# Oropharyngeal cancer (tonsil and base of tongue)

Source: https://onco.cc/cancers/oropharyngeal-cancer/  
OnCo record `oropharyngeal-cancer` (Cancer). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Cancer of the tonsils and back of the tongue now comes mostly from HPV infection rather than smoking, and behaves like a different disease: it responds well to chemoradiation, most patients are cured, and the research question is how much treatment can safely be removed.

## Summary

Oropharyngeal squamous cell carcinoma arises in the tonsils, base of tongue, soft palate and pharyngeal wall. In North America and Europe most cases are now caused by HPV type 16 and are staged separately because they carry a far better outlook than tobacco-related, HPV-negative tumours, which are more often p53-mutant and resistant. Standard treatment is cisplatin chemoradiation, or transoral robotic surgery with neck dissection and adjuvant treatment for smaller tumours; cetuximab proved inferior to cisplatin in HPV-positive disease in RTOG 1016 and De-ESCALaTE. Trials are testing lower radiotherapy doses, fewer drugs and circulating HPV DNA to guide de-escalation in HPV-positive patients, while HPV vaccination is expected to prevent most future cases. Recurrent or metastatic disease is treated with pembrolizumab, alone or with chemotherapy, on KEYNOTE-048.

## Fields

- Kind: Cancer
- Last checked: 2026-09-17
- Also known as: Oropharynx cancer; Tonsil cancer; Base of tongue cancer; HPV-positive head and neck cancer
- Tags: subtype-page
- Group: head-and-neck
- Burden: The fastest-rising head and neck cancer in high-income countries, now driven mainly by human papillomavirus in men in their fifties and sixties; HPV-positive disease is cured in most cases, HPV-negative disease in far fewer.
- Subtypes: HPV-positive (p16-positive) oropharyngeal cancer; HPV-negative (tobacco and alcohol related) oropharyngeal cancer; Tonsil; Base of tongue; Soft palate and pharyngeal wall
- Biomarkers: p16 immunohistochemistry and HPV DNA or RNA; Smoking history (worsens HPV-positive outlook); Circulating HPV DNA (surveillance and de-escalation trials); PD-L1 combined positive score (recurrent disease); TP53 mutation (HPV-negative)

## Standard of care

- Diagnosis and staging: Examination and biopsy with p16 and HPV testing, PET-CT, and separate staging for HPV-positive disease. ([HPV DNA testing and self-sampling](https://onco.cc/technologies/hpv-testing/))
- Early disease: Transoral robotic or laser surgery with neck dissection, or radiotherapy alone, chosen by expected function. ([Transoral robotic surgery (TORS)](https://onco.cc/technologies/tors/), [IMRT / IGRT (modern external beam)](https://onco.cc/technologies/imrt-igrt/))
- Locally advanced disease: Cisplatin chemoradiation (70 Gy); cetuximab only for patients who cannot have cisplatin, since RTOG 1016 and De-ESCALaTE showed it inferior in HPV-positive disease. ([Cisplatin](https://onco.cc/drugs/cisplatin/), [Cetuximab](https://onco.cc/drugs/cetuximab/), [RTOG 1016](https://onco.cc/trials/rtog-1016/), [De-ESCALaTE HPV](https://onco.cc/trials/de-escalate/), [Bonner trial (cetuximab plus radiotherapy)](https://onco.cc/trials/bonner-cetuximab-rt/))
- Recurrent or metastatic: Pembrolizumab alone for PD-L1-positive disease or with platinum-fluorouracil (KEYNOTE-048); nivolumab after platinum (CheckMate 141). ([Pembrolizumab](https://onco.cc/drugs/pembrolizumab/), [Nivolumab](https://onco.cc/drugs/nivolumab/), [KEYNOTE-048](https://onco.cc/trials/keynote-048/), [CheckMate 141](https://onco.cc/trials/checkmate-141/))
- Prevention: HPV vaccination of girls and boys; smoking cessation. ([HPV & HBV vaccination](https://onco.cc/technologies/hpv-vaccine/), [Smoking cessation in cancer patients](https://onco.cc/technologies/smoking-cessation-after-diagnosis/))

## State of the art

- HPV-positive oropharyngeal cancer has an eighth-edition staging system of its own because its survival is so much better.
- De-escalation is the frontier: reduced-dose radiotherapy after induction or surgery, and circulating HPV DNA to pick who can have less, are in phase 2 and 3 trials.
- Immunotherapy is standard in recurrent disease and is being tested with chemoradiation in the curative setting.

## Open problems

- How far treatment can be reduced in HPV-positive disease without losing cures.
- HPV-negative oropharyngeal cancer still has poor outcomes.
- Long-term swallowing and dry mouth after chemoradiation.
- HPV vaccination uptake in boys and in low-income countries.

## Sources

- Wikipedia: https://en.wikipedia.org/wiki/Oropharyngeal_cancer
- Wikipedia: https://en.wikipedia.org/wiki/Oropharyngeal_cancer

## Connected records

- trials: [Bonner trial (cetuximab plus radiotherapy)](https://onco.cc/trials/bonner-cetuximab-rt/), [CheckMate 141](https://onco.cc/trials/checkmate-141/), [De-ESCALaTE HPV](https://onco.cc/trials/de-escalate/), [KEYNOTE-048](https://onco.cc/trials/keynote-048/), [RTOG 1016](https://onco.cc/trials/rtog-1016/)
- technologies: [Adaptive radiotherapy (online replanning)](https://onco.cc/technologies/adaptive-radiotherapy/), [HPV & HBV vaccination](https://onco.cc/technologies/hpv-vaccine/), [HPV DNA testing and self-sampling](https://onco.cc/technologies/hpv-testing/), [IMRT / IGRT (modern external beam)](https://onco.cc/technologies/imrt-igrt/), [Smoking cessation in cancer patients](https://onco.cc/technologies/smoking-cessation-after-diagnosis/), [Transoral robotic surgery (TORS)](https://onco.cc/technologies/tors/)
- drugs: [Cetuximab](https://onco.cc/drugs/cetuximab/), [Cisplatin](https://onco.cc/drugs/cisplatin/), [Nivolumab](https://onco.cc/drugs/nivolumab/), [Pembrolizumab](https://onco.cc/drugs/pembrolizumab/)
- cancers: [Head and neck squamous cell carcinoma](https://onco.cc/cancers/head-and-neck/)

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JSON: https://onco.cc/api/v1/entities/oropharyngeal-cancer.json