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Pharynx

​This information should not be used for self-diagnosis or in place of a qualified physician's care.

Reviewed 2016

The basics
  • Guidelines for treating this cancer have been developed by the Head and Neck Tumour Group.
  • For health professional information on treating this cancer, please see our Cancer Management Guidelines.
  • Pharynx cancer may also be called throat cancer, pharyngeal cancer or tumour, nasopharyngeal cancer or carcinoma, NPC, or oropharyngeal cancer.
  • The pharynx is the tube or passageway that connects the nose to the larynx (the voicebox) and the back of the mouth to the esophagus. It has three parts:
    • The upper part or 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 the 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 the nearby provinces of southern China, people from the Middle East and Mediterranean basin, and Inuit peoples, regardless of their 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 (nasopharyngeal cancer).
  • 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?

  • Tobacco and alcohol use are both major risk factors.
  • The most important preventive measure to take is to not start smoking or chewing tobacco products. If you already 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 or eliminate alcohol use.

Screening for this cancer

  • No effective screening program exists for this cancer yet.
  • 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 where the cancer is located in the pharynx.
  • 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 & staging

Diagnosis

These are tests that may be used to diagnose this type of cancer.

  • 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 scan)
    • Ultrasound
    • Bone scan

For more information on tests used to diagnose cancer, see our Recommended Websites, Diagnostic Tests section.

Types and Stages

Types

  • Nearly all pharyngeal cancers are carcinomas arising from cells that line the pharynx (squamous cells).
  • A detailed and illustrated explanation of staging of pharyngeal tumours is available on the Cancer.net website.

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

Treatment

Cancer therapies can be highly individualized – your treatment may differ from what is described below.

  • The treatment plan for each patient is based on factors such as the tumour type, the size and stage of the cancer, and other factors like age, the presence of other medical conditions (comorbidities) and previous therapies.
  • Patients should be referred to one of the BCCA regional cancer centres for multidisciplinary assessment.

Radiation therapy

  • 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 will be done. 
  • 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.
  • The BC Cancer Agency provides information to help reduce mouth and teeth problems during and following radiation therapy. 
  • 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

Chemotherapy

  • 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.

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.
  • Treatment of advanced cancers (stages T3 orT4) usually involves a combination of radiation therapy and surgery.

Follow-up after Treatment

  • Guidelines for follow-up after treatment are covered on our website.
  • It is essential that patients be followed carefully for at least two years after initial treatment, by a cancer specialist and/or an otolaryngologist. A large majority of recurrences are found in the first two years after treatment, but late recurrences are more common in patients with nasopharyngeal cancer. Follow-up is recommended for the first seven years after treatment.
  • Following the active treatment phase many patients also require the services of dietitians, physiotherapists and speech therapists.
  • Excellent oral hygiene must be maintained. Detailed information about the effects of radiation on teeth is available in the Head and Neck Cancer Management Guidelines.
  • Life after Cancer focuses on the issues that cancer survivors can face.
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SOURCE: Pharynx ( )
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