Oropharyngeal and Colon Cancer Lecture

Health Horizon: Nurturing
Awareness on Colorectal
and Oropharyngeal Cancer
FATIMA YUSRA D. SAMPANG, MD, FPCP

SSGH - Internist
Objectives:
1. Review the epidemiology of oropharyngeal and colorectal
cancer.
2. Briefly explain the anatomy and histology of the oropharynx,
colon and rectum in relation to cancer.
3. Discuss separately the etiology and risk factors of both
cancers.
4. Enumerate different screening methods used in both cancers.
5. Provide an overview on the management of each cancer entity.
6. Discuss ways on how to prevent oropharyngeal and colorectal
cancer.
Oropharyngeal
Cancer
Epidemiology
• In the US, number of new cases
of head and neck cancers was
estimated at 65,630
• 4% of adult malignancies
• 14,500 estimated deaths in 2020
• Worldwide: incidence exceeds
half a million annually.
• WHO data: oral cancer deaths in
the Philippines reached 2,916 or
0.43% of the total deaths in
2020.
Normal Anatomy and Histology
• Pharynx has 3
divided parts:
• Nasopharynx
• Oropharynx
• Hypopharynx
• Oropharynx –
lined by
squamous cell
• Oral and oropharyngeal cancer are two types of head

and neck cancer, specifically SCC.
• About 90% of head and neck cancers are SCC,
originating from the stratiform squamous epithelial cells
of the mucosa.
• Oropharyngeal SCC affects the back one-third of the
tongue, tonsils, soft palate, nasopharynx, oropharynx,
and hypopharynx.
• The oropharynx
includes the:
• Soft palate
• side and back
walls of the
throat
• tonsils
• back one-third
of the tongue
Etiology and Risk Factors
Risk Factors for Oropharyngeal

Cancer
Alcohol and tobacco use
Marijuana
Occupational exposures
Human papilloma virus
Dietary factors
WHAT IS HPV?
• HPV is the most common sexually transmitted infection in
the United States.
• Of the more than 100 types of HPV, about 40 types can
spread through direct sexual contact to genital areas, as
well as the mouth and throat.
• Oral HPV is transmitted to the mouth by oral sex.
• HPV is thought to cause 60% to 70% of oropharyngeal
cancers in the United States.
Clinical Presentation
• The manifestations vary

according to stage and • It can present as:
primary site of the tumor. • Non-healing ulcers
• Changes in the fit of
• Symptoms >2-4weeks dentures
should be thoroughly • Painful lesions and masses
evaluated. • Sore throat or otalgia
• Males are more frequently • HPV: neck
affected than women. lymphadenopathy
• Advanced
oropharyngeal
cancers: • Decreased
• Severe pain tongue mobility
• Otalgia • Fistulas
• Airway obstruction • Skin
• Cranial neuropathies involvement
• Trismus • Massive
cervical
• Odynophagia lymphadenopat
• Dysphagia hy
Erythroplakia Leukoplakia
Diagnosis
• Physical examination
• Biopsy – endoscopic exam
• Oropharyngeal Cancer
• CT scan is classified through:
• MRI • TNM Staging
• PET scan
• HPV testing
Diagnosis
Treatment
• Categorized into 3 clinical

groups:
• Localized disease
• Locally or regionally advanced
disease
• Recurrent or metastatic disease
Treatment
• Localized disease:
• Treated with curative intent
• Surgery
• Radiation therapy
• Locally or regionally advanced
disease:
• Treated with curative intent
• Combined-modality therapy
• Recurrent or metastatic
disease:
• Treated with palliative intent
• Local or regional radiation therapy
• Combination chemotherapy
Is
OROPHARYNGEAL
CANCER
preventable?
HPV Vaccine
• CDC recommends HPV

