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Oropharyngeal cancer

Key sources
The following summarized guidelines for the evaluation and management of oropharyngeal cancer are prepared by our editorial team based on guidelines from the American Society of Clinical Oncology (ASCO 2022; 2019; 2018), the European Society for Radiotherapy and Oncology (ESTRO/EHNS/ESMO 2020), the American College of Radiology (ACR 2019), the American Academy of Otolaryngology-Head and Neck Surgery Foundation (AAO-HNSF 2017), the American Society for Radiation Oncology (ASTRO 2017), the United Kingdom National Multidisciplinary Guidelines (UKNMG 2016), and the American Cancer Society (ACS 2016).
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Guidelines

1.Classification and risk stratification

Staging: use the UICC TNM system for staging.
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2.Diagnostic investigations

History and physical examination: as per EHNS 2020 guidelines, obtain a clinical assessment in patients with suspected OPC.
B

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  • Diagnostic imaging

3.Diagnostic procedures

Fine-needle aspiration
Perform FNA instead of open biopsy in patients with a neck mass of uncertain diagnosis deemed at increased risk for malignancy.
B
Continue evaluating patients with a cystic neck mass, as determined by FNA or imaging, until a diagnosis is obtained instead of assuming that the mass is benign.
B

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  • Tumor biopsy

  • Immunohistochemistry and mutational testing

  • HPV testing

4.Medical management

General principles: manage patients with OPC at high-volume facilities.
B
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  • Management of locoregional disease

  • Management of advanced/metastatic disease

  • Management of recurrent disease

5.Therapeutic procedures

Technical considerations for radiotherapy, modality: use intensity-modulated radiotherapy or volumetric-modulated arc therapy for radiotherapy.
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  • Technical considerations for radiotherapy (dosing, definitive therapy)

  • Technical considerations for radiotherapy (dosing, adjuvant therapy)

  • Technical considerations for radiotherapy (radiosensitizer)

6.Surgical interventions

Indications for neck dissection, primary surgery: perform an ipsilateral elective neck dissection in patients with stage cT2-cT4, cN0 oropharyngeal SCC (no clinical or radiographic evidence of metastatic spread to the neck) treated with curative-intent surgery.
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  • Indications for neck dissection (post-treatment surgery)

7.Specific circumstances

Patients with tonsillar cancer
Offer unilateral radiotherapy in patients with well-lateralized (confined to tonsillar fossa) T1-T2 tonsillar cancer and N0-N1 nodal category.
B
Consider offering unilateral radiotherapy in patients with lateralized (< 1 cm of soft palate extension but without base of tongue involvement) T1-T2N0-N2a tonsillar cancer without clinical or radiographic evidence of extracapsular extension, after careful discussion of patient preferences and the relative benefits of unilateral treatment versus the potential for contralateral nodal recurrence and subsequent salvage treatment.
C

8.Follow-up and surveillance

Serial clinical assessment: educate and counsel all head and neck cancer survivors about the signs and symptoms of local recurrence.
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  • Serial endoscopic assessment

  • Serial imaging assessment

  • Survivorship and rehabilitation (lifestyle modifications)

  • Survivorship and rehabilitation (neuromuscular complications)

  • Survivorship and rehabilitation (neurosensory complications)

  • Survivorship and rehabilitation (speech disturbance)

  • Survivorship and rehabilitation (oral and dental care)

  • Survivorship and rehabilitation (gastroesophageal complications)

  • Survivorship and rehabilitation (thyroid dysfunction)

  • Survivorship and rehabilitation (lymphedema)

  • Survivorship and rehabilitation (fatigue)

  • Survivorship and rehabilitation (sleep disorders)

  • Survivorship and rehabilitation (psychosocial distress)