Neoplasm

Although neoplasms are not a cause of acute or chronic pharyngitis, tumors arising in the oropharynx often present with signs and symptoms that most commonly indicate an infectious etiology. Patients treated for infectious pharyngitis, who do not improve, warrant further investigation to identify a possible neoplasm. Common presenting symptoms of oropharyngeal cancer include unilateral sore throat, dysphagia, odynophagia, weight loss, and otalgia. On physical exam, an asymmetric pharyngeal mass is the hallmark clinical finding and warrants further investigation (Fig. 4). The mass may be ulcerative, fungating, or mucosal covered and detectable only by palpation. Cervical adenopathy is present with advanced disease that has metastasized to the locoregional lymph nodes. Risk factors for oropharyngeal cancer include tobacco and alcohol abuse. The human papilloma virus has a role in a subset of oropharyngeal tumors.

The majority of oropharyngeal cancers are epithelial in origin. Squamous cell cancer is the most common tumor. Adenocarcinoma and verrucous carcinoma may also arise in the oropharynx. Hematological neoplasms such as lymphoma are also found in the oropharynx and are discussed in more detail in Chapter 17. Rarely, minor salivary glands can give rise to carcinomas such as mucoepidermoid and adenoid cystic carcinoma arising in the pharynx. Tissue biopsy is necessary for pathological diagnosis and is supplemented with imaging studies (CT scans, magnetic resonance imaging, and/or positron emission

Cancer Tonsillar Fossa
FIGURE 4 Tonsillar neoplasm—a squamous cell cancer lesion is seen in the right tonsillar fossa.

tomography) for metastatic evaluation. Treatment is dependent upon proper tumor identification. Radiation, chemotherapy, and surgery may be used individually or in combination, depending on the type of tumor and extent of disease.

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