What Is Oropharyngeal Cancer?

Written by Stephanie Booth
Medically Reviewed by Elmer Huerta, MD, MPH on July 14, 2025
13 min read

Oropharyngeal cancer is a type of head and neck cancer. It affects the cells in the middle part of your throat, or what’s called the oropharynx. 

That includes the:

  • Base of your tongue
  • Soft palate (the top of your mouth, in the back)
  • Tonsils
  • Sides of your mouth

Early signs are easy to miss.

“We can't see that area very easily, even when we look in the mouth. And things can grow under the surface of the tongue, deep in the tongue, and in the back of the throat that don’t become noticeable until we have symptoms,” says Glenn J. Hanna, MD, director of the Center for Salivary and Rare Head and Neck Cancers at Dana-Farber Cancer Institute. 

You could get it because of:

Human papillomavirus (HPV). This may cause 60% to 70% of cases of oropharyngeal cancer in the U.S. If you get infected, HPV spreads to the cells in your mouth and lets them grow out of control.

“People are always rather shocked that a cancer could be, in some way, a transmissible disease,” says Jack Jacoub, MD, medical director of MemorialCare Cancer Institute in Orange County, California.

“And that’s exactly what it is. HPV is the culprit of the majority of these cancers.”

Alcohol. Over time, drinking large amounts of alcohol can hurt the cells in your mouth. The cells may lose their ability to repair that damage.

Tobacco. Smoking or chewing tobacco harms the cells in your mouth. As a result, they grow faster than normal,  which causes mistakes in their genetic material (DNA).

How common is oropharyngeal cancer?

This is a rare form of cancer. In the U.S., about 53,000 people are diagnosed every year. Of the different types of oropharyngeal cancer, tonsil cancer is the most common.

What increases your risk for oropharyngeal cancer?

You’re more likely to get it if: 

  • You’re white
  • You’re over the age of 55
  • You’re assigned male at birth 

Other risk factors include:

  • Obesity
  • Using tobacco or chewing betel quid
  • Heavy alcohol use
  • A family member with head or neck cancer

You could have:

  • A sore throat that doesn’t go away
  • Swollen lymph nodes in your neck
  • Pain when you swallow
  • Trouble moving your tongue or opening your mouth
  • Earache
  • Hoarseness
  • Weight loss without trying
  • A white patch on your tongue or inside your mouth 
  • Coughing up blood

Some people don’t have any symptoms until cancer cells have spread. Or you could have mild symptoms that you might think are being caused by something else. 

As part of your dental exam, your dentist should check you for different oral cancers. If they see symptoms, they’ll refer you to a doctor, like an ear, nose, and throat (ENT) specialist or a head and neck surgeon.

You’ll be asked about your symptoms, current health, and family history. Then your doctor will do a physical exam and order tests.

Which tests can diagnose oropharyngeal cancer?

You could have a:

Positron emission tomography (PET) scan. This test can find cancer cells. A safe amount of radioactive glucose is put into your vein. Then you lie down in a scanner that can see where it goes inside your body. Cancer cells use more blood sugar than healthy cells.

Computed tomography (CT) scan. This shows detailed pictures inside your body. Sometimes, a dye is put into your vein (known as contrast) to get even clearer images.

Magnetic resonance imaging (MRI) scan. Another imaging test, an MRI uses magnets and radio waves to take pictures of soft tissues, like your tonsils. It can help your doctor measure the size of any tumors.

Biopsy. If you have a growth, your doctor may take a tiny sample so it can be looked at under a microscope. This may be done by:

  • Endoscopy, in which a thin, flexible tube with a light is put into your throat
  • Laryngoscopy, which looks at your larynx (voice box) with a special device

How do I check myself for throat cancer?

It can be hard to see a lot inside your mouth. 

When you see a doctor, “we'll use a light and a tongue depressor, then we'll feel all around the back of the throat, the tonsils, the base of the tongue, and on both sides,” says Jacoub. “It’s an involved exam.”

Still, it can’t hurt to open wide and take a look.

