Introduction:
Cancer is one of the leading causes of death in developed nations, that have caused over ten million deaths in recent years. It is characterized by the uncontrolled growth of cells in any part of the body. The cell mass can spread into any part of the body or invade nearby tissues. Cancer is caused due to alterations in the genes that control the cell cycle (a series of events that take place in the cell during its growth and division). Common sites of cancer growth include the breast, colon, rectum, and prostate. The development of oral and pharyngeal cancer is also quite common. Pharyngeal cancer is also called throat cancer, and it is a type of head and neck cancer.
What Are Oropharyngeal and Pharyngeal Carcinomas?
Oropharyngeal and pharyngeal carcinoma is cancer that develops in the middle part of the throat behind the mouth. Cancer originates from the backside of the tongue, around the tonsils, the roof of the mouth (palate), and the sides of the throat. More than 90 % of oropharyngeal cancers develop from the flat cells that line the oral and throat mucosa.
What Causes Oropharyngeal and Pharyngeal Carcinoma?
The exact mechanism of cancer origin is not known. However, several risk factors can potentially alter the genes responsible for the cell cycle.
These include:
A. Smoking and Tobacco Abuse: A history of chronic smoking and tobacco use is harmful to the oral cavity and pharynx cells. The chemicals present in cigarettes (Nicotine, Ammonia, Benzene, etc.) cause molecular alterations in the genes leading to uncoordinated and uncontrolled growth of cells.
B. Chronic Alcoholism: Alcohol causes a synergistic effect along with smoking. It causes liver damage, nutritional deficiency, and immunosuppressive effects. All these factors increase the risk of cancer development.
C. Infections: Infectious diseases like candidiasis and HPV (human papillomavirus) release molecules (carcinogens) that alter tumor-suppressing genes like p53 and thus play a potential role in oropharyngeal cancers.
D. Betel Quid Chewing: Chemicals in the areca nut render the mucosa sensitive to carcinogens resulting in cancerous transformation. It is common in South Asian countries.
E. History of Head and Neck Cancer: People genetically susceptible and with a previous history of head and neck radiation or cancer are at risk.
What Are the Symptoms of Oropharyngeal and Pharyngeal Carcinoma?
The signs and symptoms are general and not specific to the disease. Initially, oropharyngeal cancer can be asymptomatic. Progressive cancer shows a variety of symptoms.
These include:
1. Discomfort in the mouth and throat.
2. Feeling of mass or a lump in the oropharyngeal region.
3. Trouble and pain while swallowing food or drinking water.
4. Inability to move the tongue.
5. Inability to open the mouth.
6. Pain in the ears.
7. Unexplained weight loss.
8. Changes in speech, such as slurring or lack of clarity.
9. Blood while coughing.
10. Numbness in different parts of the mouth.
11. Red or white patches in mouth and throat.
12. Non healing ulcer and loss of function.
Other Uncommon Symptoms Include:
1. Occasional or persistent headaches.
2. Feeling of a congested nose.
3. Pain in the facial region.
4. Bleeding from the nose (epistaxis).
5. Changes in hearing and ringing sensation in the ears or tinnitus.
How Is Oropharyngeal and Pharyngeal Carcinoma Diagnosed?
The diagnosis can be established after the investigation and screening of cancer.
Investigations and Screening:
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Includes chair side and clinical examination and understanding of the medical history.
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Imaging techniques involving panoramic radiographs, CT (computed tomography), MRI (magnetic resonance imaging), PET (positron emission tomography), and USG (ultrasonography) are routinely used.
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A biopsy is taken from the site for microscopic examination.
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Blood investigation to detect tumor and genetic markers.
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Advanced chemiluminescence or fluorescence spectroscopy for early detection and screening.
What Is the Treatment for Oropharyngeal and Pharyngeal Carcinoma?
Treatment mainly depends on the extent of the lesion, age, health, and other general patient factors. The ultimate goal of the treatment is to:
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Cure cancer and destruction of malignant cells.
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Preserve and restore the form and function of the structures.
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Prevent the recurrence of the tumor.
The Available Treatment Options (Individual or Combination) Include:
A. Surgery: Surgery is preferred when the tumors lack sensitivity to radiation and involve bone. Surgery is combined with other treatment modalities when there is a chance of cancer cells being left behind after the surgery or when the tumor has invaded the local structures. Recurrent tumors in areas that have previously received radiotherapy must be surgically excised.
B. Radiotherapy: Radiotherapy is usually preferred after surgery when there is an estimated risk of recurrence. If the tumor is in the advanced stage, radiotherapy is the treatment of choice. Radiotherapy gives good cosmetic outcomes compared to surgery.
C. Chemotherapy: It is an adjuvant given after surgery or radiation therapy. It shrinks the tumor and is less invasive. It has several complications, such as hair loss, mouth sores, diarrhea, low blood count, etc.
What Is the Outcome After the Treatment of Oropharyngeal and Pharyngeal Carcinoma?
The recovery after treatment depends on several factors like age, general health of the patient, and the extent of the cancer. Tumors associated with HPV infections (an infection that causes the formation of warts in different body parts) have a satisfactory recovery rate. The survival rate for oropharyngeal cancer is up to 70 %. Additionally, habits like smoking and alcoholism increase the chance of recurrence.
Conclusion:
Oropharyngeal cancer and pharyngeal carcinoma is cancer that develops behind the oral cavity and on the sides of the neck. It is a type of head and neck cancer, and the majority of these cancers originate from squamous cells. Symptoms of oropharyngeal cancer include a feeling of a lump in the neck, difficult and painful swallowing, blood while coughing, loss of function of the oral structures, etc. The treatment option depends on patient factors and the extent of the cancer. Overall, the survival rate for oropharyngeal cancer is estimated to be 70 %.
