Patient Guide

Oropharyngeal Cancer

Introduction

The diagnosis of cancer in a patient is often accompanied by disbelief, and feeling of helplessness. The feeling of helplessness is partly due to fear, lack of knowledge and little awareness of the many treatment options available.

This series of pamphlets aims to educate the reader about common head and neck cancers - how the condition presents in patients, symptoms they may experience, investigations that are required and treatment options available. For more specific information, you are advised to seek a head and neck cancer specialist’s opinion for a face to face discussion of the condition.

Oropharyngeal Cancer

The oropharynx is the back of the throat that includes the back of the tongue, the tonsils and the soft palate with uvula. Oropharyngeal cancers result primarily from smoking and alcohol consumption, but there is increasing evidence to suggest that some of these cancers are associated with an infection with the Human Papilloma virus (HPV), the same virus that causes cervical cancer in women.

In patients who developed oropharyngeal cancer because of this virus, there is an association with having previous multiple sexual partners and engaging in oral sex. Common presenting symptoms include a lump at the back of the throat and neck lumps due to enlarged lymph glands.

Examination and Tests

Your doctor will examine you and will perform nasoendoscopy, where a fibreoptic camera is placed through the nose to obtain a view of the back of the tongue and throat.

Two types of investigations are required:

  1. Biopsy of the oropharynx to determine the presence of cancer (this is usually done under general anaesthesia).
  2. Scans to determine the extent of the disease. Commonly-performed scans include Magnetic Resonance Imaging (MRI) scan of the tongue and neck, to determine local extent of disease and whether or not it has spread to the neck. Your doctor will also order either a Computed Tomography (CT) scan of the chest and liver or a Positron Emission Tomography (PET) scan. These scans determine if the cancer has spread to any other organs.

Treatment

The treatment of oropharyngeal cancer depends on the stage of disease. Early stage cancers can be treated with either surgery or radiotherapy.
Advanced stage oropharyngeal cancer requires surgery and radiotherapy or chemoradiotherapy. Patients with HPV-associated oropharyngeal cancers usually respond relatively well to chemoradiotherapy and this is often the treatment of choice.

Cancer Patient Services

The Department of Otorhinolaryngology (Ear, Nose, Throat) in Tan Tock Seng Hospital offers the following services in relation to head and neck cancers:

  1. Diagnosis of whether or not the patient has a head and neck cancer.
  2. Appropriate staging of the cancer.
  3. Treatment of the cancer. Every patient with cancer is discussed at our multidisciplinary tumour board to work out the best possible treatment for you based on the latest clinical evidence for each condition.
  4. Long term follow up and surveillance to ensure the cancer does not return.

Cancer Care Management

We work closely with other medical specialists and allied health professionals to ensure the best possible outcome for our cancer patients.

Our radiologists provide their expertise in interpreting scans and aiding us in the exact staging of patients.

Our radiation oncologists and medical oncologists also provide expertise to our patients who may need radiotherapy and chemotherapy in the treatment of their cancers.

Patients who undergo surgery may sometimes need reconstruction of defects left by tumour removal. We have a team of reconstructive plastic surgeons who can reconstruct the defect to restore form and function.

The speech and swallowing therapy team will work rigorously with you to obtain the best possible outcome for speech and swallowing. Additionally, you will also meet our dietician who will provide dietary advice before, during and after treatment. We also collaborate with the dental team to ensure your teeth are in optimal condition before embarking on radiotherapy.

Our aim is the same as yours: to fight off the cancer and to return you to an optimal quality of life.

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