Let your doctor know if:

  • You see something new in your mouth or it doesn’t look the same on both sides.
  • You feel a painless lump in your neck and you haven’t recently had an infection.
  • You feel like something’s in the back of your throat or around your tongue or you have trouble when you swallow.

HPV-positive oropharyngeal cancer vs. HPV-negative oropharyngeal cancer

HPV is a sexually transmitted infection (STI). There are more than 100 types, and 40 of them can spread to your mouth and throat. One way is during oral sex. It can take years after you’ve been exposed for this to happen.

One HPV strain that has a strong link to oropharyngeal cancer is HPV-16.

If you’re diagnosed with oropharyngeal cancer, your doctor will test for HPV. That helps them choose your treatment and explain your prognosis (outcome).

There isn't an FDA-approved screening test for oral HPV infection. Health care providers generally don't test for oral HPV for many reasons, including that there aren’t tests that can detect the early signs. However, doctors may check for both HPV-positive and HPV-negative throat cancer if you have certain risk factors. The screening can be done with a physical examination of the mouth followed by the use of a telescope and tiny camera to view the base of the tongue, back of the throat, larynx, and vocal cords. 

All types of cancer are assigned a stage. Staging is how your doctor measures the amount of cancer in your body. It also helps them decide your treatment.

Staging is based on:

  • Where the tumor is
  • How big the tumor is and how fast it’s growing
  • If the cancer is anywhere else in your body 

A number system is often used to stage most types of cancer.

With oropharyngeal cancer, there are two separate staging systems based on whether or not your cancer is linked to HPV.

HPV-negative oropharyngeal cancer staging

If HPV isn't part of your cancer, your doctor will use this system. 

Stage 0 HPV-negative oropharyngeal cancer

In this stage, the cancer is only in the top layer of cells. It hasn’t spread. This is called “carcinoma in situ.” That means “cancer in place.”

Only HPV-negative oropharyngeal cancer can be stage 0. 

Stage 1 (I) HPV-negative oropharyngeal cancer 

You have a tumor that’s 2 centimeters (peanut-sized) or smaller.

Stage 2 (II) HPV-negative oropharyngeal cancer 

The tumor is between 2 and 4 centimeters.

Stage 3 (III) HPV-negative oropharyngeal cancer 

In this stage, the tumor is:

  • Larger than 4 centimeters or has spread to your epiglottis, the flap that covers your windpipe when you swallow.

OR

  • Is any size but has spread to one lymph node on the same side of your neck as the tumor. The lymph node is 3 centimeters (the size of a grape)  or smaller.

Stage 4 (IV) oropharyngeal cancer

This stage has three parts.

Stage IVA

  • The cancer has spread to your larynx (voice box), roof of the mouth, lower jaw, or tongue. It may be in one lymph node, 3 centimeters or smaller, on the same side of the neck as your tumor.

OR

  • The tumor is any size and cancer is in the top of the epiglottis, larynx, front part of the roof of the mouth, lower jaw, or tongue muscles. It’s also in one lymph node (between 3 to 6 centimeters) on the same side of the neck as the tumor or more than one lymph node (6 centimeters or smaller) anywhere in your neck.

Stage IVB

At this stage, the cancer:

  • Has spread to your lower jaw or to the area behind your nose or around major blood vessels in your neck. Cancer cells may also be in lymph nodes in your neck.

OR

  • Is any size and has spread to other parts of your head or neck. It may be in a lymph node (larger than 6 centimeters) or has spread to nearby tissue.

Stage IVC

Cancer cells have been found throughout your body, like in your bones or liver. You may hear this called metastatic oropharyngeal cancer because the cancer has metastasized, or spread.

HPV-positive oropharyngeal cancer staging

If HPV caused your cancer, your doctor will use this system.

Stage 1 (I) HPV-positive oropharyngeal cancer

This stage means:

  • You have one or more lymph nodes with HPV-positive cancer, but it’s unclear where the cancer started. Your lymph nodes are 6 centimeters (egg-sized) or smaller and are only on one side of your neck.

