Treatments for advanced stage oropharyngeal cancer

The following are treatment options for advanced stage (stages 3 and 4) oropharyngeal cancer. Your healthcare team will suggest treatments based on your needs and work with you to develop a treatment plan.

Treatment options for advanced stage oropharyngeal cancer depend on whether or not your healthcare team think the entire tumour can be removed safely with surgery. If it can’t be removed with surgery, your healthcare team will try to determine which treatment option will give you the best chance of being cured and the best chance of functioning well after treatment. They will consider the location of the cancer, how far it has spread, the expected side effects of each treatment and your overall health.

If the cancer can’t be completely removed by any one treatment, then a combination of these treatments may be used to relieve symptoms and improve survival.

Surgery is a main treatment for advanced stage oropharyngeal cancer. It is used to remove the tumour along with a margin of healthy tissue around it.

The type of surgery you have will depend on where the cancer started and how far it has spread. Surgery may include:

• surgical resection
• transoral resection - transoral robotic surgery (TORS) or transoral laser microsurgery (TLM)
• tonsillectomy to remove the tonsils
• glossectomy to remove part or all of the tongue
• mandibulectomy to remove part of the lower jawbone (mandible)
• maxillectomy to remove part of the upper jawbone (maxilla)
• laryngectomy to remove part or all of the larynx (voice box)
• palatal resection to remove part of the soft palate
• neck dissection to remove lymph nodes in the neck (cervical lymph nodes)
• salvage surgery to remove cancer that remains after chemoradiation or radiation therapy
• reconstructive surgery to maintain as much of the look and function of the mouth and neck as possible

When a neck dissection is done as part of surgery to remove the tumour, it is followed by chemoradiation or radiation therapy. A neck dissection may also be done after radiation therapy or chemoradiation if cancer is still in the lymph nodes. This is called adjuvant therapy.

Other surgical procedures may be done to help with breathing and nutrition. These include:

• placement of a feeding tube (usually with a gastrostomy) to make sure you get enough nutrients
• placement of a breathing tube (called a tracheostomy) to help you breathe

Chemoradiation is a main treatment for advanced stage oropharyngeal cancer. In chemoradiation, chemotherapy is given during the same time period as radiation therapy. The chemotherapy makes the radiation more effective.

For advanced stage oropharyngeal cancer, cisplatin is usually the chemotherapy drug given along with radiation to the tumour and lymph nodes on both sides of the neck.

If chemoradiation therapy is used as a main treatment, you will need to have surgery if the cancer comes back. This is called salvage surgery. Salvage surgery is used because the same area can’t be treated with radiation therapy again.

External radiation therapy is a main treatment for advanced stage oropharyngeal cancer. It may be given alone as the main treatment or after surgery to remove the tumour (called adjuvant radiation therapy). Radiation therapy for advanced oropharyngeal cancer is usually given as part of chemoradiation.

Intensity-modulated radiation therapy (IMRT) is a specialized type of external radiation therapy. It may be used to lessen the damage to tissues around the tumour.

Radiation is given to the tumour in the oropharynx and lymph nodes in the neck. Where the radiation is given depends on where the tumour started and where the cancer has spread (metastasized).

Cancer in the tonsil is treated with radiation to the tumour and tissue around the tumour. Radiation is also given to the lymph nodes on the same side of the neck as the tumour or on both sides of the neck.

Cancer in the base of the tongue or the soft palate is treated with radiation to the tumour, tissue around the tumour and lymph nodes on both sides of the neck.

If radiation therapy is used as a main treatment, you will need to have surgery if the cancer comes back. This is called salvage surgery. Surgery is used because that same area can’t be treated with radiation therapy again.

Chemotherapy may be given before or after surgery, with or without radiation therapy. It may be given before chemoradiation. The most common chemotherapy drug combination used to treat oropharyngeal cancer is cisplatin and fluorouracil (also called 5-fluorouracil or 5-FU). Sometimes another drug is added to this combination.

You may be offered targeted therapy for advanced stage oropharyngeal cancer. Cetuximab (Erbitux) is the most common targeted therapy drug used to treat oropharyngeal cancer.

Stage 4B oropharyngeal cancer means that the cancer has spread to other parts of the body. It is usually treated with chemotherapy, targeted therapy, immunotherapy or a combination of treatments. Sometimes radiation therapy is given to help relieve symptoms or prevent symptoms from getting worse.

You may want to consider a type of care to make you feel better without treating the cancer itself. This may be because the cancer treatments don’t work anymore, they’re not likely to improve your condition or they may cause side effects that are hard to cope with. There may also be other reasons why you can’t have or don’t want cancer treatment.

Talk to your healthcare team. They can help you choose care and treatment for advanced cancer.

Talk to your doctor about clinical trials open to people with oropharyngeal cancer in Canada. Clinical trials look at new ways to prevent, find and treat cancer. Find out more about clinical trials.