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Pharynx
December 2009
The information presented here should not be used to self-diagnose, or be used in place of a qualified physician’s care.
Pharynx Cancer
- Pharynx cancers are treated by members of the BC Cancer Agency’s Head & Neck Tumour Group.
- Pharynx cancer may also be called throat cancer, pharyngeal cancer or tumour, nasopharyngeal cancer or carcinoma, NPC, oropharyngeal cancer.
- The pharynx is the tube or passageway that connects the nose to the larynx (or voicebox), and the back of the mouth to the esophagus. It consists of three distinct parts:
- The Nasopharynx is the part of the airway that lies behind the nose and above the soft palate. The Eustachian tubes from the middle ear enter the side walls of the nasopharynx.
- The middle part or Oropharynx lies at the back of the mouth and includes the soft palate, the tonsils, the uvula, the base of the tongue and the back or posterior wall of the throat
- The lower section (Hypopharynx or Laryngopharynx) lies on either side of and behind the larynx and connects to the esophagus.
What causes it and who gets it?
Listed below are some of the known risk factors for this cancer. Not all of the risk factors below may cause this cancer, but they may be contributing factors.
- Tobacco use in any form (including passive or second-hand smoking) increases risk of developing pharyngeal cancer. The longer tobacco has been used, the greater the risk.
- Heavy drinking greatly increases the risk for pharyngeal cancer.
- Drinking alcohol in combination with tobacco use greatly increases the risk of pharyngeal cancer.
- Cancer of the nasopharynx is more common in people from Hong Kong and adjacent provinces of southern China, people from the Middle East and Mediterranean basin, and Inuit peoples, regardless of smoking or alcohol consumption patterns.
- Exposure to the Epstein-Barr virus increases the risk.
- Human papilloma virus (HPV) infection is a risk factor.
- Eating a steady diet of salt-cured meats and fish increases the risk.
- Men are two to three times as likely as women to develop NPC.
- Aging is a factor. In BC, the vast majority of these cancers are diagnosed in people aged 40 and older.
- Pharynx cancers are rare in Canada
- Statistics
Can I help to prevent it?
- Some factors cannot be controlled, but since tobacco and alcohol use are major risk factors for developing this cancer, quitting tobacco use is the most important preventive measure to take.
- Don’t start smoking or chewing tobacco products. If you smoke, quit. If you chew tobacco, stop. Stopping tobacco use will reduce your risk, even after years of use.
- After being cured of pharyngeal cancer, stopping tobacco use will also reduce the risk of developing a second primary pharyngeal tumour.
- Reduce the frequent consumption of alcohol.
Screening for this cancer
- No general screening program is effective for pharynx cancer.
- Physical examination of the head and neck by a physician is effective for diagnosing pharyngeal cancer.
- People who regularly use tobacco and alcohol (or who regularly used them in the past) should go for a thorough physical examination by a doctor at least once a year.
Signs and Symptoms
- A common symptom is an enlarged, usually painless, lump in the neck.
- Other symptoms depend on the site. Some tumours may produce no symptoms and may be found at a routine examination.
- Symptoms of cancer of the nasopharynx include: Frequent nosebleeds, deafness on one side or feeling that one ear won't "pop" (blocked Eustachian tube), persistent headache, double vision (due to involvement of the nerves that lie just above the nasopharynx), numbness or change in sensation over the face.
- Symptoms of oropharyngeal cancer include: Persistent sore throat, pain on swallowing, earache, coughing up blood, difficulty swallowing, change in voice or hoarseness.
- Symptoms of hypopharyngeal cancer are: Persistent sore throat, pain or difficulty when swallowing, hoarseness.
- Many of the common symptoms of cancer of the pharynx are also symptoms of non-cancerous conditions. People showing any of the above symptoms for more than two weeks should be evaluated by a physician:
Diagnosis
This is a list of some or all of the tests used to diagnose this type of cancer. More information on diagnostic tests is available.
- Physical examination of the nose, mouth, throat, neck, often using a light and mirror.
