Oropharynx cancer

Abstract

Squamous cell carcinoma of the oropharynx is, without a doubt, the mucosal neoplasm of the head and neck in which more interesting changes have occurred in the last couple of decades. On the one hand the incidence of it is rising due to the increasing association of oropharyngeal neoplasms with the human papilloma virus. On the other hand, the treatment of oropharyngeal carcinoma (OPC) has evolved dramatically, from conventional surgery plus radiation to various combinations of radiation, chemotherapy, and biologically active agents, and now, again, to surgery done transorally with the laser or the robot. In this rapid evolution, a large amount of scientific material has been introduced in the literature. As a result, the clinician managing a patient with OPC can be easily overwhelmed by the volume and variety of information available. In this chapter, we endeavor to use typical clinical situations to help the reader navigate through the pertinent information a clinician needs, today, to make appropriate decisions in the diagnostic evaluation and management of a patient with OPC. The questions that must be answered in this process include whether or not a tumor should be tested for HPV, what is the most appropriate test to use, what are the implications of a positive test, and how to address the peculiar questions brought about by patients, relatives, or partners upon learning that their tumor is associated with a virus. Then, using common clinical situations, we present the best evidence in the literature to help the clinician decide which of the various modalities, available at this time for the treatment of OPC, is the best suited for a particular patient, both in terms of the management of the primary tumor and of the cervical lymph nodes.