Diagnosing Oropharyngeal Cancer

NYU Langone doctors are experienced in recognizing and diagnosing oropharyngeal cancer, which develops in the oropharynx. This includes the back of the tongue, the tonsils, the soft palate—the spongy, flexible part of the roof of the mouth—and the sides and back wall of the throat.

The oropharynx assists with breathing and swallowing. It moves air from the nose and mouth to the throat and the windpipe, or trachea. It also moves food and liquid from the mouth to the throat and the esophagus, the muscular tube that transports food to the stomach.

The oropharynx also helps with speaking. The back third of the tongue and soft palate help produce speech sounds.

Oropharyngeal cancers most often arise from precancerous cells found in the mucosa, or lining, of the oropharynx. Precancerous cells, also called dysplasia, appear as white, red, or white and red patches. They are often detected during regular check-ups with a dentist or doctor.

The most common form of oropharyngeal cancer develops in squamous cells, the flat cells found in the mucosa. When squamous cells become cancerous, these cells can spread to the tissue below the mucosa. These are called squamous cell carcinomas.

Risk Factors

Smoking and drinking alcohol, especially when combined, increases the risk of developing oropharyngeal cancer and precancerous lesions. NYU Langone doctors encourage people who drink to do so in moderation and, if they smoke, to quit. Our Tobacco Cessation Programs provide you with the guidance and support you need.

Oropharyngeal cancers are also strongly associated with human papillomavirus, or HPV, infection. HPV is easily transmitted through sexual contact, usually vaginal, oral, and anal sex. There are ways to decrease your risk of contracting the virus.

Other risk factors include taking medications that suppress the immune system to prevent the body from rejecting a transplanted organ or to manage immune system conditions. A suppressed immune system may increase the likelihood of contracting HPV, and of being unable to fight the infection. Human immunodeficiency virus, or HIV, can also increase the risk.

Men are more likely than women to develop oropharyngeal cancer, possibly because they have higher rates of smoking, although this gap is closing. Risk also increases with age. Because oropharyngeal cancer may take years to develop, most people are older than age 55 when they are diagnosed. However, cancers associated with HPV may occur in people who are in their 30s and 40s.

Signs and Symptoms

Symptoms of oropharyngeal cancer can include persistent soreness on one side of the throat, where the condition may develop. You may also have difficulty swallowing or feel a lump, either in the back of your throat or toward the back of the mouth.

You may also notice a mass on the neck, which may be a swollen lymph node. Lymph nodes are small glands that produce and store lymphocytes, which are white blood cells that help fight infection. They are often the first place oropharyngeal cancer spreads. Oropharyngeal cancer may also cause ear pain, since the mass may press on nerves leading to the ear. Some people don’t experience any symptoms.

To help detect oropharyngeal cancer or precancerous cells as early as possible, NYU Langone doctors encourage screening during visits to a dentist or primary care doctor. People with suspicious findings should be referred to a head and neck cancer specialist for testing.

Diagnostic Tests

At NYU Langone, doctors examine the mouth and back of the throat and ask about your symptoms and medical history, including whether you smoke, drink alcohol, or have been exposed to HPV. If specialists suspect you have oropharyngeal cancer or a precancerous growth, they may perform several tests.

Biopsy

To diagnose oropharyngeal cancer, doctors perform a biopsy. After administering a local anesthetic, a doctor uses small surgical tools to take a tissue sample from a suspicious lesion. This procedure can usually be performed in the doctor’s office. A pathologist then examines the sample under a microscope for signs of cancer or precancerous growths.

If a mass in one of the tonsils cannot be easily sampled, the doctor may need to perform a tonsillectomy. During this procedure, the doctor removes the entire tonsil, so it can be examined under a microscope. This usually requires general anesthesia and is an outpatient procedure.

At NYU Langone, pathologists examine cancerous oropharyngeal tissue to determine whether it contains HPV. If the tissue tests positive, it may respond better to radiation therapy than a type of cancer that doesn’t involve HPV.

After a biopsy or tonsillectomy, you may experience soreness in the back of the mouth or throat or mild bleeding for several days.

Fine Needle Aspiration

Oropharyngeal cancer can spread to nearby lymph nodes, causing swelling and one or more neck masses. Doctors may perform fine needle aspiration, in which they insert a small needle into the mass to withdraw a sample of cells for examination under a microscope. Molecular testing for HPV can be performed on this tissue.

The doctor may use ultrasound, in which sound waves are used to identify structures in the neck, to guide the needle during this procedure.

CT Scans

If you receive a diagnosis of oropharyngeal cancer, your doctor may perform a CT scan, which creates two- or three-dimensional images of the body using X-rays and a computer.

A CT scan can help your doctor determine whether the cancer has spread to adjacent structures or nearby lymph nodes in the neck. The scan can also detect cancer in distant parts of the body, such as in the lungs or liver. A special dye may be injected into a vein in the arm to enhance the CT image.

PET/CT Scans

To help determine whether oropharyngeal cancer has spread throughout the body, your doctor may order a PET/CT scan, which combines CT scan technology with PET imaging. The PET portion of the scan requires an intravenous (IV) infusion of radioactive glucose, or sugar, into a vein. This substance collects in cancer cells, which are detected during the scan.

The CT scan provides detailed pictures of the body’s organs. The two images are then fused to provide doctors with useful and accurate information about the cancer.

PET/MRI Scans

This experimental technology combines PET and MRI scans to create detailed images of the body. Clinical trials at Perlmutter Cancer Center are evaluating whether this scan might provide a more detailed view of oropharyngeal cancer than other imaging methods and whether it may better help doctors determine if the cancer has spread to the lymph nodes or other parts of the body. Your doctor can discuss whether this clinical trial is right for you.