oropharyngeal Cancer 
treatment

INCLUDES TONSIL CANCER

 

What do we mean by 'Oropharyngeal Cancer'? It is a type of Throat Cancer that your doctor might call by the part it has grown in, like tonsil or tongue base cancer. If it's not the cancer type you're looking for, please explore the information about other types of Throat Cancers or other types of Head and Neck Cancers.


 
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1. Treatment options for Oropharyngeal Cancer

Following a diagnosis of Oropharyngeal Cancer, your cancer care team will discuss the treatment options including the possibility of participating in a clinical trial that is suitable for you. This is also a good time to consider if you would like a second opinion.

The most suitable treatment for Oropharyngeal Cancer depends on many things including:

  • size and location of the cancer

  • whether the cancer has spread

  • whether the cancer is caused by smoking or HPV

  • personal factors (e.g. age, general health and treatment history)

  • treatments available (and whether any clinical trials are available)

  • your preferences for treatment

There are three types of treatment available for Oropharyngeal Cancer. These include:

  • Surgery

  • Radiation therapy

  • Chemotherapy

For many people there may be more than one treatment option that gives approximately the same chance of curing the cancer. Each treatment option has its advantages and disadvantages.

Generally, people with curable Oropharyngeal Cancer may be offered one of two treatment options: surgery and definitive radiation therapy.
  • Surgery — which depending on the pathology results, may need to be followed by a course of radiation therapy (adjuvant radiation therapy); either on its own or at the same time (concurrent) as chemotherapy.

  • Definitive radiation therapy — either on its own or at the same time as chemotherapy (concurrent chemoradiation) 

Watch a 3D video explainer about Oropharyngeal Cancer:


2. Surgery for Oropharyngeal Cancer

There are a number of different operations that can help treat Oropharyngeal Cancer. If surgery is recommended, the type of operation will depend on the person and their cancer.

While some people can be treated with surgery alone, others may need extra treatment after surgery to reduce the risk of the cancer returning. Your cancer care team will help decide whether it is necessary for you, based on a detailed report on the cancer from the pathologist 1–2 weeks after surgery.

Adding another type of treatment after surgery is called adjuvant therapy.

This can be either radiation therapy alone or in combination with chemotherapy (chemoradiation), which is typically started about 4 weeks after surgery to allow recovery and for planning purposes. The treatment itself usually lasts about 6 weeks.

How can I prepare for the surgery?

Your doctor will explain details of the surgery, general risks and side effects of surgery. Ask your doctor if you have questions. They may recommend:

  • stopping blood thinners (e.g. aspirin) before surgery to reduce the risk of bleeding

  • special stockings to reduce the risk of blood clots

  • early mobilisation (i.e. not to stay in bed) to reduce the risk of blood clots and chest infection

  • antibiotics to lower the risk of wound infection.

If you smoke, it is important that you consider stopping smoking before starting treatment to help reduce the risk of infection and help you recover after your treatment.

The different surgical options for oropharyngeal cancer include: 

TRANS-ORAL ROBOTIC SURGERY (TORS)

Sometimes, oropharyngeal cancers can be removed through the mouth without any external cuts using a robotic system or by using laser surgery.

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NECK DISSECTION

This involves removal of lymph nodes from the neck. This is important even when there is no sign of cancer in the lymph nodes on your scan, because there is a risk of microscopic cancer in the lymph glands of the neck.
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MANDIBULOTOMY

Surgery for oropharyngeal cancer may need to be more extensive in some patients. This can be because the cancer is too far back to remove through the mouth or because it is very large. A mandibulotomy involves cutting the jaw bone to allow better access to the cancer in the throat. The jaw is put back together at the end of the operation with titanium plates.
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FREE FLAP RECONSTRUCTIVE SURGERY

In people, who have had a large area of tissue taken out, they may need reconstructive surgery. This involves taking skin and its blood supply from another part of the body and using that skin to cover the throat. This operation is carried out by a surgeon who specialises in reconstructive surgery, your head and neck surgeon or another surgeon.
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TRACHEOSTOMY

A tracheostomy is used to create an opening in the trachea (windpipe) in the lower neck, where a tube is inserted to allow air to flow in and out, when you breathe. This is used as swelling after major head and neck surgery may affect your ability to breathe. The tracheostomy tube is usually removed within a week of surgery once normal breathing is possible.
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FEEDING TUBES

  • A gastrostomy tube (called a PEG tube) goes through the skin and the muscles of your abdominal wall into the stomach. Gastrostomy is recommended if feeding is needed for a medium to longer time (months or years).
  • A nasogastric tube goes through the nose down into the stomach. Nasogastric feeding is used for short time (days or weeks).
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Side effects of surgery

Treatment for oropharyngeal cancer may lead to a number of side effects . You may not experience all of the side effects. Speak with your doctor if you have any questions or concerns about treatment side effects.

