Oropharyngeal cancer

Oropharyngeal cancer

Anatomy

    • The nasopharynx passes into the oropharynx at the level of the palate
    • The oropharynx is bounded in front by the free edge of the soft palate, below by the epiglottis; in front – anterior palatine arch
    • The oropharynx includes the soft palate, tonsils of the pharynx, the posterior and lateral walls of the pharynx, the base of the tongue
    • The peripharyngeal space is an area of ​​early spread of oropharyngeal cancer. Glossopharyngeal, lingual and inferior alveolar nerves, internal maxillary artery pass through this space.
    • Lymph from the oropharynx flows into the anterior cervical lymph nodes
    • Tumors of the soft palate, the lateral wall of the oropharynx, and the base of the tongue metastasize to the retropharyngeal and intrapharyngeal lymph nodes
    • Tumors of the retromolar triangle area can affect the submaxillary lymph nodes.

Risk factors – smoking, alcohol, ionizing radiation, immune damage.

TNM classification (see also Tumor, staging)

    • Tis – carcinoma in situ
    • T, – formation up to 2 cm in size along the greatest length
    • T2 – tumor 2-4 cm in size along the largest diameter
    • T3 – tumor lesion larger than 4 cm
    • T4 – tumor larger than 4 cm with growth into the bone and / or soft tissues of the neck, root of the tongue.

Clinical assessment

    • Symptoms
    • Sore throat often accompanies ear pain on the affected side (radiates along the tympanic branch of the glossopharyngeal nerve)
    • Subjective sensation of sore throat, difficulty in moving the tongue (hot potato voice), dysphagia, and bleeding from the mouth
    • exhaustion
    • Enlarged cervical lymph nodes. Lymph nodes are affected by metastases in 76% of patients with cancer of the base of the tongue and in 60% of those with cancer of the tonsils.
    • During the initial examination, the tonsils and the base of the tongue will need to be carefully palpated.
    • Diagnosis is often late, because in the early stages of the disease (before pronounced tumor growth and ulceration), the course is asymptomatic. A diagnostic biopsy is necessary for a correct diagnosis.

Treatment

    • For stages T and T2, radiation therapy is indicated
    • With metastatic lesions of the lymph nodes, combined treatment is indicated.
    • The most common type of surgery is complex resection (jaw-neck method)
    • Tumor removal, radical cervical lymphadenectomy and mandibular resection
    • Tracheostomy
    • Laryngectomy in the following cases
    • Tumor invasion into the preepiglottic space
    • The need to remove the base of the tongue and hypoglossal nerves.

The prognosis depends on the period of diagnosis

    • For tonsil cancer, the 5-year survival rate ranges from 63% in stage T to 21% in stage T4
    • Patients with cancer of the base of the tongue have a 5-year survival rate of 40-60% in stage T, and 10-20% in stage T4.
    • In patients with tumors of the palate, the 5-year survival rate is 20-77%
    • The presence of metastases in the lymph nodes reduces the 5-year survival rate.

See also Tumor, radiotherapy, Tumor, markers; Tumor,

methods of treatment; Tumor, stages

ICD. C10 Malignant neoplasm of oropharynx

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