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Oropharyngeal Cancer

Appointments

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The oropharynx includes the middle of the throat from the tonsils to the tip of the voice box. Cancers can occur at the base of the tongue, in the tonsils, on the soft palate, and in the walls of the pharynx. There are two types of these cancers: HPV-positive, which are related to human papillomavirus infection, and HPV-negative. HPV-negative oral cancer is often related to heavy tobacco or alcohol usage.                                             

Diagnoses of HPV-positive head and neck cancers increased 225 percent in the last two decades. 

Why Choose Sylvester Comprehensive Cancer Center?

More board-certified head and neck surgical specialists than any other South Florida provider. Our team offers advanced, simplified surgery solutions. In the majority of cases requiring reconstruction, you have just one operation for cancer removal and any reconstructive surgery. Sylvester is one of the best places in the country for simultaneous head and neck cancer surgery and microvascular reconstruction.

Greater access to the latest treatments. Clinical trials that focus on robotic surgery, chemotherapy, immunotherapy, and reducing radiation toxicity are often available for head and neck cancer patients. Your access to treatments that are not available elsewhere give you the best chance for the best treatment outcomes.

Advanced expertise in surgical techniques. Sylvester is one of the best places in the country for simultaneous cancer surgery and microvascular reconstruction. In the majority of cases requiring reconstruction, you have one operation to remove the tumor and to rebuild what you lost. 

The best surgical approach for your HPV cancer. Sylvester participates in the ECOG Protocol for treatment of HPV oropharyngeal squamous cell cancer using robotics, providing the least invasive surgical approach with shorter recovery times and less pain.

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Treatments


At Sylvester Comprehensive Cancer Center, each cancer has a wide range of treatments that can be used alone or in combination to give the best outcome for your specific cancer, including standard therapies and novel therapies only available in clinical trials. That’s why careful diagnosis is so important.

Head & Neck/Airway Multidisciplinary Clinic: This outpatient unit serves patients with different head and neck or airway problems as a result of their cancer or the treatment. Several specialties, including head and neck surgery, radiation oncology, head and neck medical oncology, otolaryngology, endocrinology, pulmonology, and speech pathology can all see you there. 

Part of the clinic is a support group for people learning to speak again after laryngectomy. Having the understanding and compassion of a caring staff and other people who understand greatly improves your progress back to a full life.  

Radiation therapy  is the primary way to treat oropharyngeal cancers. Sometimes, surgery is the main treatment (instead of radiation therapy). Decisions are based on your exact case and diagnosis. 

  • Surgery

    The goal of surgery is to take out a tumor from the head and neck region and remove lymph nodes if cancer has spread to them. The smaller the tumor, the higher the chance of minimizing its impact on speaking, swallowing, and other parts of daily living.

    • Transoral Robotic-Assisted Surgery: This technique is helpful for tumors of the tonsils and tongue base. It is performed using a powerful microscope and robotic tools. There are no external incisions. Our surgeons perform the surgery with tiny instruments and a very thin scope. The scope is inserted through your mouth. If lymph nodes are involved, a separate neck incision may be required. Transoral robotic surgery can eliminate any need for chemotherapy after surgery. Radiation therapy may be used after the procedure, based on the surgical results.

    • Reconstructive Surgery: Sometimes, head and neck surgeries can cause substantial cosmetic changes. Your Sylvester head and neck experts will plan before any treatment starts for both the cancer removal and any bone or tissue reconstruction.

      • Often these reconstructive procedures can utilize small pieces of tissue, skin or bone from your own body for a more natural look and feel — such as from your lower leg, shoulder blade, chest, forearm and other areas.

      • Another option is to develop a prosthesis (artificial replacement). Sylvester's head and neck cancer team will collaborate with our prosthodontist. Prosthodontists are dentists who specialize in making tooth and facial structure replacements.

      • Custom prosthetic facial parts also can be created for you when needed. These prosthetics are designed to blend into your face, head, and neck.

  • Radiation Therapy

    Small tumors may be treated with radiation therapy. Surgery is often offered afterward to destroy any remaining cancer. 

    Sylvester has one of the largest, most experienced, and most sophisticated head/neck cancer radiation sections in the nation. Radiation therapy uses highly targeted radiation beams. Radiation kills cancer cells and shrinks tumors. Chemotherapy or targeted therapy may be offered after or before a radiation therapy approach. Our techniques include: 

    • Oral Health Evaluation: An oral exam by a knowledgeable dentist helps us to identify any infection, fractured teeth, restorations, or periodontal disease. These issues could contribute to oral complications when cancer therapy begins.

    • Intensity modulated radiation therapy (IMRT):  IMRT is an advanced form of external beam radiation therapy. Our radiation specialists will focus the radiation doses to the exact three-dimensional shape of your tumor. The precise control and flexibility of IMRT can decrease any radiation going to surrounding healthy tissue. 

