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Oropharyngeal cancer: current understanding and management
Current Opinion in Otolaryngology and Head & Neck Surgery, 05/01/09

Cohan DM et al. - In a review of the current understanding and management of oropharyngeal cancer, it seems that management of squamous cell carcinoma (SCC) of the oropharynx is in a period of transition because of evolving changes in the understanding of the oncogenic process; evolving diagnostic techniques; and evolving combinations of therapies, both surgical and nonsurgical. For the time being, using local subsite and disease stage to guide therapeutic decision-making was proposed.

Methods

The goals of this article are: to review oropharyngeal anatomy; provide a review of epidemiology of oropharyngeal cancer in the Western Hemisphere; review the literature on the association of human papilloma virus with oropharyngeal cancer; review the literature on evolving diagnostic techniques for oropharyngeal cancer; and summarize accepted management strategies for oropharyngeal cancer by subsite.

Results

Incidence of oropharyngeal cancer may be increasing among younger age groups in the Western Hemisphere, and this may be related to an increased association with human papillomavirus 16.
Implications of this viral association with regard to outcomes and management strategies remain under investigation.
Screening with toluidine blue, autofluorescence, or both may be a useful adjunct to physical examination and panendoscopy in assessing potentially invasive or dysplastic lesions of the oropharynx.
MRI and PET scan are proving to be useful techniques for assessing local extension, regional metastases, and recurrences of SCC of the oropharynx in selected cases, but serial computed tomography scanning remains the imaging modality of choice in the US.
Early SCCs of the oropharynx (T1-2) may be managed effectively with either surgery or primary irradiation, though, with either technique, clinicians must have a management plan for the neck.
Advanced SCCs of the oropharynx (T3-4, nodally aggressive, or both) require multimodal approaches consisting of either surgery along with adjuvant irradiation or concurrent chemoradiation along with salvage surgery (as necessary).

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