Oropharynx is the middle part of pharynx, which is a continuation of nasopharynx and directly passes into larynx. Oropharynx is limited by the back and side walls, in front it is connected to oral cavity by pharynx. Pharynx is an open space between oral cavity and oropharynx, bounded above by soft palate, below by the root of tongue, and on sides by palatine brackets behind which are palatine tonsils. According to its function, oropharynx belongs to respiratory organs (upper) and gastrointestinal tract organs. That is, this organ is a conductor for air, food and water.
Oropharyngeal cancer is a group of oncological malignant lesions that are primarily localized in this area. Squamous oropharyngeal carcinoma is the most common. Squamous cell cancer type accounts for 95% of all malignant oropharynx tumors. The risk group of this disease is men after 50 years, especially those who abuse alcohol and smoke cigarettes. Among persons aged 30-50, oropharyngeal cancer is associated with human papillomavirus carriage (especially types 16 and 18).
Oropharyngeal cancer is a disease with serious prognosis, in some patients it is detected at a late stage due to untimely application for medical help. If you suspect that you or a close relative has such a disease, don't waste time! Immediately seek qualified medical care from a doctor with experience in cancer patients management. These are those specialists who help people every day in Oncology Department of Maimonides Multidisciplinary Medical Center. Our clinic works on modern Israeli oncology centers model, uses all Israeli medicine experience to effectively help people facing serious diseases. All clinical cases are conducted jointly by the attending oncologist, the head of department – Dr. Stefanska Irina and responsible oncologist directly from Israel. Thus, in Ukrainian conditions every patient can get access to Israeli-model medicine.
Of course, any malignant diseases treatment is an expensive process, so we made sure that all our patients could receive the necessary care, regardless of financial capabilities. Maimonides Medical Center works under the patronage of “Keren Or for our Child” the Charitable Foundation , which helps pay medical bills partially or fully of seriously ill patients.
Oropharyngeal cancer is a serious but completely curable disease if it is detected in time and a modern comprehensive approach to therapy is applied. Our department employs not only oncologists, but also the rest of narrow specialists who take part in diagnosis process, treatment plan development and its subsequent implementation (surgeons, ENT doctors, radiation therapists, chemotherapists, plastic surgeons, psychologists, rehabilitators , and others). All diagnostic procedures and treatment regimens comply with the latest modern global protocols and recommendations. At the same time, doctors practice a purely individual approach to each patient. All the smallest details are taken into account – age, gender, general health state, main diagnosis, histological tumor type, its size, disease stage, concomitant severe pathologies presence, patient’s wishes, etc. With the help of such a patient-oriented approach, we get only the best treatment results, which has a positive effect on the long-term prognosis and survival.
Only highly qualified doctors work in our medical institution. Most of them have successfully completed training at the most world’s famous oncology centers (Israel, USA, Germany). Each specialist perfectly knows modern diagnostic and treatment procedures, has psychological communicationg skills with oncology patients. If a certain narrow specialist or rare medical and diagnostic equipment is not available, the patient is referred to subsidiary institutions of Maimonides Medical Center or our Israeli partner clinics, where he is guaranteed to receive the full range of necessary medical services.
Oropharyngeal cancer causes
The direct cause of any oncological process development is a mutation in a certain cell, which, as a result, acquires the ability for uncontrolled growth and division, which gives rise to a tumor. What exactly causes this primary mutation is not known for certain, but there are risk factors, presence of which significantly increases baseline risk of malignant disease development. For oropharyngeal cancer, these are the following risk factors:
- Smoking (including electronic cigarettes), chewing tobacco.
- Alcohol abuse.
- Improperly fitted dentures or implants.
- Carrier of human papillomavirus transmitted sexually.
- Primary or secondary immunodeficiency presence.
- Chronic inflammatory processes of ENT organs (tonsillitis, pharyngitis, sinusitis).
- Benign background lesions presence – leukoplakia, papillomas, oropharyngeal erythroplakia.
- Age (over 50 years), gender (male), family history of oropharyngeal cancer.
Oropharyngeal cancer symptoms and types
The symptoms of oropharyngeal cancer are very similar to respiratory infections symptoms of upper respiratory tract. Often, patients delay a visit to the doctor, waiting that symptoms resolve on their own for months. That is why patients arrive late to see an oncologist or an ENT doctor.
Characteristic symptoms of oropharyngeal cancer are:
- sore throat,
- dysphagia - swallowing disorder,
- odynophagia – painful feeling when food passes through esophagus,
- dysarthria is a speech disorder manifested in difficult pronunciation or distortion of some sounds, words,
- Otalgia – ear pain.
Oropharynx cancer is often manifested by enlarged lymph nodesappearance on the neck, which are already affected by metastases. Lymph nodes of one half of the neck are anatomically connected with lymph nodes of the opposite side, as a result of which bilateral metastasis is characteristic.
95% of oropharyngeal malignancies are oropharyngeal squamous cell carcinomawhich may be with or without keratinization. Other malignant neoplasms of oropharynx include: mucoepidermoid carcinoma, adenocarcinoma, lymphomas, fibrosarcoma, osteosarcoma, chondrosarcoma, and melanoma.
Oropharyngeal cancer diagnosing methods
In order to overcome any disease, especially cancer, diagnosis stage is extremely important. Examination should be quick and accurate. At Maimonides Medical Center, every patient can count on efficient and quick diagnosis. All our doctors have modern examination methods and accurately interpret received data. Error risk is minimal. And modern expert-class diagnostic equipment makes examination process comfortable and safe for patient.
