Oropharyngeal Cancer: History & Exam


  • Select appropriate treatment
  • Avoid unnecessary surgery
  • Avoid surgery that is beyond the scope of the surgeon

Primary tumour

  • Location and extent by visual inspection, palpation
  • Mobility of tumour with swallowing and on palpation: if mobile it suggests that PPS is not involved
  • Trismus
  • Fixation to prevertebral fascia: Gently rock soft tissue of tonsil fossa medially and laterally using bimanual palpation with one finger intraorally and opposite hand extra-orally
  • Function of lingual, inferior alveolar, mental and hypoglossal nerves
  • Position of internal carotid artery (inspection and palpation)


  • If adherent, then assess for mandible invasion
  • Check for dental caries if to receive radiation therapy


  • Palpable nodes in Levels 1-3: assume metastases
  • Nodes outside lymphatic basin e.g. lateral cancer with contralateral nodes: Consider FNAC / nodal biopsy

Distant metastasis: CXR / CT / PET

Synchronous Primary (upper aerodigestive tract, lungs)

  • History and office examination
  • Panendocopy
  • CXR / CT / PET

Functional impairment resulting from treatment

  • Pharyngeal function is complex (Swallowing/speech/aspiration)
  • Will soft palate resection cause significant nasal regurgitation and rhinolalia aperta?
  • Can function be maintained with reconstruction with a flap?
  • Will nonsurgical treatment ensure better swallowing and speech?

Access for transoral resection (incl. TORS)

  • Mouth opening
  • Trismus (possible medial pterygoid and/or infra-temporal involvement)
  • Dentition
  • Cervical spine extension
  • Mallampati score


Index: Clinical Practice Guidelines for Oropharyngeal Cancer

Resource Appropriate Oropharyngeal Cancer Guideline Scenarios