    • Radiosensitizing Treatment: In some cases, such as in cancers of the larynx (voice box) and oropharynx (middle of the throat), we may use chemotherapy and radiation therapy together to kill all the cancer cells. This can help reduce the need for surgery and preserve your voice box and/or throat structures.

  • Chemotherapy

    The high level of experience of Sylvester’s medical oncology team allows our physicians to choose and deliver the most advanced chemotherapy approaches, often before they become commonly used in the community. Your doctor may prescribe chemotherapy before or after surgery or will combine chemotherapy with radiation therapy to try and avoid surgery altogether. Most chemotherapy drugs used for head and neck patients don’t cause hair loss.  

    If you need intravenous (infusion) chemotherapy, you can have it at the Comprehensive Treatment Unit (CTU) at Sylvester’s main location in Miami, a 12,000-square-foot unit that includes 33 recliners and 11 private rooms. If you prefer, you may have your infusion treatments at the Deerfield Beach, Plantation, Hollywood, Coral Springs, Coral Gables, and Kendall locations.

  • Targeted Therapy 

    This treatment uses medicines that target specific parts of cancer cells. For example, a protein called EGFR may accelerate the growth of head and neck cancer cells. The most commonly used medicine that targets these cells is called cetuximab. It blocks EGFR, so the cancer cell growth  often slows or stops.


Tests

In addition to a complete medical history and physical examination, procedures for diagnosing head and neck cancers may include the following:

  • Endoscopic Ultrasound

    This exam uses a long, thin, flexible tube called an endoscope with a light at the end. It is put in through the nose so the doctor can get a close look at the inside of your nasal cavity, the back of your nose, throat, and voice box. A special tool on the endoscope may be used to remove samples of suspicious tissue.

  • Modified Barium Swallow

    This is a series of X-rays taken while you swallow a safe, chalky substance called barium. The study is performed by a radiologist and a speech and swallowing therapist. The barium coats the inside of your throat so any swallowing changes or obstructions can be seen on the X-rays.

  • Computed Tomography (CT or CAT Scan)

    In this test, an X-ray beam takes a series of pictures of the inside of your body from many angles. These images are then combined by a computer, giving a detailed 3-D picture of your body. The CT scan can be used to check the head and neck and is sometimes used to evaluate the chest, too.

  • Magnetic Resonance Imaging (MRI)

    This test uses magnets and radio waves to take detailed pictures of the inside of your body to look for cancer in the neck.

  • Biopsy

    A biopsy, taking a sample of the suspicious tissue, is the only sure way to know if you have cancer. The sample is checked by a pathologist who looks at the tissue under a microscope to check for cancer cells. The tissue is removed from the primary tumor site in the head/neck area. If the suspicious area is a lump or lymph node on your neck, your doctor uses a process called fine needle aspiration to check for cancerous cells in your lymph nodes. 

  • Chest X-ray or Chest CT Scan

    An chest X-ray or CT Scan can determine if cancerous cells have spread to your lungs.

  • PET Scan (Positron Emission Tomography)

    This test measures metabolic activity in your body tissue. Radioactive material in small amounts is injected into a vein. The radioactive material is seen in the images as highlighted places where cancer cells could be growing. 

  • Staging Head and Neck Cancers

    Staging is the word used to describe how early or advanced a cancer is and how fast it is growing. Stages range from I (low) to IV (advanced). Staging helps us to decide what treatment might be best for your cancer.  

Accepted Insurances

Note: Health plans that are currently contracted with UHealth are listed below. However, please check with your insurance provider to verify that UHealth is part of your provider network.