vaccination for 11- to 12-
year-olds. CDC also
recommends HPV vaccination
for everyone through age 26,
if not vaccinated already.
• DOH – Quadrivalent HPV
vaccination to all girls aged
9-13.
HPV Vaccine
Dosing Schedules
• Two doses of HPV vaccine are
recommended for most persons
starting the series before their
15th birthday.
• The second dose of HPV vaccine should
be given 6 to 12 months after the first
dose.
• Adolescents who receive two doses
less than 5 months apart will require a
third dose of HPV vaccine.
HPV Vaccine
• Three doses of HPV vaccine are
recommended for teens and young
adults who start the series at ages 15
through 26 years, and for
immunocompromised persons.
• The recommended three-dose
schedule is 0, 1–2 and 6 months.
• Three doses are recommended for
immunocompromised persons
(including those with HIV infection)
aged 9 through 26 years.
Colorectal Cancer
Epidemiology
• 2nd leading cause of cancer death in
the US
• 149,500 new cases and 52,980
deaths in 2021.
• Incidence decreased in individuals 50
years of age or older.
• Incidence increased by 2% each year
for <50 years of age.
• Ranks 4th among the cancer-related
deaths of Filipinos.
• It is estimated that one out of 1800
Normal Anatomy
Blood supply:
Mesenteric artery
Superior and
inferior rectal
arteries
Normal Anatomy
• Based on sites of onset:
• Rectal cancer accounts for
49.66%, colon cancer accounts
for 49.09%, and both sites
combined account for 1.25%
• Among colon cancers, the
most common sites are the
sigmoid colon (55%), followed
by the ascending colon
(23.3%), transverse colon
(8.5%), descending colon
(8.1%), cecum (8.0%), and
Pathophysiology
• Most colorectal cancers
arise from adenomatous
polyps.
• Clinically, the probability
of an adenomatous polyp
becoming cancer depends
on:
• Gross appearance of
the lesion
• Its histologic feature
Risk Factors for the Development of Colorectal
Cancer
Diet : Animal fat, Obesity
Hereditary Syndromes
Polyposis Coli
MYH-associated polyposis
Nonpolyposis syndrome (Lynch’s Syndrome)
Inflammatory bowel disease
Streptococcus bovis bacteremia
Tobacco use
• Symptoms vary with the

anatomic location of the
tumor.
• Proximal Colon tumors
• Distal Colon tumors
• Rectosigmoid tumors
Staging and Prognostic Factors
Staging:
• TNM Classification
Method
Prognosis:
• Depth of tumor
penetration
• Presence of regional
lymph node
involvement
• Presence of distant
metastasis
Prevention
Primary Prevention - include avoiding CRC risk factors and
increasing protective factors for CRC.
Avoiding Risk Factors: Increasing Protective

• Smoking cessation Factors:
• Restriction of fat intake. • Aerobic physical activity
• Diet: High in fruits and
vegetables
• Aspirin
• Estrogen
• Calcium and Vitamin D
Prevention
Secondary
Prevention - called
CRC screening, consist
of methods for the
diagnosis and removal
of the precancerous
lesions of CRC, called
neoplastic colorectal
polyp.
Screening
Screening Strategies for Colorectal
Cancer
Digital Rectal Examination
Stool testing
Occult blood
Fecal DNA
Imaging
Contrast Barium enema
Virtual
Endoscopy
Flexible Sigmoidoscopy
Colonoscopy
Treatment
• Total resection of the

tumor – optimal treatment
• Radiation therapy to the
pelvis – recommended for
rectal cancer.
• Systemic therapy –
chemotherapy
( neoadjuvant, adjuvant,
palliative)
THANK YOU for
LISTENING!

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Health Horizon: Nurturing

FATIMA YUSRA D. SAMPANG, MD, FPCP

• Oral and oropharyngeal cancer are two types of head

Risk Factors for Oropharyngeal

• The manifestations vary

• Categorized into 3 clinical

• CDC recommends HPV

• Symptoms vary with the

Avoiding Risk Factors: Increasing Protective

• Total resection of the

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