Let's learn about oropharyngeal cancer. It's important for you to know these things!

You may also experience a sore throat, a change in your voice, or difficulty swallowing, right? We often ignore these minor symptoms. We think it's just a cold or a sore throat. However, sometimes these seemingly normal symptoms can be caused by something more serious. Today we're going to talk about a topic that requires a little more thought. That is ``Oropharynegal Cancer,'' a cancer that occurs in the middle of the throat, at the back of our mouth, where the throat begins. Don't be afraid, the most important thing is to be aware of this.

What is this cancer in the middle part of the throat (Oropharyngeal Cancer)?

Simply put, `Oropharyngeal Cancer` is a cancer that develops when cells in the middle part of your throat, called the `Oropharynx` , grow abnormally and become cancerous. The `Oropharynx` includes the back of your mouth, the base of your tongue, the tonsils, and the soft palate at the top of your throat. This area produces saliva, keeps your mouth and throat moist, and helps you digest the food you eat. Doctors have various ways to treat this cancer. However, sometimes it can `recur` after treatment. Although this cancer cannot be completely prevented, you can reduce your risk of developing it by taking care of some things. For example, it is very important to protect yourself from the `Human Papillomavirus (HPV)` virus, not smoking, and controlling alcohol consumption.

How common is this condition?

In fact, `Oropharyngeal Cancer` is a relatively rare type of cancer. For example, according to the American Cancer Society, about 53,000 people in the United States are diagnosed with this cancer every year. However, if we take breast cancer, it affects more than 290,000 people every year. So, compared to that, this is a little low. This condition is also diagnosed in Sri Lanka, but it is not that common compared to other types of cancer.

Are there different types of `Oropharyngeal Cancer`?

Yes, there are mainly several types of this.

• Tonsil cancer is the most common type of cancer.
• In addition, these cancers can also occur in the gums, floor of the mouth, and other parts of the oropharynx.

What are the symptoms of `Ophoryngeal Cancer`?

This is very important, because the symptoms of this cancer can sometimes be similar to the symptoms of other minor conditions. Therefore, it is very important to be aware of this.

• Persistent sore throat (` Pharyngitis` ) : A sore throat that does not get better.
• Difficulty or pain in swallowing (`Dysphagia : A feeling of being unable to swallow food.
• Difficulty opening the mouth completely (`Trismus`) or difficulty moving the tongue.
• Unexplained weight loss : If you lose weight without trying.
• Voice changes : A hoarseness or change in the voice that does not improve.
• Earache : A persistent, unrelenting earache (especially on one side).
• A lump in the back of the throat or in the mouth : A lump that you can feel or see.
• A lump in the neck : A swelling or lump in the neck.
• Coughing up blood .
• A white spot on the tongue or inside the mouth : If the spot does not go away after some time.

Important: If you have one or more of these symptoms, don't worry, it's definitely cancer. However, if these symptoms persist for more than two weeks, you should definitely see a doctor for advice.

What are the causes of `Ophoryngeal Cancer`?

There are several main reasons for the development of this cancer.

• Human Papillomavirus ( HPV ) infection : This is the main cause that has been identified. The HPV virus affects the genes that control the growth of cells in our mouth and throat. This can cause the cells to grow rapidly and become cancerous, or tumors.
• Tobacco use : Smoking cigarettes, cigars, and chewing tobacco can damage the cells in your throat. This damage causes the cells to divide more than normal. This increases the chances of DNA errors, which can lead to the development of cancer cells.
• Alcohol : Drinking alcohol can damage the cells in your throat and affect your ability to repair DNA. Drinking alcohol while smoking increases the risk even more.

What are the risk factors for developing `Oropharyngeal Cancer`?

There are several factors that increase the risk of developing this cancer:

• HPV infection , especially HPV type 16.
• Having a history of using cigarettes and other tobacco products.
• Excessive alcohol consumption.
• If you have previously had head or neck cancer.
• If you have had radiation therapy to the head or neck area.

How do doctors diagnose Oropharyngeal Cancer?

When you go to see a doctor, he or she will first ask you about your symptoms, your medical history (such as whether you have had cancer in the past, whether you have had radiation therapy), and your lifestyle (such as whether you smoke or drink alcohol). Then, they will carefully examine your mouth, throat, and neck. They will also feel for any lumps in your neck. Sometimes, they may use a mirror, a light, or a thin tube with a camera (a `fiberoptic scope`) to examine the inside of your mouth and throat.

