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Oropharyngeal cancer

Guidelines

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 2023,2019,2018), 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 ...
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Classification and risk stratification

Staging: as per EHNS/ESMO/ESTRO 2020 guidelines, use the UICC TNM system for staging.
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Diagnostic investigations

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

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  • Diagnostic imaging

Diagnostic procedures

Fine-needle aspiration
As per AAO-HNSF 2017 guidelines:
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

Medical management

General principles: as per EHNS/ESMO/ESTRO 2020 guidelines, 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

Therapeutic procedures

Technical considerations for radiotherapy, modality: as per EHNS/ESMO/ESTRO 2020 guidelines, use intensity-modulated radiotherapy or volumetric-modulated arc therapy for radiotherapy.
A

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  • Technical considerations for radiotherapy (dosing, definitive therapy)

  • Technical considerations for radiotherapy (dosing, adjuvant therapy)

  • Technical considerations for radiotherapy (radiosensitizer)

Surgical interventions

Indications for neck dissection, primary surgery: as per ASCO 2019 guidelines, 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.
A
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  • Indications for neck dissection (post-treatment surgery)

Specific circumstances

Patients with tonsillar cancer
As per ASTRO 2017 guidelines:
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

Follow-up and surveillance

Serial clinical assessment: as per ACS 2016 guidelines, educate and counsel all head and neck cancer survivors about the signs and symptoms of local recurrence.
B
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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)