  • Aetna WC
  • Aetna Affiliates/Signature Adm (ASA)
  • Aetna Behavioral Health
  • Aetna Elect Choice (EPO)
  • Aetna Florida Healthy Kids
  • Aetna HMO
  • Aetna Medicaid HMO
  • Aetna Medicare HMO
  • Aetna Medicare PPO
  • Aetna POS
  • Aetna PPO
  • Aetna UM Employee HMO 1
  • Aetna UM Employee HMO 2
  • Aetna UM Employee POS HRA
  • Aetna/Coventry Institutes of Excellence (IOE)
  • Amerigroup Florida Healthy Kids
  • Amerigroup Medicaid HMO
  • Argus Vision
  • AvMed Choice
  • AvMed HMO/POS
  • AvMed MDC and JHS Groups
  • AvMed Medicare HMO
  • AXIS
  • BCBS Blue Options Network Blue PPO
  • BCBS BlueCare HealthOptions HMO
  • BCBS BlueChoice PPC/PPO
  • BCBS Miami Dade Blue PPO Limited Benefits Plan
  • BCBS of Florida (All products except "SELECT" Plans)
  • BCBS of Florida (Commercial plans exclude HIX Select)
  • BCBS Traditional PHS/PPO
  • Beacon Health (ValueOption)
  • Beech Street PPO
  • Broward Health Medical Center
  • CarePlus Medicare HMO
  • Catholic Hospice
  • CCP/CMS Title XIX (Medicaid Enrolled in South Florida)
  • CCP/CMS Title XXI (Non Medicaid Enrolled in South Florida)
  • CCP/MMA (Broward County residents)
  • Charlotte County Sheriffs Office PPO
  • Cigna Affiliates
  • Cigna Behavioral Health
  • Cigna Dental HMO/PPO
  • Cigna EPO
  • Cigna HMO
  • Cigna Life Source (Intracorp is part of Cigna Lifesource)
  • Cigna MDCPS Jackson Sr. High
  • Cigna POS
  • Cigna PPO
  • Cigna Shared Administration
  • Clear Health Alliance SNP Medicaid HMO
  • Concordia Behavioral Health
  • CorVel WC
  • Coventry First Health WC
  • Coventry Health Care of Florida (HIP) HMO/POS
  • Coventry Health Care of Florida (HIP) PPO
  • Coventry Health Plan of Florida (Foundation) HMO
  • Coventry Health Plan of Florida (Foundation) POS
  • Coventry National PPO
  • Coventry Summit Medicare HMO
  • Coventry Vista Medicare HMO
  • Coventry First Health PPO
  • Delta Dental PPO
  • DentaQuest (ADI)
  • DIKLA
  • Dimension WC
  • Dimension Plus PPO
  • EHN PPO
  • EQUIAN (Health Systems International)
  • Europe Assistance/Global Corporate Solutions (Care Management Network)
  • eyeQuest
  • FCCI WC
  • Florida Healthcare Plan (Affiliate of BCBSFL)
  • Florida PACE (FPC)
  • Freedom Health Medicaid HMO
  • Freedom Health Medicare HMO
  • Gallagher Bassett WC (MDCPS & FCSRMC)
  • Global Excel Mgt PPO
  • Great West (Cigna) HMO/POS
  • Guardian Life PPO
  • HAA Preferred Partners
  • Health First Health HMO/POS
  • Health First Health Medicare HMO
  • Health First Health PPO
  • Health Net Veterans Choice HMO
  • Heritage Summit Healthcare WC
  • Humana Behavioral Health (LifeSynch)
  • Humana Dental/CompBenefits/OHS
  • Humana EPO
  • Humana HMO
  • Humana Medicaid HMO
  • Humana Medicare HMO
  • Humana National Transplant
  • Humana PPO
  • Humana Premier
  • iCare Health Solutions
  • Interlink Health Services
  • International Kids Fund (IKF)
  • League Medical Concepts Federal Inmates
  • Life Trac
  • Magellan Behavioral Health
  • Magellan Complete Care SNP Medicaid HMO
  • MDAbroad
  • Medica Medicare HMO
  • Medical Development In't (MDI)-Federal Inmates
  • Medicus
  • Metlife Dental PPO
  • MHNet Behavioral Network (MHNet)
  • Molina
  • Molina Market Place
  • Molina Medicaid HMO
  • Molina Medicare HMO
  • Morgan White International
  • MultiPlan PPO
  • Naphcare (Federal Prisoners)
  • National Healthcare Solutions Inc.
  • Neighborhood HealthPlan HMO/POS
  • Neighborhood HealthPlan PPO
  • North Broward Hospital District PPO
  • Olympus Managed Healthcare
  • Optum
  • Positive Healthcare SNP Medicaid HMO
  • Positive Healthcare SNP Medicare HMO
  • Prestige Health Choice Medicaid HMO
  • Prime Health Services WC
  • Quality Health Management
  • Religious Order of Jehovah's Witnesses PPO
  • Rockport Healthcare Group WC
  • Royal Caribbean Cruises PPO
  • Sanus Health Corporation
  • Seasons Hospice
  • Simply Healthcare Medicaid HMO
  • Solstice Dental HMO/PPO
  • Start Healthcare Network
  • Sunshine
  • Sunshine AMBETTER
  • Sunshine Healthy Kids HMO
  • Sunshine Medicaid HMO
  • Sunshine Medicare HMO
  • Tricare South Prime HMO
  • Tricare South Standard PPO
  • United Behavioral Health (UBH)
  • UnitedHealthcare Affiliates
  • UnitedHealthcare Healthy Kids HMO
  • UnitedHealthcare HMO/POS
  • UnitedHealthcare Medicaid HMO
  • UnitedHealthcare Medicare Nursing Home Plan
  • UnitedHealthcare PPO
  • University of Miami Athletic Dept PPO
  • VUMI
  • Wellcare/Staywell Healthy Kids HMO
  • Wellcare/Staywell Medicaid HMO
  • Wexford Health State Inmates
  • Worldwide Managed Care