Oropharyngeal cancer
Anatomy
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- 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)
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- 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
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- 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
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- 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
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- 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