|Oropharyngeal Cancer Becoming More Common|
|Sunday, 15 March 2009 17:00|
Dear Mayo Clinic:
A friend of mine was recently diagnosed with tongue cancer. I've never heard of such a thing. Is this common? What is he up against, and how is it treated?
Cancers of the head and neck are more common in people who use tobacco and those who drink alcohol in excess. But, quite often, people who don't have those risk factors are also affected. We're now seeing oropharyngeal cancer in a younger, healthier group of patients. The reason is not clear.
Some research has suggested that the human papillomavirus (HPV), which can cause cervical cancer, also may have a role in oropharyngeal cancer. About 45 percent of patients who have oropharyngeal cancer also have HPV. More research is needed to determine if HPV and oropharyngeal cancer are linked, but perhaps the HPV vaccine that's now available may provide some protection from oropharyngeal and other head and neck cancers.
Oropharyngeal cancer has few symptoms and can be difficult to detect. Usually, people who have the condition notice a lump in their neck that doesn't go away and seek treatment. That lump is a sign the cancer has already spread to the lymph nodes in the neck.
Because oropharyngeal cancer is frequently not diagnosed until it has already spread, expedited treatment is essential. Treatment typically includes surgery as well as chemotherapy or radiation therapy, or both.
Traditionally, the surgery for oropharyngeal cancer involved an invasive procedure that divided the jawbone to access the tumor and affected lymph nodes. Fortunately, that procedure has largely been replaced by less invasive surgeries that have much less impact on a person's speech and ability to swallow, and result in significantly shorter recovery times.
Laser surgery is one minimally invasive technique that has been effective in tumor removal. This surgery uses beams of high-intensity light to shrink or vaporize cancer cells. Laser surgery is not always an option, though, because a laser beam travels only in a straight line. So some tumors are not accessible to this treatment.
Another treatment option is robot-assisted surgery. While watching a 3-D image of the surgical field that is projected on a screen, the surgeon manipulates hand controls that guide the surgical tools to perform the operation. The robotic assistance allows the surgeon to operate in hard-to-reach areas within the head and neck.
At Mayo Clinic, this procedure is the surgical treatment of choice for oropharyngeal cancer. But robotic surgical systems are expensive and require specialized training, limiting the number of medical centers that offer this treatment.
After surgery to remove the tumor and affected lymph nodes, most people with oropharyngeal cancer require additional treatment with chemotherapy or radiation or both. How much additional treatment is required depends on the cancer's stage and how far it has spread.
Follow-up care and monitoring are critical. Most recurrences of oropharyngeal cancer occur within the first two years after treatment. Typically patients return for follow-up exams every three months for two years. These exams may include a computerized tomography (CT) scan or a positron emission tomography (PET) scan, in addition to a physical exam, to check for cancer recurrence.
For those whose oropharyngeal cancer is detected and treated quickly before it has spread to distant parts of the body - and if the tumor can be completely removed - the long-term outlook often is good.
- Eric Moore, M.D., Otorhinolarygngology, Mayo Clinic, Rochester, Minn.oem software