OR

  • A tumor in your throat is 4 centimeters (about the size of a walnut) or smaller. You may also have cancer in one or more of your lymph nodes on the same side of your neck as the tumor. None of your lymph nodes are bigger than 6 centimeters.

Stage 2 (II) HPV-positive oropharyngeal cancer

You have:

  • One or more lymph nodes with HPV-positive cancer. They’re 6 centimeters or smaller and are on one or both sides of your neck.

OR

  • There’s a tumor smaller than 4 centimeters. Cancer is in lymph nodes that are 6 centimeters or smaller, either on the opposite side of the neck as the tumor or both sides of your neck.

OR

  • You have a tumor larger than 4 centimeters or cancer has spread to the top of your epiglottis. Cancer may also be in at least one lymph node, 6 centimeters or smaller, anywhere in your neck.

Stage 3 (III) HPV-positive oropharyngeal cancer

If you are diagnosed at stage III:

  • Cancer is in your larynx (voice box), front part of the roof of your mouth, lower jaw, tongue muscles, or other parts of your head or neck. It may also be in lymph nodes in your neck.

OR

  • The tumor is any size and cancer is in your voice box, front part of the roof of your mouth, lower jaw, tongue muscles, or other parts of your head or neck. It’s spread to one or more lymph nodes in your neck, 6 centimeters or larger.

Stage 4 (IV) HPV-positive oropharyngeal cancer

The cancer has spread to other parts of your body, like your bones or lungs.

Your treatment will depend on many things, including the cancer stage and your general health. 

It could include:

  • Surgery to remove tumors
  • Radiation, which uses powerful X-rays to damage the DNA of cancer cells
  • Chemotherapy to stop cancer cells from spreading
  • Targeted therapy, medications that target cancer cells
  • Immunotherapy, which uses your immune system to attack the cancer

Your doctor will explain your options. They’ll let you know what to expect as you go through treatment and connect you to other experts, like a head and neck surgeon or rehab specialist, who will be part of your care team.

Is there a cure for oropharyngeal cancer?

Curing this type of cancer is often the goal. But sometimes, oropharyngeal cancer may come back after treatment.

You may have a better outcome if:

  • The cancer was caught early. 
  • You have HPV-positive cancer.
  • You don’t use tobacco. 

What’s the survival rate for oropharyngeal cancer?

Five-year survival rates show how many people with your same type of cancer are alive five years after completing treatment. 

For oropharyngeal cancer, the five-year survival rate is 57%. But everyone is different. Many things can affect your outcome, including your general health, lifestyle choices, and how well you respond to treatment. 

“HPV-related oropharynx cancers, in general, have a better prognosis overall,” says Hanna. “They respond well to our current treatments, as compared to smoking-related cancers.”

If you can, seek treatment from experts in head and neck cancer.

“There’s a lot of specialization and very nuanced decision making for this type of cancer,” Hanna says. 

Surgery for oropharyngeal cancer

All stages usually need surgery. Your surgeon will remove the tumor as well as some tissue around it. Then, you may need another treatment, like chemotherapy or radiation, to target any leftover cancer cells.

Surgery techniques for oropharyngeal cancer keep getting better. For instance, transoral robotic surgery (TORS) allows your surgeon to use robot arms and very small tools to remove tumors from hard-to-remove places.

It’s minimally invasive, which means that you won’t need a large incision (cut).

If you have TORS, you may recover faster and have fewer long-term issues with speaking and eating. But you may still need reconstructive surgery or speech therapy after the procedure.

How does radiation therapy for oropharyngeal cancer work?

Very strong rays of energy are used to kill cancer cells. Different devices and techniques can be used to do this. For instance, you might lay down on a table like you’re getting an X-ray, while a machine rotates around you.

Studies show that radiation for head and neck cancers can help you live longer.

Does chemotherapy help treat oropharyngeal cancer?

Chemotherapy drugs help cancer cells stop growing and spreading. You may get a pill by mouth or get the medicine by IV. 

You might have chemotherapy before surgery to help shrink tumors and make them easier to remove. You can also have it after surgery to make sure no cancer cells were left behind.

