Recently, there has been a marked decrease in the incidence of oropharyngeal cancer associated with smoking, but there has been an increase in the number of cases of cancer associated with HPV, which may be explained by a decrease in the number of smokers and the development of sexual practices.
HPV + oncology can occur at an earlier age and has better survival at any stage than HPV- cancer.
The oropharynx consists of soft palatine tonsils, almond posts, the base of the tongue (lingual tonsils, posterior papules) and the pharynx wall.
Anatomical boundaries: upper plane above the soft palate; the lower plane of the superior hyoid bone (or the bottom of the valve).
There is a very important lymphatic drainage section in this area.
Oropharyngeal cancer can be treated both surgically and with modern radiotherapy. However, exclusive first-line radiosurgery is performed only for small tumors. Simultaneous chemotherapy is carried out using the drug - cisplatin 100 mg / m2 every 3 weeks.
The second treatment option is cetuximab. Induction chemotherapy is not effective in the treatment of this type of cancer.
Tonsil lesions may require radical tonsillectomy, often with partial mandibulectomy. Tumors at the base of the tongue require partial or complete glossectomy and reconstruction of the myocutaneous flap. Generally, for locally advanced oropharyngeal cancer, the preservation of organs using radiosurgery or chemotherapy is often preferred. Complete treatment of the cervical lymph nodes is usually performed in the case of partial or radical surgery, depending on the stage and how much they may be affected. The total dose of delivered radiation is 70 Gy in 33–35 sessions aimed at the tumor and pathological lymph nodes, once a day, five times a week. A total dose of 45-50 Gy is delivered to risk areas (mucous membranes and risk areas, tissues around pathological ganglia and tumors).