16 | Chapter 1 head and neck tumors, the 5-year relative survival rate has been increasing over the years, although survival remains low for hypopharyngeal cancer. The survival rate for laryngeal cancer remains approximately constant over time6. We will delve into two specific HNC types that we studied in this thesis. Oropharyngeal carcinoma The oropharyngeal carcinoma is a relatively rare form of cancer that originates in the mucous membrane of the middle throat cavity. The oropharynx is a critical anatomical area within the throat, encompassing structures such as the base of the tongue, the soft palate, the tonsillar regions, and the pharyngeal walls. Given the complexity of this anatomical area, treatment approaches must be precise and conservative to preserve critical functions such as speech and swallowing while minimizing morbidity. Maintaining the patient’s quality of life is paramount, underscoring the importance of tailored treatment strategies that address both the cancer and its potential impact on essential physiological processes7–9. Symptoms of oropharyngeal carcinoma can vary but often include persistent sore throat, difficulty swallowing (dysphagia), ear pain, a lump in the neck (due to enlarged lymph nodes), and changes in voice or hoarseness. Diagnosis typically involves a comprehensive assessment, including physical examination, imaging studies such as CT scans or MRIs, and biopsy for pathological analysis. Risk factors for oropharyngeal cancer include smoking, alcohol consumption, and HPV infection. There are notable differences between HPV-positive and HPV-negative tumors. HPV-positive tumors, often found in younger individuals, has a relatively favorable prognosis compared to HPV-negative tumors, which are more commonly associated with traditional risk factors such as tobacco and alcohol use10. In the Netherlands, as elsewhere, the epidemiology oropharyngeal cancer has evolved, notably influenced by human papillomavirus (HPV) prevalence11, making HPV+ tumors more common. This shift has implications for treatment decisions and outcomes. Treatment for oropharyngeal tumors varies according to the stage of the cancer. For advanced stages (Stage III and IV), where the tumor has spread to nearby lymph nodes or tissues, treatment typically involves a combination of surgery, radiation, and chemotherapy. Chemoradiation is often the primary approach for locally advanced tumors to shrink the tumor and target any spread cancer cells. Surgery may still be considered in certain cases, either before or after chemoradiation, to address remaining tumor or affected lymph nodes12. For recurrent or metastatic disease, treatment options may include surgery, radiation therapy, chemotherapy, targeted therapy, or immunotherapy, with a focus on palliative care to alleviate symptoms and improve quality of life13.
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