Tonsil Cancer

Determining Your Prognosis

Your prognosis is a prediction of the outcome of your disease. What is the risk of succumbing to the cancer or the risk of its coming back? These are the big questions on most people’s minds after receiving a diagnosis of throat cancer. Prognosis is based on many factors, and a survival rate is an estimate based on large populations of patients who have been given a similar stage of their throat cancer. There are many specific factors that are unique to each patient that may influence treatment success.

The following aspects of the cancer may affect your prognosis.

Human Papillomavirus (HPV) Status Unlike other head and neck cancers, squamous cell cancers of the oropharynx can be divided into HPV-related and HPV-unrelated cancers. Details are still being worked out, but it is becoming clear that with current treatment methods, patients with HPV-related oropharynx cancer have a better chance at being cured than those with HPV-unrelated oropharynx cancer.
Stage It is very important to know the stage to help determine your chance of cure. However, the staging system at this point does not separate HPV-positive from HPV-negative cancers.
Spread to Lymph NodesSpread of Cancer Cells Outside Lymph Node Capsule This goes along with stage. However, even without other factors, if there is spread to lymph nodes in the neck, there’s a diminished chance of cure, particularly if there is evidence of spread of cancer outside the lymph node. Still, for HPV-related oropharynx cancer, there is some data indicating that spread outside of lymph nodes is not as bad a sign as HPV-unrelated oropharynx cancer.
Tumor Margins The ability to completely remove the tumor can be a very important factor that will influence the likelihood of being cured.
Spread into Local Structures Spread into large nerves, vessels or lymphatics might make your prognosis worse.

To give you a percentage chance of cure is difficult because the SEER data groups different types of cancers together and may include patients from a long time ago. SEER stands for Surveillance Epidemiology and End Results. It is a cancer database maintained by the National Cancer Institute. This database collects statistics on patients with cancer around the country. Also, oropharynx cancer is treated in many different ways, and this data does not separate different treatment methods. Most importantly, much of the data in these large databases do not separate HPV-positive from HPV-negative oropharynx cancers. In general, for patients with cancer of the oropharynx (including soft palate), SEER data shows the following:

Estimated Disease-Specific Survival at Five Years Estimated Disease-Specific Survival at Ten Years
Oropharynx Cancer
Oropharynx Cancer
Stage I 56% 42%
Stage II 58% 46%
Stage III 55% 44%
Stage IV 43% 37%

Estimated Disease-Specific Survival is the percentage of people with a specific cancer who are alive at a given time point, such as five years after diagnosis. It excludes people who may have died from a disease other than their cancer. It is probably the best estimate we have in these large national databases as to the prognosis of a particular type of cancer at each stage.

A contemporary study that analyzed survival in HPV-related oropharynx cancers versus non-HPV related oropharynx cancers revealed some interesting results. This study found that for Stage III and Stage IV oropharynx cancer, there was a difference in survival after three years based on the HPV status (82 percent in HPV positive cancers versus 57 percent in HPV negative cancers). Due to this discrepancy in the prognosis for HPV positive and HPV negative cancers, there is active research to determine if HPV negative tumors should be treated in the same manner as HPV positive tumors.


1 Ang KK, Harris J, Wheeler R, Weber R, Rosenthal DI, Nguyen-Tân PF, Westra WH, Chung CH, Jordan RC, Lu C, Kim H, Axelrod R, Silverman CC, Redmond KP, Gillison ML. Human papillomavirus and survival of patients with oropharyngeal cancer. N Engl J Med. 2010 Jul 1;363(1):24-35. doi: 10.1056/NEJMoa0912217. Epub 2010 Jun 7.

2 Blot WJ, McLaughlin JK, Winn DM, et al. Smoking and drinking in relation to oral and pharyngeal cancer. Cancer research. Jun 1 1988;48(11):3282-3287.

3 D'Souza G, Kreimer AR, Viscidi R, et al. Case-control study of human papillomavirus and oropharyngeal cancer. The New England journal of medicine. May 10 2007;356(19):1944-1956.

4 Moreno-Lopez LA, Esparza-Gomez GC, Gonzalez-Navarro A, Cerero-Lapiedra R, Gonzalez-Hernandez MJ, Dominguez-Rojas V. Risk of oral cancer associated with tobacco smoking, alcohol consumption and oral hygiene: a case-control study in Madrid, Spain. Oral oncology. Mar 2000;36(2):170-174.

5 Koivunen P, Rantala N, Hyrynkangas K, Jokinen K, Alho OP. The impact of patient and professional diagnostic delays on survival in pharyngeal cancer. Cancer. Dec 1 2001;92(11):2885-2891.

6 Roistacher SL, Tanenbaum D. Myofascial pain associated with oropharyngeal cancer. Oral surgery, oral medicine, and oral pathology. May 1986;61(5):459-462.

7 Rogers SN, Vedpathak SV, Lowe D. Reasons for delayed presentation in oral and oropharyngeal cancer: the patients perspective. The British journal of oral & maxillofacial surgery. Jul 2011;49(5):349-353.

8 Spiro RH, Thaler HT, Hicks WF, Kher UA, Huvos AH, Strong EW. The importance of clinical staging of minor salivary gland carcinoma. Am J Surg. 1991 Oct;162(4):330-6.

