><div class="bk_ref" id="article-113372.r5">Mizukawa N, Swe Swe Win, Zaw Moe Thein, Moe Thida Htwe, Yoshioka Y, Kimata Y, Iida S, Myo Khin, Okada S, Than Sein The Incidence of Oral and Oropharyngeal Cancers in Betel Quid-Chewing Populations in South Myanmar Rural Areas. <span><span class="ref-journal">Acta Med Okayama. </span>2017 Dec;<span class="ref-vol">71</span>(6):519-524.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/29276225" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 29276225</span></a>]</div></dd><dt>6.</dt><dd><div class="bk_ref" id="article-113372.r6">Helgadottir H, Höiom V, Jönsson G, Tuominen R, Ingvar C, Borg A, Olsson H, Hansson J. High risk of tobacco-related cancers in CDKN2A mutation-positive melanoma families. <span><span class="ref-journal">J Med Genet. </span>2014 Aug;<span class="ref-vol">51</span>(8):545-52.</span> [<a href="/pmc/articles/PMC4112445/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC4112445</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/24935963" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 24935963</span></a>]</div></dd><dt>7.</dt><dd><div class="bk_ref" id="article-113372.r7">Marks MA, Chaturvedi AK, Kelsey K, Straif K, Berthiller J, Schwartz SM, Smith E, Wyss A, Brennan P, Olshan AF, Wei Q, Sturgis EM, Zhang ZF, Morgenstern H, Muscat J, Lazarus P, McClean M, Chen C, Vaughan TL, Wunsch-Filho V, Curado MP, Koifman S, Matos E, Menezes A, Daudt AW, Fernandez L, Posner M, Boffetta P, Lee YC, Hashibe M, D'Souza G. Association of marijuana smoking with oropharyngeal and oral tongue cancers: pooled analysis from the INHANCE consortium. <span><span class="ref-journal">Cancer Epidemiol Biomarkers Prev. </span>2014 Jan;<span class="ref-vol">23</span>(1):160-71.</span> [<a href="/pmc/articles/PMC3947141/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC3947141</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/24351902" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 24351902</span></a>]</div></dd><dt>8.</dt><dd><div class="bk_ref" id="article-113372.r8">Chimenos-Küstner E, Marques-Soares MS, Schemel-Suárez M. [Aetiopathology and prevention of oropharyngeal cancer]. <span><span class="ref-journal">Semergen. </span>2019 Oct;<span class="ref-vol">45</span>(7):497-503.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/31079896" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 31079896</span></a>]</div></dd><dt>9.</dt><dd><div class="bk_ref" id="article-113372.r9">Gillison ML, Koch WM, Capone RB, Spafford M, Westra WH, Wu L, Zahurak ML, Daniel RW, Viglione M, Symer DE, Shah KV, Sidransky D. Evidence for a causal association between human papillomavirus and a subset of head and neck cancers. <span><span class="ref-journal">J Natl Cancer Inst. </span>2000 May 03;<span class="ref-vol">92</span>(9):709-20.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/10793107" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 10793107</span></a>]</div></dd><dt>10.</dt><dd><div class="bk_ref" id="article-113372.r10">Yete S, D'Souza W, Saranath D. High-Risk Human Papillomavirus in Oral Cancer: Clinical Implications. <span><span class="ref-journal">Oncology. </span>2018;<span class="ref-vol">94</span>(3):133-141.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/29241220" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 29241220</span></a>]</div></dd><dt>11.</dt><dd><div class="bk_ref" id="article-113372.r11">Taberna M, Mena M, Pavón MA, Alemany L, Gillison ML, Mesía R. Human papillomavirus-related oropharyngeal cancer. <span><span class="ref-journal">Ann Oncol. </span>2017 Oct 01;<span class="ref-vol">28</span>(10):2386-2398.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/28633362" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 28633362</span></a>]</div></dd><dt>12.</dt><dd><div class="bk_ref" id="article-113372.r12">Pickard RK, Xiao W, Broutian TR, He X, Gillison ML. The prevalence and incidence of oral human papillomavirus infection among young men and women, aged 18-30 years. <span><span class="ref-journal">Sex Transm Dis. </span>2012 Jul;<span class="ref-vol">39</span>(7):559-66.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/22706220" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 22706220</span></a>]</div></dd><dt>13.</dt><dd><div class="bk_ref" id="article-113372.r13">Lewis-Jones H, Colley S, Gibson D. Imaging in head and neck cancer: United Kingdom National Multidisciplinary Guidelines. <span><span class="ref-journal">J Laryngol Otol. </span>2016 May;<span class="ref-vol">130</span>(S2):S28-S31.</span> [<a href="/pmc/articles/PMC4873922/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC4873922</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/27841111" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 27841111</span></a>]</div></dd><dt>14.</dt><dd><div class="bk_ref" id="article-113372.r14">Melong JC, Rigby MH, Bullock M, Hart RD, Trites JR, Taylor SM. Transoral laser microsurgery for the treatment of oropharyngeal cancer: the Dalhousie University experience. <span><span class="ref-journal">J Otolaryngol Head Neck Surg. </span>2015 Sep 30;<span class="ref-vol">44</span>:39.