The first and extremely important stage of diagnosis is a consultation with an oncologist. Specialist will carefully ask the patient about all complaints, collect medical and life anamnesis, determine whether a person has certain risk factors for oropharyngeal cancer, examine the patient in general (by organs and systems), palpate all groups of peripheral lymph nodes, conduct independently or together with ENT doctor different specific examinations that will help to suspect one or another oropharynx tumor.
Doctor will perform oropharyngoscopy (oral cavity and oropharynx examination), direct laryngoscopy (larynx examination), rhinoscopy (nasal cavity examination) to all patients. The examination is performed with the help of modern endoscopic equipment, which allows not only to conduct a direct test, but also to make photo and video recordings of findings on mucous membrane, as well as to perform a biopsy.
After biopsy we send all materials to the best pathohistological laboratories in the world (USA, Israel, Germany). Thanks to such double molecular checks, our doctors are absolutely sure of the diagnosis and selected treatment regimen effectiveness based on received data about the tumor.
Molecular diagnostics (molecular genetic research) is an integral part of malignant diseases modern diagnostics. The direct cause of many tumors is a mutation in a certain gene, due to which it begins to function incorrectly, and a cell with such mutation acquires signs of malignancy and ability to divide and grow uncontrollably. Thanks to molecular genetic diagnostics, we can find these mutations and choose the most effective therapy regimens, because the response to certain drugs effect depends on mutations type. An example of such modern diagnostics are test systems for molecular genetic testing. Such as Foundation One and Caris Molecular Testing. All patients of our clinic have the opportunity to provide these modern diagnostic tests.
All patients with oropharyngeal cancer suspicion are recommended to perform comprehensive clinical and biochemical blood tests,blood coagulation system studies , urinalysis, human papillomavirusHPV вірусу папіломи людини HPV 16 and 18 subtypes determination in biopsy specimens by PCR method.
As part of examination, an ECG (electrocardiography), chest X-ray , abdominal organs, kidneys, heart, and peripheral lymph nodes Ultrasound must be performed on each patient. In case of lymph node metastatic lesion suspicion, doctor will perform a puncture biopsy under ultrasound control.
After diagnosis histological confirmation, patient is subjected to an in-depth diagnosis in order to scan the entire body and detect metastatic lesions (if present). For this purpose, modern medical imaging methods are used – CT, MRI with contrast, bone scintigraphy, PET-CT or PET-MRI. Only after such a thorough examination, oncologist starts making up a treatment plan taking into account all obtained data at diagnostic stage.
Many innovative and modern diagnostic methods are used in our medical center. Their choice is oncologist prerogative, depending on clinical situation of each patient. All necessary diagnostic procedures can be performed directly in clinic, without leaving Ukraine.
Oropharyngeal cancer modern treatment
Oropharyngeal cancer is a serious disease, but it is completely curable with timely and correct diagnosis, modern treatment protocols and a comprehensive approach. Treatment plan always includes several methods that provide the best possible results for patient. It can be surgical tumor removal, radiation therapy, chemotherapy, targeted therapy, modern immunobiological drugs application and other treatment methods, depending on the need.
Surgery is increasingly used as primary treatment for oropharyngeal cancer. Transoral laser microsurgery (TLM) is a modern procedure used to resect tonsils tumors and tongue base using an endoscopic method. It allow to avoid complications typical of open surgery.
Transoral robotic surgery (TORH) is an innovative high-tech surgical procedure for certain oropharyngeal pathological changes treatment. During THOR, surgeon uses a console to control a surgical robot with multiple manipulators. The robot's articulated manipulators and endoscopic camera are inserted through patient's mouth (which is held open by a retractor). The robotic procedure provides better structures visualization and contributes to fewer surgical complications compared to open surgery. If THOR is performed in patients with late-stage tumors, postoperative radiation or chemo radiation therapy is often used additionally.
Radiation therapy, sometimes combined with chemotherapy (chemo radial therapy), may be used as initial treatment or after primary surgery. Traditionally, radiation is used to treat malignant tumors in early stages, and chemo radial therapy is used in case of late stages diseases.Intensity-modulated radiation therapy (IMRT) is increasingly being used as a way to preserve tissue surrounding and reduce long-term side effects. This is achieved thanks to modern and safe devices for radiation therapy – linear accelerators.
For oropharynx tumors, a contact radiation therapy method – brachytherapy is also actively used. At this case, radioactive material is placed in a special container (capsule, plate, etc.), which is placed directly in tumor tissue. In this way, radiation effect is localized precisely in pathological focus, while healthy surrounding tissues are almost not negatively affected.
Chemotherapy is used in combination with surgery and/or radiation therapy, and is almost never given alone. The therapeutic effect of these method is based on special anticancer drugs application (cytostatics), which inhibit malignant cells growth and division and destroy them. As a rule, for oropharyngeal cancer are used platinum drugs and taxanes.
With stage 3 and 4 cancer, modern immunobiological drugs and targeted drugs can be added to complex treatment together with chemotherapy or instead of it. The main advantage of this treatment is these drugs ability to affect only tumor cells, while healthy cells are not affected in any way. Targeted drugs production and certain immunobiological drugs is a high-tech process using genetic engineering and molecular genetic research. Often, such drugs are made individually for each patient, depending on tumor data obtained at the stage of molecular diagnosis from biopsy specimens (personalized oncology).
Also, all our patients have the opportunity to participate in clinical trials of experimental treatment methods. For some of them, this is the only chance for recovery, especially for those people for whom all available treatment methods have proven ineffective.