Oropharyngeal cancer (tonsil and base of tongue)
Prepared with OnCo (onco.cc/prep/oropharyngeal-cancer/). Orientation, not medical advice; your team knows your case.
My details
What I know, what is unclear, changes to discuss
Saved in this browserMy questions
18 on the sheet- 1.What is my exact diagnosis, stage, and grade, and which tests established them?
- 2.Which biomarkers have been tested on my tumour (for example p16 immunohistochemistry and HPV DNA or RNA, Smoking history, Circulating HPV DNA, PD-L1 combined positive score, TP53 mutation), and what were the results?
- 3.Which subtype is my cancer, and does that change the recommended treatment?
- 4.Is germline (inherited) genetic testing recommended for me or my family?
- 5.For my situation (diagnosis and staging), which of the standard options do you recommend and why?
- 6.For my situation (early disease), which of the standard options do you recommend and why?
- 7.For my situation (locally advanced disease), which of the standard options do you recommend and why?
- 8.Am I a candidate for Cisplatin, Cetuximab, and what side effects should I expect?
- 9.How do the results of RTOG 1016 and De-ESCALaTE HPV apply to someone like me?
- 10.For my situation (recurrent or metastatic), which of the standard options do you recommend and why?
- 11.Am I a candidate for Pembrolizumab, Nivolumab, and what side effects should I expect?
- 12.How do the results of KEYNOTE-048 and CheckMate 141 apply to someone like me?
- 13.For my situation (prevention), which of the standard options do you recommend and why?
- 14.Are there clinical trials I could join, for example of De-ESCALaTE HPV, Adaptive radiotherapy (online replanning), HPV & HBV vaccination?
- 15.Would a second opinion at a high-volume centre change anything, and can you help arrange it?
- 16.What supportive care (symptom control, nutrition, exercise, mental health, financial help) is available from the start?
- 17.I read that “How far treatment can be reduced in HPV-positive disease without losing cures”. How does that affect my plan?
- 18.I read that “HPV-negative oropharyngeal cancer still has poor outcomes”. How does that affect my plan?
Tests and results to bring
Diagnosis and staging: Examination and biopsy with p16 and HPV testing, PET-CT, and separate staging for HPV-positive disease.
Biomarker results to ask for: 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).
Scans and tests linked to this cancer: HPV DNA testing and self-sampling.
Bring copies of scan reports, pathology and blood results, and a list of every medicine and supplement.
The treatments I may be offered
- Prevention: HPV vaccination of girls and boys; smoking cessation. (HPV & HBV vaccination, Smoking cessation in cancer patients)
- Early disease: Transoral robotic or laser surgery with neck dissection, or radiotherapy alone, chosen by expected function. (Transoral robotic surgery (TORS), IMRT / IGRT (modern external beam))
- 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, Cetuximab, RTOG 1016, De-ESCALaTE HPV, Bonner trial (cetuximab plus radiotherapy))
- Recurrent or metastatic: Pembrolizumab alone for PD-L1-positive disease or with platinum-fluorouracil (KEYNOTE-048); nivolumab after platinum (CheckMate 141). (Pembrolizumab, Nivolumab, KEYNOTE-048, CheckMate 141)
From the standard of care recorded for this cancer; which apply depends on your stage and biomarkers. Ask which the team recommends and why.