# 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, a head and neck cancer, 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)

## Sections of this record

The page is a hub with ten sections in reading order; large sections have their own page. The same plan as JSON: https://onco.cc/api/v1/cancers/oropharyngeal-cancer/sections.json

- Overview (on the hub): The TL;DR, the family this cancer belongs to, the organ, who gets it and what the state of the art is. https://onco.cc/cancers/oropharyngeal-cancer/#overview [1 subtype, 3 state-of-the-art points]
- Types and stages (on the hub): Anatomy, the subtypes and how they differ, how it is staged, and where advanced disease spreads. https://onco.cc/cancers/oropharyngeal-cancer/#what-it-is [6 subtypes]
- Symptoms and diagnosis (on the hub): How this cancer shows itself, how the diagnosis is confirmed, and the biomarkers clinicians test for. https://onco.cc/cancers/oropharyngeal-cancer/#finding-it [5 biomarkers]
- Treatment (on the hub): The standard of care by setting, the medicines, surgery and radiotherapy named in it, and the regimens behind them. https://onco.cc/cancers/oropharyngeal-cancer/#treating-it [5 settings, 4 decisions with options]
- Trials and papers (on the hub): Trials recruiting now, the landmark trials, the trials held by this cancer's subtypes, the key papers and what they mean, the latest literature, and the milestones year by year. https://onco.cc/cancers/oropharyngeal-cancer/#evidence [12 trials, 4 trials in the subtypes, 5 key papers, 5 milestones]
- Biology and targets (on the hub): The molecular landscape: the targets and how often each appears, the pathways, the mechanics stages and the preclinical models. https://onco.cc/cancers/oropharyngeal-cancer/#science [2 targets]
- Countries and centres (own page): Cases by country, the UK and NHS pathway and other country lenses, the expert centres with trials on record, and the centres named on this cancer's subtypes. https://onco.cc/cancers/oropharyngeal-cancer/where-you-are/ [10 centres in the subtypes]
- Decisions and support (on the hub): The decisions you may face, the aids that walk through them, the warnings on record, the first sixty days and the questions to ask. https://onco.cc/cancers/oropharyngeal-cancer/#living-with-it [18 questions, 6 red cards]
- Pipeline and open problems (own page): Everything in development, the medicines held by this cancer's subtypes, the open problems and what is being done about them, the roadmaps, and what changed on this record. https://onco.cc/cancers/oropharyngeal-cancer/coming/ [4 medicines, 2 medicines in the subtypes, 12 trials, 4 open problems]
- Data (own page): Every connected record, the notes, the JSON, Markdown and RDF twins, and where the record came from and when it was checked. https://onco.cc/cancers/oropharyngeal-cancer/data/ [41 connected records]

## 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

- cancers: [Head and neck squamous cell carcinoma](https://onco.cc/cancers/head-and-neck/), [HPV-negative head and neck squamous cell carcinoma (including HPV-negative oropharyngeal cancer)](https://onco.cc/cancers/hpv-negative-head-and-neck-cancer/), [HPV-positive oropharyngeal cancer](https://onco.cc/cancers/hpv-positive-oropharyngeal-cancer/), [Hypopharyngeal cancer](https://onco.cc/cancers/hypopharyngeal-cancer/), [Laryngeal and hypopharyngeal cancer](https://onco.cc/cancers/laryngeal-cancer/), [Oral cavity cancer (mouth and tongue)](https://onco.cc/cancers/oral-cavity-cancer/), [Recurrent or metastatic head and neck squamous cell carcinoma](https://onco.cc/cancers/recurrent-metastatic-hnscc/)
- trials: [A Study to Evaluate Lenti-HPV-07 Immunotherapy Against HPV+ Cervical or Oropharyngeal Cancer](https://onco.cc/trials/nct06319963/), [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/), [ECOG-ACRIN E3311](https://onco.cc/trials/ecog-e3311/), [KEYNOTE-048](https://onco.cc/trials/keynote-048/), [NRG-HN002 & NRG-HN005 (HPV+ de-escalation)](https://onco.cc/trials/nrg-hn002-hn005/), [ORATOR](https://onco.cc/trials/orator/), [PATHOS](https://onco.cc/trials/pathos/), [RRx-001 for Reducing Oral Mucositis in Patients Receiving Chemotherapy and Radiation for Head and Neck Cancer](https://onco.cc/trials/nct05966194/), [RTOG 1016](https://onco.cc/trials/rtog-1016/), [Safety and Efficacy of APG-157 in Head and Neck Cancer](https://onco.cc/trials/nct05312710/)
- key papers: [CheckMate 141: nivolumab for recurrent head and neck squamous cell carcinoma after platinum](https://onco.cc/key-papers/paper-checkmate-141-ferris-nejm-2016/), [De-ESCALaTE HPV: radiotherapy plus cisplatin or cetuximab in low-risk HPV-positive oropharyngeal cancer](https://onco.cc/key-papers/paper-de-escalate-lancet-2019/), [Human papillomavirus and survival of patients with oropharyngeal cancer (RTOG 0129)](https://onco.cc/key-papers/paper-ang-hpv-oropharyngeal-nejm-2010/), [KEYNOTE-048: pembrolizumab, alone or with chemotherapy, as first treatment for recurrent or metastatic head and neck cancer](https://onco.cc/key-papers/paper-keynote-048-lancet-2019/), [NRG Oncology RTOG 1016: radiotherapy plus cetuximab versus cisplatin in HPV-positive oropharyngeal cancer](https://onco.cc/key-papers/paper-rtog-1016-lancet-2019/)
- technologies: [Adaptive radiotherapy (online replanning)](https://onco.cc/technologies/adaptive-radiotherapy/), [Head and neck reconstruction: the free flap, and what it gives back](https://onco.cc/technologies/rejuv-recon-head-neck/), [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/), [Swallowing therapy around head and neck radiotherapy](https://onco.cc/technologies/rejuv-rehab-swallowing/), [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/)
- people: [Anthony C. Nichols](https://onco.cc/people/anthony-nichols/), [Robert L. Ferris](https://onco.cc/people/robert-ferris/)
- terms: [Lung cancer after chest radiotherapy and after alkylating chemotherapy](https://onco.cc/terms/second-primary-lung-after-chest-radiotherapy/)

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