9 Krause CJ, Carey TE, Ott RW, Hurbis C, McClatchey KD, Regezi JA. Human squamous cell carcinoma. Establishment and characterization of new permanent cell lines. Arch Otolaryngol. Nov 1981;107(11):703-710.

10 Licitra L, Perrone F, Bossi P, et al. High-risk human papillomavirus affects prognosis in patients with surgically treated oropharyngeal squamous cell carcinoma. Journal of clinical oncology: official journal of the American Society of Clinical Oncology. Dec 20 2006;24(36):5630-5636.

11 Eveson JW, Cawson RA. Tumours of the minor (oropharyngeal) salivary glands: a demographic study of 336 cases. Journal of oral pathology. Jul 1985;14(6):500-509.

12 Jan JC, Hsu WH, Liu SA, Wong YK, Poon CK, Jiang RS, Jan JS, Chen IF. Prognostic factors in patients with buccal squamous cell carcinoma: 10-year experience. J Oral Maxillofac Surg. 2011 Feb;69(2):396-404.

13 Sinha P, Lewis JS Jr, Piccirillo JF, Kallogjeri D, Haughey BH. Extracapsular spread and adjuvant therapy in human papillomavirus-related, p16-positive oropharyngeal carcinoma. Cancer. 2012 Jul 15;118(14):3519-30.

14 Pradhan SA, Rajpal RM. Marginal mandibulectomy in the mangement of squamous cancer of the oral cavity. Indian J Cancer. 1987;24;167-171.

15 Maddox WA, Urist MM. Histopathological prognostic factors of certain primary oral cavity cancers. 1990 Dec;4(12):39-42; discussion 42, 45-6.

16 Piccirillo JF, Costas I, Reichman ME. Chapter 2: Cancers of the Head and Neck. Ries LAG, Young JL, Keel GE, Eisner MP, Lin YD, Horner M-J (editors). SEER Survival Monograph: Cancer Survival Among Adults: U.S. SEER Program, 1988-2001, Patient and Tumor Characteristics. National Cancer Institute, SEER Program, NIH Pub. No. 07-6215, Bethesda, MD, 2007.

17 Cohen, E. E., LaMonte, S. J., Erb, N. L., Beckman, K. L., Sadeghi, N. , Hutcheson, K. A., Stubblefield, M. D., Abbott, D. M., Fisher, P. S., Stein, K. D., Lyman, G. H. and Pratt‐Chapman, M. L. (2016), American Cancer Society Head and Neck Cancer Survivorship Care Guideline. CA: A Cancer Journal for Clinicians, 66: 203-239. doi:10.3322/caac.21343

18 Adelstein, D. J., et al. (2012). “Transoral resection of pharyngeal cancer: summary of a National Cancer Institute Head and Neck Cancer Steering Committee Clinical Trials Planning Meeting, November 6-7, 2011, Arlington, Virginia.” Head Neck 34(12): 1681-1703. 

19 Amin M, Edge S, Greene F, et al. (2017). AJCC Cancer Staging Manual, 8th ed. New York: Springer.

20 Barnstetter BF, Blodgett TM, Zimmer LA et al. (2005). “Head and neck malignancy: is PET/CT more accurate than PET or CT alone?” Radiology 235(2):580-586.

21 Beitler JJ, Zhang Q, Fu KK, et al. (2014). “Final results of local-regional control and late toxicity of RTOG 9003: a randomized trial of altered fractionation radiation for locally advanced head and neck cancer.” Int J Radiat Oncol Biol Phys 89(1):13-20.

22 Cracchiolo, J. R., et al. (2016). “Increase in primary surgical treatment of T1 and T2 oropharyngeal squamous cell carcinoma and rates of adverse pathologic features: National Cancer Data Base.” Cancer 122(10): 1523-1532.

23 Denis F, Garaud P, Bardet E at al. (2004). “Final results of the 94-01 French Head and Neck Oncology and Radiotherapy Group randomized trial comparing radiotherapy alone with concomitant radiochemotherapy in advanced-stage oropharynx carcinoma.” J Clin Oncol 22(1):69-76.

24 Haughey, B. H., et al. (2011). “Transoral laser microsurgery as primary treatment for advanced-stage oropharyngeal cancer: a United States multicenter study.” Head Neck 33(12): 1683-1694.

25 Hinni, M. L., et al. (2013). “Margin mapping in transoral surgery for head and neck cancer.” Laryngoscope 123(5): 1190-1198.

26 Li RJ, Richmon JD. (2012). “Transoral edoscopic surgery: new surgical techniques for oropharyngeal cancer.” Otolaryngol Clin North Am 45(4):823-844.

27 Sher, D. J., et al. (2017). “Radiation therapy for oropharyngeal squamous cell carcinoma: Executive summary of an ASTRO Evidence-Based Clinical Practice Guideline.” Pract Radiat Oncol 7(4): 246-253.

28 Zumsteg, Z. S., et al. (2017). “Impact of concomitant chemoradiation on survival for patients with T1-2N1 head and neck cancer.” Cancer 123(9): 1555-1565. 

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