What kind of tests are done for this?

Doctors can perform several tests to confirm the disease:

• Endoscopic Biopsy : This involves inserting a thin, flexible tube (endoscope) through the mouth, using a small camera at the end to take a small piece of tissue from the suspicious area. The tissue is then examined under a microscope in a laboratory to see if there are cancer cells or HPV infection.
• `Computed Tomography (CT) Scan` : This `CT` scan can measure the size of the cancer and see if it has spread to other areas. Sometimes this can be done in conjunction with a `Positron Emission Tomography (PET) Scan`.
• Magnetic Resonance Imaging (MRI) Scan : This MRI scan can produce detailed images of the body's soft tissues, especially the tonsils and the base of the tongue. This can also help determine the size of the tumor.

Are there stages of `Oropharyngeal Cancer`?

Yes, absolutely. Doctors plan treatment and give an idea of ​​the prognosis based on the stage of the cancer (Cancer Staging). There are four main stages of Oropharyngeal Cancer (Stage I to IV). These stages may vary slightly depending on whether you have HPV infection or not. In addition, the size of the tumor, whether it has spread to nearby lymph nodes, or to distant parts of the body, also play a role in determining the stage.

How is `Oropharyngeal Cancer` treated?

Doctors mainly use methods such as surgery, radiation therapy, chemotherapy, targeted drug therapy, or immunotherapy to treat this cancer. Their main goal is to remove the cancer cells in a way that affects your ability to speak and swallow as little as possible.

Surgery

If the cancer is small and has not spread to other areas, it can be removed surgically.

• `Transoral Robotic Surgery (TORS)`: This is a new, minimally invasive surgical procedure performed through the mouth. It can remove cancers deep in the throat, in places that are difficult to reach. Because it uses robotic technology, there is no need to make a large incision in the neck or to remove the uvula. It also usually does not require a `tracheostomy` (insertion of a breathing tube).
• Advantages of `TORS`:
• The hospital stay after surgery is short.
• You can recover quickly.
• There is less damage to surrounding tissues and muscles that help with swallowing.
• There are fewer long-term problems with speaking and swallowing.
• Side effects/complications of `TORS`:
• Abnormal bleeding (`Hemorrhage`).
• Food or liquids getting into the lungs (`Aspiration`).
• Inability to get enough oxygen to the lungs (Respiratory Compromise).
• Difficulty swallowing (Dysphagia).
• Difficulty chewing food.
• Permanent loss of voice or difficulty speaking.
• Need for a tracheostomy due to difficulty breathing.
• Changes in facial appearance.

Some people may need additional treatments after TORS surgery, such as reconstructive surgery, speech therapy, or nutritional therapy, to manage side effects.

Chemotherapy

Your doctor may give chemotherapy alone or with radiation therapy. In cases where surgery is not possible, for example if the cancer is too large to be removed surgically, these two treatments may be given together. Also:

• If the cancer has spread from the oropharynx to other parts of the body.
• Crush the tumor before surgery.
• This treatment is also used to destroy any cancer cells that may remain after surgery.
• Side effects of chemotherapy and radiation therapy: When these two treatments are given together, your ability to speak may be affected. This is because radiation therapy to the throat can damage healthy tissue, making it difficult to speak and swallow. This may require special therapy.

Targeted Therapy

These are special proteins made in the lab (monoclonal antibodies). These treatments work by blocking a protein that helps cancer cells divide, grow, and spread.

• Side effects: These vary depending on the type of medication. For example, common side effects of the drug `Cetuximab` may include:
• Signs of infection such as fever and chills.
• Skin irritation, itching.
• Dizziness.
• Dry mouth.
• Indigestion.
• Skin and nail changes.

Immunotherapy

This is a first-line treatment if the cancer comes back or has spread. Immunotherapy works by helping your own immune system find and destroy cancer cells. Pembrolizumab (Keytruda®) and Nivolumab (Opdivo®) are two such drugs.

• Side effects:Most of the time, the side effects are minor.
• Fatigue.
• Itchy rash.
• Diarrhea.
• Nausea and vomiting.

Can Oropharyngeal Cancer be prevented?