3. Radiation Therapy for Oropharyngeal Cancer

The most common radiation therapy approach for Oropharyngeal Cancer is called external beam radiation.  This type of radiation therapy applies radiation from outside the body. 

Radiation therapy can be used in the following ways:

Definitive

Radiation therapy is the main treatment for oropharyngeal cancer. It is used without surgery to cure oropharyngeal cancer. Typically radiation therapy is delivered daily (but not on weekends) for 7 weeks. Sometimes chemotherapy is added to the radiation therapy (chemoradiation) to make it more effective.

Adjuvant

This is when radiation therapy is given after surgery to kill cancer cells that may not have been taken out during surgery. It usually starts about 4 weeks after surgery to allow recovery from surgery. Radiation therapy treatment usually lasts for about 6 weeks. Sometimes chemotherapy is added to the adjuvant radiation therapy (chemoradiation) to make it more effective.

Palliative

In cases where a cure is not possible, radiation therapy is used to relieve symptoms of advanced oropharyngeal cancer. Symptoms that may require palliative radiation therapy include pain, bleeding, breathing and trouble swallowing.


How do I prepare for radiation therapy? 

You will meet with many members of the cancer care team, who will help you learn how to look after yourself through radiation therapy, recovery and long term follow-up. They will also talk to you about side effects and how to manage them. It may be helpful to write down questions as they come up, so you can ask anyone in your cancer care team when you see them. 

Radiation therapy mask-making and simulation 

  • Radiation therapy is a precise treatment. In order to make sure, that the cancer is covered by the treatment, you will need to be very still during the treatment, usually for about five minutes. A radiation therapy mask that is made to fit perfectly to your shape, will be put on you during each treatment to help the machine target where the cancer is.
  • You will have a planning CT scan (and sometimes other scans) with the mask on. Your radiation oncologist and radiation therapists will use these scans with all your other clinical information to develop a radiation therapy plan just for you (a personalised plan). Your plan will be checked by the radiation therapy and radiation oncology physics team before it is ready to be used for your treatment. This whole process can take approximately 2-3 weeks.
 

Teeth and mouth care

You might need to have some of your teeth taken out, this will depend on the area being treated and the dose of radiation therapy. It is important to take out any broken or infected teeth before radiation therapy. Taking out unhealthy teeth after radiation therapy can cause problems with the jaw bone.

 

 

Diet, nutrition and the role of your dietitian

Your cancer and its treatment can make it hard to eat and drink. Your doctor will recommend you see a dietitian to maximise your nutrition during treatment as well as while you are recovering. Sometime feeding tubes may be recommended depending on the area being treated and the dose of radiation therapy.
There are two common types of feeding tubes: 

  • Gastrostomy tube (sometimes called a PEG tube): this type of tube is inserted through your abdominal wall into your stomach, with part of the tube staying outside the stomach.  A syringe can be attached to the tube to give you food this way if needed. The tube is inserted using a camera through the mouth into the stomach (gastroscopy) or using a CT scanner to guide insertion directly through the skin. If a PEG tube is needed, your doctor will organise this before starting your radiation therapy.

  • Nasogastric tube: this type of tube goes through the nose down into the stomach and is usually used for short periods (days or weeks). A nasogastric tube can be inserted at any time (before, during or after treatment).

 
 

Speech, voice and swallowing

Your cancer and its treatment can make swallowing and speech difficult. Your doctor will recommend you see a speech pathologist, who can help you with ways to manage swallowing and communication difficulties, during and after treatment.

 

 

There are many other aspects of supportive care that are available, ask your doctor if you have any specific needs.

Side effects

The side effects of radiation therapy start around two weeks into treatment and progress through treatment to peak in the last week or just after treatment ends. The side effects start to improve 2–3 weeks after the end of treatment.

Side effects of radiation therapy depend on:

  • the dose of radiation therapy

  • the area being treated

  • whether or not chemotherapy is added to the radiation therapy.