- In-depth examination by a head and neck specialist (an otolaryngologist) using an endoscope.
- Biopsy (removal of a small bit of tissue for microscopic examination by a pathologist)
- Imaging of the tumour or distant sites by one or more of the following methods:
- Computed tomography (CT)
- Magnetic Resonance Imaging (MRI)
- X-ray
- Positron Emission Tomography (PET)
- Ultrasound
- Bone scan
Types & Stages
Staging describes the extent of a cancer. The TNM classification system is used as the standard around the world. In general a lower number in each category means a better prognosis. The stage of the cancer is used to plan the treatment.
- T describes the site and size of the main tumour (primary);
- N describes involvement of lymph nodes;
- M relates to whether the cancer has spread (presence or absence of distant metastases).
| Stage T1 |
- the tumour is small and limited to one initial area |
| Stage T2 |
- the tumour is greater than 2 cm but less than 4 cm and may involve the soft tissue of the throat |
| Stage T3 |
- the tumour is greater than 4 cm and may have spread into nearby bone or sinuses |
| Stage T4 |
- the tumour has spread into nearby structures and extends into the soft tissues and / or bones of the neck, larynx, esophagus, jaw and skull base |
Treatment
- Cancer therapies can be highly individualized – your treatment may differ from what is described below.
- Selection of the treatment plan for each patient is based on factors such as the tumour type, the size and stage of the cancer, and patient-specific factors such as age, presence of other medical conditions (co-morbidities), previous therapies.
- Patients should be referred to one of the BCCA regional cancer centres for multidisciplinary assessment.
- Radiation therapy is the treatment of choice for all early stage pharyngeal cancers. Types of RT used include:
- External beam radiotherapy
- Brachytherapy
- 3-D conformal and stereotactic radiotherapy
- Intensity modulated radiotherapy (IMRT)
- Before beginning radiation therapy, patients should have a thorough dental evaluation. A detailed dental evaluation and treatment plan is found here: http://www.bccancer.bc.ca/HPI/CancerManagementGuidelines/HeadnNeck/Dentistry/RadiationTherapyEvaluationandTreatmentPlan+.htmTreatment planning for radiation therapy is complex and requires construction of a custom made mask to keep the head and neck from moving during therapy. The treatment planning phase may take 7 to 10 days before treatment can start.
- Radiation therapy in the head and neck region is likely to cause some of the following side effects:
- Dry mouth
- Dental problems
- Mouth sores
- Difficulty swallowing
- Hearing loss
- Nasopharyngeal cancer is more sensitive to chemotherapy than other cancers of the head and neck. Chemotherapy alone does not offer a cure for pharynx cancers, but it may be used with radiation therapy to increase control of the disease.
- Treatment of advanced cancers (stages T3 orT4) usually involves a combination of radiation therapy and surgery.
- Involvement of the lymph nodes is common in cancers of the pharynx and is generally treated with radiation therapy. Surgical removal of regional lymph nodes may also be required.
Follow-up after Treatment
Coping with Cancer
- BC Cancer Agency staff can help with quality of life issues for those living with or affected by cancer. This includes the physical, emotional, psychological and practical aspects of care. Each cancer experience is different, but in one way or another, many cancer patients share the same needs.
- The effects of cancer and its treatment can present unique challenges: from practical concerns like money and housing, to emotional concerns like anxiety and grief. If you need support with the practical and emotional impacts of cancer, or in managing symptoms and side effects you can use the information in Coping with Cancer to connect to these resources
Search our library catalogue
- Automatically get a bibliography of books, videos and other items available through our library.
Recommended websites
The following websites have been selected and evaluated by the BC Cancer Agency.
- NCI http://www.cancer.gov/
- CCS http://www.cancer.ca/
- ASCO http://www.cancer.net/
- BC Cancer Agency Recommended Websites http://www.bccancer.bc.ca/PPI/RecommendedLinks/typesofcancer/headandneck.htm
Can I help with research at BCCA?
BCCA cancer patients are very helpful when it comes to the fight against cancer. Here are a few ways that you can help.
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