Oropharynx

Anatomy/subsites
Soft palate - Tonsil - Base of tongue - Posterior and lateral pharyngeal walls

Lymph node patterns of spread
II, III, IV, retropharynx
Clinically N0 patients have about 20% risk in levels II, III, IV and 5-10% in retropharynx
Clinically N+ patients have 70% risk in level II, 40% in III, 25% in IV, 10% retropharynx

Epidemiology
15-16,000 cases per year
Tonsil is the most common subsite

Risk factors
HPV+ (strain 16; patients with HPV-associated oropharynx cancer have a much better prognosis) (PMID 20530316)
Smoking
Alcohol

Pathology
Vast majority of tumors are SCC

Clinical
Symptoms include sore throat, hoarseness, dysphagia, ear pain, hemoptysis, airway obstruction, neck mass
Do not forget panendoscopy and dental exam when evaluating pts with head and neck cancers