Although it can't be completely prevented, there are things you can do to reduce your risk:

• Avoid getting infected with the Human Papillomavirus (HPV). Having multiple sexual partners and/or engaging in oral sex increases your risk of getting HPV. Ask your doctor about the HPV vaccine.
• Don't start smoking. If you smoke, stop. Continuing to smoke greatly increases your risk of developing a second cancer of the mouth, throat, larynx, or lungs. Ask your doctor for help quitting.
• Do not drink alcohol frequently or in large quantities. Alcohol increases the carcinogenic effects of tobacco. Therefore, it is very important to avoid using the two together.
• Eat a healthy, balanced diet. Exercise regularly.
• See your doctor and dentist on a regular schedule. They can examine your mouth and throat and detect any changes early.

What happens if I have this condition?

If you have oropharyngeal cancer, you will need to have regular follow-up examinations to check for recurrence or new cancers. If you drink alcohol or smoke, talk to your doctor about quitting. Smoking and alcohol use increase the risk of cancer coming back or developing a new cancer.

Can `Oropharyngeal Cancer` be cured?

Doctors can treat this cancer. However, it can come back even after successful treatment. According to the American Cancer Society, about 70% of people with oropharyngeal cancer are still alive five years after diagnosis. Doctors have identified several factors that affect the course of the disease:

• Like most cancers, outcomes are better if the cancer is detected and treated before it spreads.
• People who develop cancer due to HPV infection have better outcomes than those who do not have the virus.
• People who don't use tobacco get better results than those who do.

How do I take care of myself?

The best way you can take care of yourself is to:

• Avoid tobacco. If you smoke, try to quit.
• Avoid alcohol.
• If you have HPV, talk to your doctor about getting a vaccine to protect against new infections.
• Ask for help. Your treatment may make it difficult to speak or eat. However, there are special therapies and programs to help manage these side effects.
• See the doctor often.Monitor your overall health and whether the cancer has recurred.

When should I see a doctor? When should I go to the emergency room?

It is very important to see your doctor regularly after treatment. You may need to have regular check-ups for the rest of your life. Typically, you will be asked to have check-ups every 6-12 weeks for the first year after treatment, every 3 months for the second year, every 3-4 months for the third year, and then every 6 months after that. If you have had surgery to remove cancerous tumors, you should go to the emergency room right away if you have any signs of infection . These signs include:

• Fever.
• If the surgical site is red and painful.
• If there is pus-like fluid coming from the surgical site.

What questions should I ask my doctor?

You can ask these questions when you visit the doctor:

• Where exactly is my cancer?
• Has my cancer spread? What stage is it in? What does that mean?
• What other tests do I need to do?
• Who are the doctors on my treatment team?
• Is my cancer related to Human Papillomavirus (HPV)?
• What changes do I need to make in my lifestyle?
• What is my treatment plan? What are all my options?
• What are the chances of my disease being cured?
• What are the side effects of the treatment?
• What happens if the cancer comes back? What are my options?

Is ``Oropharyngeal Cancer'' the same as ``Oral Cancer''?

No. Although they are both types of head and neck cancer, they are different.

• Oral cancer is cancer that develops in your mouth or oral cavity. It can occur on the front of your tongue, inside your cheeks, in the front of your roof of your mouth, and on the floor of your mouth.
• Oropharyngeal Cancer is a cancer that develops in your oropharynx, which includes the tonsils, back of the tongue, soft palate, sides and back of the throat. These are formed from the squamous cells that line the surface of the mouth and throat.

Oropharyngeal cancer is a relatively rare type of head and neck cancer. Although doctors can treat it, it can come back after treatment. Most often, this cancer is caused by exposure to the Human Papillomavirus (HPV). People who use tobacco and drink alcohol are also at higher risk of developing this cancer.

Take-Home Message

Okay, so let's remind you of some important points from what we've talked about.

• Oropharyngeal cancer is a cancer that occurs in the middle part of the throat. HPV infection, smoking, and alcohol use are the main risk factors.
• Persistent sore throat, difficulty swallowing, changes in voice, lumps in the neckBe aware of symptoms such as: If these persist for more than two weeks, seek medical advice.
• There are several treatment options. Early detection is very important.
• The risk can be reduced by things like the HPV vaccine, avoiding smoking, and excessive alcohol consumption.
• If you have a condition like this or have any doubts, don't be afraid to see a doctor and talk to them. They will help you.

Remember, awareness is the best defense. It's worth taking care of your health.