Each person responds to radiation therapy differently. Some people may experience a few side effects while others may not experience any at all.
The following are some common side effects of radiation therapy.
  • tiredness

  • skin irritation in the treated area e.g. redness, dryness and itching, weeping skin, scaling or sometimes skin breakdown (sores)

  • dry mouth and throat due to loss of saliva (called xerostomia)

  • altered taste, which is usually a loss of taste or sometimes an unpleasant taste in the mouth

  • pain on swallowing or difficulty with swallowing

  • loss of weight.

Most side effects are short lived and may go away within 4–6 weeks of finishing radiation therapy. Some side effects may last for months after you finish radiation therapy and some may be permanent.

Once your radiation therapy ends, you will have regular follow-up appointments so your cancer care team can check your recovery and monitor any side effects that you may have. About 12 weeks after your last radiation therapy session, your doctor will usually arrange for a PET scan to make sure the cancer has completely gone. If the cancer has not gone away after radiation therapy, or comes back in the future, you may still be able to have surgery to try to remove the cancer.

Your doctor may recommend some specific supportive care options to help you during your treatment and recovery.

To learn more about Radiation Therapy and to watch
a video of an Immobilisation Maks being made click here



Immobilisation-Mask.png

4. Chemotherapy for Oropharyngeal Cancer

Chemotherapy works by destroying or damaging cancer cells. For Oropharyngeal Cancers, it is usually given into a vein through a needle with a cannula (tube) attached.

There are a number of different types of chemotherapy that may be used to treat Oropharyngeal Cancers:

Definitive

Sometimes chemotherapy is added to definitive radiation therapy (chemoradiation). It is usually used for advanced stage oropharyngeal cancers. This may be given once every 3 weeks or once a week throughout the duration of radiation therapy. Although chemotherapy makes the radiation more effective at destroying cancer cells, it may also lead to increased side effects for most patients.

Adjuvant

This is when chemotherapy is given after surgery, usually in combination with radiation therapy (called concurrent chemoradiation). This may be given once every 3 weeks or once a week throughout the duration of radiation therapy. Although chemotherapy makes the radiation more effective at destroying cancer cells, it may also lead to increased side effects for most patients.

Neo-adjuvant

This is when chemotherapy is given before surgery or radiation therapy to help shrink large cancers making them easier to remove during surgery, or target with radiation therapy.

Palliative

This is used when the cancer is incurable. The cancer may be too large or has spread too much to be removed by surgery. Palliative chemotherapy helps to slow the growth of cancer and reduce symptoms. It is important to remember that palliative chemotherapy is not as intense as other types and is much less likely to have significant side effects.

Before you start treatment, your medical oncologist will choose one or more chemotherapy medication that will be best to treat the type of cancer you have.

The particular chemotherapy medications used will depend on:

  • whether the treatment is curative or palliative

  • when it is used

  • ​your medical history

Side effects 

The side effects of chemotherapy depend on the medication used and the the dose. The most common medications are cisplatin, carboplatin and 5-Fluoruracil (5-FU). 

Each person responds to chemotherapy differently. Some people may experience a few side effects while others may not experience any at all. The following are common side effects of chemotherapy: 

  • a feeling of wanting to vomit (nausea) or vomiting

  • more side effects of radiation, if you have chemotherapy at the same time as radiation 

  • loss of feeling in the fingers and toes

  • kidney damage (caused by some medications) 

  • hearing loss/thinning

  • ringing in the ears

  • rash

  • higher risk of infection (if the chemotherapy reduces the number of white cells in the blood).

Most side effects are short lived and may go away once you finish chemotherapy. Some side effects can take months to years to improve or may be permanent.
Once your treatment ends, you will have regular follow-up appointments so that your doctor can check your recovery, make sure the cancer has not returned and monitor and treat any side effects that you may have.

Your doctor may recommend that you receive supportive care to help during your recovery. 
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All the information in this section is available in a PDF.
Download it here.
IN THIS SECTION
  • What is Oropharyngeal Cancer?
  • What is the oropharynx?
  • What does the oropharynx do?
  • What causes Oropharyngeal Cancer?
  • Human Papilloma Virus
  • Signs and Symptoms of Oropharyngeal Cancer
  • Tests for Oropharyngeal Cancer
  • Treatment options for Oropharyngeal Cancer
  • Surgery 
  • Radiation Therapy
  • Chemotherapy
FURTHER INFORMATION
  1. Head and Neck Cancer Australia Resources 
  2. External Links to other Head and Neck Cancer Resources