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


RESULTS
The 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. The implications of this viral association with regard to outcomes and management strategies remain under investigation. Screening with toluidine blue, autofluorescence, or both may be useful adjuncts to physical examination and panendoscopy in assessing potentially invasive or dysplastic lesions of the oropharynx. These techniques remain under study. MRI and PET scan are proving to be useful techniques for assessing local extension, regional metastases, and recurrences of squamous cell carcinoma (SCC) of the oropharynx in selected cases. However, serial computed tomography scanning remains the imaging modality of choice in the United States. Early SCCs of the oropharynx (T1-2), in general, 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).


CONCLUSIONS
Management of SCC of the oropharynx is in a period of transition because of evolving changes in our understanding of the oncogenic process; evolving diagnostic techniques; and evolving combinations of therapies, both surgical and nonsurgical. For the time being, we propose using local subsite and disease stage to guide therapeutic decision-making.
Roswell Park Cancer Institute, Buffalo, New York 14226, USA.
David M
DM
Cohan
Saurin
S
Popat
Seth E
SE
Kaplan
Nestor
N
Rigual
Thom
T
Loree
Wesley L
WL
Hicks
D002294:Carcinoma, Squamous Cell / Q000175:diagnosis* / Q000453:epidemiology / Q000601:surgery*; D003131:Combined Modality Therapy; D006801:Humans; D015994:Incidence; D008279:Magnetic Resonance Imaging; D008339:Mandibular Neoplasms / Q000473:pathology; D037981:Neck Dissection; D009367:Neoplasm Staging; D009959:Oropharyngeal Neoplasms / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*; D009960:Oropharynx / Q000000981:diagnostic imaging / Q000378:metabolism / Q000473:pathology; D010160:Palate, Soft / Q000473:pathology; D030361:Papillomavirus Infections / Q000453:epidemiology / Q000821:virology; D049268:Positron-Emission Tomography; D014057:Tomography, X-Ray Computed; D014067:Tonsillar Neoplasms / Q000473:pathology