Dharamshila Narayana Superspeciality Hospital

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Oropharyngeal Cancer Treatment

Your treatment will depend on the stage and grade of your cancer as well as your general health. Your specialist will explain more about the most appropriate treatment for your cancer.

The usual treatments for oropharyngeal cancer include:

  • surgery
  • radiotherapy
  • chemotherapy
  • biological therapies

Your doctor will recommend the treatment that is likely to be the most successful in treating your cancer. They will also consider the side effects you’re likely to have and how treatment will affect your ability to speak and swallow. In early oropharyngeal cancer, both surgery and radiotherapy are equally effective. You’ll probably have radiotherapy if surgery is likely to seriously affect your speech and swallowing. Larger cancers are often treated with a combination of different treatments.

The following treatments can either be given separately or combined in a number of ways.

Radiotherapy

Radiotherapy treats cancer by using high-energy rays to destroy cancer cells, while doing as little harm as possible to normal tissue.

It is given from a radiotherapy machine, which is similar to an x-ray machine. Occasionally, a specialised radiotherapy technique is used called intensity-modulated radiotherapy (IMRT). With IMRT the radiotherapy beams are shaped very precisely to the area of cancer. This ensures that a higher dose of radiation is given to the tumour while healthy surrounding cells and nearby structures receive a lower dose of radiation. This can reduce the side effects of radiotherapy treatment, such as a dry mouth. IMRT is only available in some hospitals.

Radiotherapy can be given alone with the aim of curing a cancer (radical radiotherapy) or after surgery to reduce the risk of the cancer coming back (adjuvant therapy). It can also be used if the cancer comes back in someone who has had previous surgery (but no radiotherapy). Radiotherapy can be given together with chemotherapy (called chemoradiation). It can also be given to the lymph nodes in the neck.

Side effects

During radiotherapy the skin over your face and neck will usually redden or darken and become sore (like sunburn). This starts after about two weeks of treatment and may last for 2-4 weeks after treatment has finished. Sometimes your skin will peel or break. The radiotherapy team will tell you how to look after your skin.

Your mouth and throat will usually become sore and inflamed after a couple of weeks of treatment and you may develop some mouth ulcers. Your voice may also become hoarse. There may be changes to your sense of taste and smell.

Eating food can become difficult and swallowing can become painful. Your doctor can prescribe you some medicines to help improve this.

Occasionally, some people may need to have artificial feeding through a tube if they’re unable to eat and losing a lot of weight. A tube may be passed through the nose and into the stomach (nasogastric [NG] tube) or passed directly into the stomach. This is only done for a short time until treatment is finished and your swallowing is back to normal.

Radiotherapy to this area can cause the salivary glands to produce less saliva. The lining of the mouth and throat may become dry and this can make eating and speech difficult. There are artificial saliva sprays that can help make your mouth feel more comfortable. You can read more about this in our information on coping with a dry mouth.

Most of these side effects are usually temporary and will gradually improve once your treatment is over. However, many people continue to have problems with a dry mouth after their treatment is over.

Surgery

Surgery may also be used although radiotherapy, on its own or with chemotherapy is more commonly used. Surgery can also be used if the cancer comes back after previous radiotherapy or to relieve symptoms.

The length of time you spend in hospital will depend on the extent of the surgery you need. Your surgeon will explain more about this. People having more complicated surgery may be looked after in a high dependency unit/intensive care for a while after their operation.

The surgeon will usually make a cut (incision) in your neck or jawbone to remove the cancer. The amount of tissue removed will depend on the size of the cancer as well as where it is. Your surgeon will also try to remove a section of normal tissue free of cancer cells. This is known as a clear margin and helps reduce the chance of the cancer coming back. You may also have some of the lymph nodes in your neck removed (called a neck dissection).

Some people may need to have larger operations that involve removing part of their jawbone or tongue. This will be done by a specialist head and neck surgeon. The surgery will involve rebuilding the area using tissue, skin or bone taken from somewhere else in the body. People having this type of surgery may need to stay in hospital for up to a few weeks.

Side effects

These depend on the type and extent of surgery that you have. They may affect your speech, swallowing or your sense of taste and smell. Some people may have a change in their appearance.

You will usually see a dietitian and speech therapist after the operation. They will help you cope with some of these changes.

Chemotherapy

Chemotherapy is the use of anti-cancer (cytotoxic) drugs to destroy cancer cells. Chemotherapy may be given:

before radiotherapy or (rarely) before surgery at the same time as radiotherapy (chemoradiation) after radiotherapy or surgery (adjuvant chemotherapy) if the cancer has spread to other parts of the body.

Chemoradiation may be used instead of surgery if the cancer has spread from where it started to areas nearby (locally advanced). This can avoid the effects on speech and swallowing that surgery may cause. It’s important that someone is fit enough to cope with having the two treatments. The side effects, particularly a sore skin and mouth, are worse when chemotherapy and radiotherapy are given together.

Biological therapy

Biological therapies use substances that are produced naturally in the body to destroy cancer cells. There are several types of biological therapy that may be used to treat head and neck cancers. These include monoclonal antibodies and cancer growth inhibitors. Biological therapies are mainly given as part of cancer research trials.

Monoclonal antibodies

Monoclonal antibodies are drugs that attach themselves to proteins (receptors) found in particular cancers.

Some cancer cells have special types of receptors known as epidermal growth factor receptors (EGFRs). When chemical messengers in the body called growth factors attach to these receptors, the cancer cells are stimulated to grow and divide. Monoclonal antibodies can stop the cancer cells from growing by locking onto these receptors. They may also make the cancer cells more sensitive to the effects of radiotherapy and chemotherapy.

Cancer growth inhibitors In order to grow and divide, cancer cells ′communicate′ with each other using chemical signals. Cancer growth inhibitors interfere with this process, affecting the cancer′s ability to develop. Cancer growth inhibitors, have been used in trials to treat some types of head and neck cancer, including oropharyngeal cancers that have come back after initial treatment. It′s still not known how effective these drugs area because trials are still being carried out.

Follow-up

After your treatment is completed, you will have regular check-ups and possibly scans or x-rays. These will probably continue for several years. If you have any problems or notice any new symptoms between these times, let your GP or hospital doctor know as soon as possible.

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