</span> [<a href="/pmc/articles/PMC4589206/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC4589206</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/26419647" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 26419647</span></a>]</div></dd><dt>15.</dt><dd><div class="bk_ref" id="article-113372.r15">Tirelli G, Boscolo Nata F, Piovesana M, Quatela E, Gardenal N, Hayden RE. Transoral surgery (TOS) in oropharyngeal cancer: Different tools, a single mini-invasive philosophy. <span><span class="ref-journal">Surg Oncol. </span>2018 Dec;<span class="ref-vol">27</span>(4):643-649.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/30449487" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 30449487</span></a>]</div></dd><dt>16.</dt><dd><div class="bk_ref" id="article-113372.r16">Furness S, Glenny AM, Worthington HV, Pavitt S, Oliver R, Clarkson JE, Macluskey M, Chan KK, Conway DI., CSROC Expert Panel. Interventions for the treatment of oral cavity and oropharyngeal cancer: chemotherapy. <span><span class="ref-journal">Cochrane Database Syst Rev. </span>2010 Sep 08;(9):CD006386.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/20824847" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 20824847</span></a>]</div></dd><dt>17.</dt><dd><div class="bk_ref" id="article-113372.r17">Roskies M, Kay-Rivest E, Mascarella MA, Sultanem K, Mlynarek A, Hier M. Survival outcomes in patients with oropharyngeal cancer treated with carboplatin/paclitaxel and concurrent radiotherapy. <span><span class="ref-journal">J Otolaryngol Head Neck Surg. </span>2016 Oct 10;<span class="ref-vol">45</span>(1):50.</span> [<a href="/pmc/articles/PMC5057223/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC5057223</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/27724969" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 27724969</span></a>]</div></dd><dt>18.</dt><dd><div class="bk_ref" id="article-113372.r18">Lydiatt WM, Patel SG, O'Sullivan B, Brandwein MS, Ridge JA, Migliacci JC, Loomis AM, Shah JP. Head and Neck cancers-major changes in the American Joint Committee on cancer eighth edition cancer staging manual. <span><span class="ref-journal">CA Cancer J Clin. </span>2017 Mar;<span class="ref-vol">67</span>(2):122-137.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/28128848" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 28128848</span></a>]</div></dd><dt>19.</dt><dd><div class="bk_ref" id="article-113372.r19">Moeckelmann N, Ebrahimi A, Tou YK, Gupta R, Low TH, Ashford B, Ch'ng S, Palme CE, Clark JR. Prognostic implications of the 8th edition American Joint Committee on Cancer (AJCC) staging system in oral cavity squamous cell carcinoma. <span><span class="ref-journal">Oral Oncol. </span>2018 Oct;<span class="ref-vol">85</span>:82-86.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/30220324" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 30220324</span></a>]</div></dd><dt>20.</dt><dd><div class="bk_ref" id="article-113372.r20">Fung N, Faraji F, Kang H, Fakhry C. The role of human papillomavirus on the prognosis and treatment of oropharyngeal carcinoma. <span><span class="ref-journal">Cancer Metastasis Rev. </span>2017 Sep;<span class="ref-vol">36</span>(3):449-461.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/28812214" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 28812214</span></a>]</div></dd><dt>21.</dt><dd><div class="bk_ref" id="article-113372.r21">Turner L, Mupparapu M, Akintoye SO. Review of the complications associated with treatment of oropharyngeal cancer: a guide for the dental practitioner. <span><span class="ref-journal">Quintessence Int. </span>2013 Mar;<span class="ref-vol">44</span>(3):267-79.</span> [<a href="/pmc/articles/PMC3773981/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC3773981</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/23444208" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 23444208</span></a>]</div></dd><dt>22.</dt><dd><div class="bk_ref" id="article-113372.r22">Balaji SM. Oral squamous cell carcinoma: Advances in management. <span><span class="ref-journal">Indian J Dent Res. </span>2015 Nov-Dec;<span class="ref-vol">26</span>(6):559.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/26888230" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 26888230</span></a>]</div></dd><dt>23.</dt><dd><div class="bk_ref" id="article-113372.r23">Fried JL. Confronting human papilloma virus/oropharyngeal cancer: a model for interprofessional collaboration. <span><span class="ref-journal">J Evid Based Dent Pract. </span>2014 Jun;<span class="ref-vol">14 Suppl</span>:136-46.e1.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/24929598" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 24929598</span></a>]</div></dd></dl></div><div><dl class="temp-labeled-list small"><dt></dt><dd><div><p class="no_top_margin">
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<b>Disclosure: </b>Zohaib Jamal declares no relevant financial relationships with ineligible companies.</p></div></dd><dt></dt><dd><div><p class="no_top_margin">
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<b>Disclosure: </b>Fatima Anjum declares no relevant financial relationships with ineligible companies.</p></div></dd></dl></div></div></div>
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