When oropharyngeal cancer is advanced, chemotherapy can also help slow down how quickly it spreads in your body.

How does immunotherapy for oropharyngeal cancer work?

These medications make it easier for your immune system to find and attack cancer cells. 

For instance, drugs called PD-1 inhibitors switch off a “checkpoint” protein (PD-1) on your immune cells. Usually, PD-1 prevents immune cells from attacking parts of your body by mistake, but this also allows cancer cells to hide. Once PD-1 is switched off, your immune cells can “see” and stop them.

If your oropharyngeal cancer has spread or it’s come back, your doctor may try immunotherapy before other types of treatment.

Targeted therapy for oropharyngeal cancer

These drugs target cancer at a cellular level. They block certain molecules that cancer cells need to grow. Your doctor may suggest targeted therapy if you can’t have chemotherapy. 

Other treatment options

Experts keep looking for new ways to treat oropharyngeal cancer. If you join a clinical trial, you can help be part of their research. These studies rely on volunteers to try new medications, surgical procedures, medical devices, or lifestyle changes that could improve your outcome.

Ask your doctor if a clinical trial may be a good fit for you.

The  treatment for oropharyngeal cancer can work well, but it can be tough. “The general location of where this cancer develops is a very complex area,” says Jacoub. “You need it for nutrition. You need it to breathe, you need it to swallow. You need it to speak. It’s just such a critical area that the treatment is very difficult.”

During and after treatment, it can help to:

See your doctor often. They’ll help you manage side effects and make sure your cancer doesn’t come back.

Ask for support. That may include an occupational therapist, nutritionist, speech therapist, or counselor. 

Get regular exercise. It’s good for your body as well as your mind. 

Stop tobacco and alcohol. Both can make your treatment less likely to work. They can also raise the chances that your cancer comes back. If you need tips to quit, talk to your doctor.

Think through your day. Treatment may change how you look or how well you can talk or eat. Think about how you’ll get through your daily routine. What can help? What can you say if people ask questions? Thinking it through ahead of time can help you feel prepared.

Oropharyngeal cancer is cancer that grows in your oropharynx, which is the middle part of your throat. Being infected with HPV makes this more likely to happen. A chronic sore throat or lump in your neck are symptoms that should be checked out right away by your doctor. Oropharyngeal cancer can often be treated, but it may return. 

What are the red flags for throat cancer?

Symptoms for throat cancer include swollen lymph nodes, a sore throat or ear pain that doesn’t go away, coughing, and voice changes. You could also have trouble opening your mouth, swallowing, or moving your tongue. During an exam, your doctor may look for signs like a red or white patch in the back of your throat or one tonsil that’s bigger than the other.

What’s the most common age for oropharyngeal cancer?

According to the American Cancer Society, the average age is 64. But 1 in 5 cases happen in people who are younger than 55.

What’s commonly mistaken for throat cancer?

Throat cancer is sometimes mistaken for an infection. That’s because an early symptom is a swollen lymph node in your neck. Your doctor may try to treat it with antibiotics first,  then do more tests if it doesn’t clear up.

How does oropharyngeal cancer start?

DNA changes in healthy throat cells can lead to cancer. Research shows that two specific genes play a part. Changes to a gene known as PIK3CA can lead your cells to grow out of control. Mutations to the TP53 gene keep damaged cells from being repaired.

How quickly does oropharyngeal cancer grow?

One small study found that it took between one month to two years for oropharyngeal cancer cells to grow throughout your body. Different types can grow at different speeds. For instance, verrucous carcinoma, which often affects your gums and cheeks, is slow-growing. It often doesn’t spread. 

Is oropharyngeal cancer terminal?

Oropharyngeal cancer is not terminal. Terminal cancers can’t be cured or managed. This type can be treated, although cancer cells may come back at some point. 

Can a dentist see oropharyngeal cancer?

A dentist can spot changes in your mouth and throat that may signal cancer. If so, you’ll need to see a specialist for further tests and treatment. Your dentist may be able to give you the name of a head and neck surgeon and even help you make the appointment.