Oropharyngeal cancer

The oropharyngeal ( German, hardly common translation: oropharyngeal cancer) is a cancer of the oropharynx ( pars oralis of the pharynx, oropharynx or mesopharynx called ). Together with the hypopharyngeal and nasopharyngeal carcinoma the oropharyngeal belongs to the group of revenge cancers ( of the pharynx ), which in turn belong to the class of head and neck tumors. There usually are squamous cell carcinomas. In addition there occur malignant lymphoma, adenoid cystic carcinomas and adenocarcinomas, as well as Mukodermoidkarzinome.

Oropharynx

For oropharynx include the areas from the soft part of the palate, the tonsils and base of the tongue (the area where the tongue has grown ). Most common are the tonsils of carcinogenesis affected ( Tonsillenkarzinom ).

Epidemiology

The incidence of oropharyngeal carcinomas is between 0.5 and 2 per 100,000 inhabitants and year. Here men are affected about three to four times as often as women. The disease usually breaks out between the sixtieth and seventieth year.

Etiology

In the development of oropharyngeal lifestyle, environmental and genetic factors play a major role.

Most patients with oropharyngeal were for many years carcinogenic, that is exposed to carcinogenic substances ( exposed). For tobacco use in the form of cigarettes, pipe tobacco and cigars, there is a direct dose -response relationship. You can the risk of cancer in the neck and throat area increase significantly. So 85 percent of patients suffering from head and neck cancer patients, an increased consumption of alcohol and tobacco could be detected.

Specifically, alcohol abuse is a cofactor in the formation of a Oropharynxkarzinoms dar. The mechanism of action of alcohol is not yet fully understood. Various models are discussed at the time: a collection of carcinogens to the mucous membranes and systemic effects of alcohol abuse, such as general immune deficiency and liver injury. Outside Europe, the consumption of chewing tobacco still plays a significant role in the development of oropharyngeal carcinomas.

Whether poor oral hygiene or poor fitting dentures have an influence in the development of a Oropharynxkarzinoms, has not yet been demonstrated.

Obviously there is also a connection with infection with the HPV virus. A case-control study found in patients who were suffering from an oropharyngeal, significantly more often a previous infection with HPV ( type 16 and others) in comparison to non-diseased control group. The relationship was independent of alcohol or tobacco use. The study concludes that an HPV infection " highly associated with the occurrence of a Oropharynxkarzinoms in patients with or without known risk factors of tobacco and alcohol consumption. "

Diagnosis

Oropharyngeal can already be diagnosed by a mirror examination often. As a rule, in addition there is a panendoscopy the entire pharynx with general anesthesia. The patient is thereby taken by biopsy, small tissue samples are examined cellular level to confirm the diagnosis.

Imaging techniques such as sonography for tumor staging and therapy planning (ultrasound), computed tomography (CT) or magnetic resonance imaging ( MRI), are used. While sonography provides a good overview of a possible infestation of the lymph nodes, the tumor extent can the other two imaging modalities determined in the depth and infiltration of other structures such as ' eg the neck vessels are examined. To screen for distant metastases an X-ray or CT scan of the lung as well as an ultrasound of the liver are usually made. For the exclusion of metastases in bone scintigraphy can be performed.

An oropharyngeal classified the tumor diameter at its greatest spread as follows:

  • T1 tumor of 2 cm or less
  • T2 tumor greater than 2 cm but not greater than 4 cm
  • T3 tumor larger than 4 cm in its greatest extent
  • T4 tumor infiltration into surrounding structures such as bone, soft tissues of neck or deep tongue muscles, regardless of tumor size

Neither diagnosis nor exclusion are possible via a blood test.

Therapy

For the therapy of a Oropharynxkarzinoms the location of the tumor is crucial. For cancers of the tonsils ( tonsils ) are operated in the first place. For larger tumors occurs sometimes radiotherapy. In the palate or tongue carcinoma high-dose radiation therapy is often the treatment of choice. It is usually five times a week over a period of seven weeks. The effectiveness of the treatment is significantly increased even further by a chemotherapy.

For the treatment of regional lymph nodes different forms of surgical dissection and en bloc resection are applied.

Forecast

The prognosis is mainly determined by the behavior of the tumor metastasis. With appropriate treatment, the following average five-year survival rates are achieved:

  • Stage I: 90%
  • Stage II: 75 %
  • Stage III: 45 to 75%
  • Stage IV: <35%

Patients over 70 years have a better survival rate than younger patients.

Squamous-cell carcinoma History of tobacco Medical diagnosis Medical imaging
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