Oropharyngeal cancer: symptoms, HPV link, tests and treatment

Cancer Research UK explains that mouth and oropharyngeal cancers happen when abnormal cells in the mouth and oropharynx divide and grow uncontrollably, and that most develop in squamous cells, so they are called squamous cell carcinomas. The pharynx, or throat, has three parts: the oropharynx, the nasopharynx and the laryngopharynx. The oropharynx includes the back third of the tongue, the soft palate, the tonsils and tonsillar pillars and the back wall of the throat.

The term throat cancer can be confusing because people use it for several different cancers, including the voice box, thyroid and food pipe. Cancer Research UK stresses that it is important to know the exact type, because cancers are treated according to where they start.

The charity also notes that cancers starting in the mouth and oropharynx can spread to lymph nodes in the neck because they are close by, which is why the neck is examined and sometimes treated.

Cancer Research UK lists the symptoms below. It says many can be due to other conditions and most people with these symptoms do not have mouth or oropharyngeal cancer, but you must get them checked by a GP or dentist.

• A mouth ulcer or sore area that does not heal.

• A lump in the neck, which may be an enlarged lymph node. A hot red painful lump usually means infection, and lumps that come and go are not usually cancer.

• Pain in the mouth that does not go away.

• Red or white patches in the mouth or throat.

• A persistent sore throat, particularly on one side.

• Pain or difficulty swallowing, or food sticking in the throat.

• Voice changes or speech problems.

• Weight loss, bad breath, an unusually large tonsil on one side, or ear pain that does not settle.

Cancer Research UK says you usually see your GP or dentist first. They will ask about your general health and examine you, and may do tests or refer you to a specialist. Your GP should arrange a test or specialist appointment if you have symptoms that could be due to mouth or oropharyngeal cancer.

The charity notes that a persistent sore throat can also be caused by viral or bacterial infections, acid reflux, smoking or hay fever, and that white patches that rub off and disappear with antifungal treatment are not related to cancer. A symptom that does not settle, or keeps returning in the same place, is the reason to be seen rather than any single feature.

Cancer Research UK says that we do not know what causes most mouth or oropharyngeal cancers, but some factors can increase risk. The strongest recognised link for the oropharynx is HPV, a common virus that causes no harm in most people but in some can cause changes in the throat that make cancer more likely in the future. The charity says there has been an increase in HPV-positive oropharyngeal cancer in recent years.

The charity states that around 8,900 new cases of mouth and oropharyngeal cancer are diagnosed in the UK each year, that oral cancer is more common in men than women, and that most HPV-positive and non-HPV cases happen in middle-aged or elderly people.

According to Cancer Research UK, tests include a nasoendoscopy and a biopsy, which is a sample of tissue. Doctors then test the cells to see whether they contain HPV, which affects the stage of the cancer and the outlook.

The stage tells you about the size of the cancer and whether it has spread, the type is the type of cell it started from, and the grade describes how abnormal the cells look under the microscope. The doctor also examines the mouth and neck and may arrange tests for nearby lymph nodes.

Cancer Research UK says treatments include surgery, radiotherapy, chemoradiotherapy, targeted drugs and immunotherapy, and that what you have depends on your cancer type, its size, whether it has spread and your general health. A team of doctors and other professionals discusses the best treatment and care for you.

After treatment you have regular check-ups and tests at the hospital so the doctors can check how you are and whether you have any problems. Cancer Research UK also describes preparing for treatment and life afterwards, called prehabilitation, which can help you feel more in control.

The mouth and oropharynx help us breathe, talk, eat, chew and swallow, so treatment can affect these functions. The charity says practical and emotional support can help you cope with the diagnosis and with life during and after treatment, and notes that it is common to struggle with your mental health when you have cancer.

On the NHS, suspected head and neck cancer is referred by the GP or dentist to a specialist team, where tests such as nasoendoscopy and biopsy are arranged and a team of doctors and other professionals discusses the best treatment. The route is free at the point of use.

Some people see a private ENT or head and neck specialist to speed up assessment or for a second opinion. The tests are essentially the same, and treatment of confirmed cancer is usually planned by specialist multidisciplinary teams in both sectors, so ask which team will be responsible for each stage.