What is pharyngeal Cancer?
Cancer starts when cells begin to grow out of control. Pharyngeal cancer is a type of throat cancer that forms in the pharynx - the hollow tube that runs from the back of the nose to the top of the esophagus. Pharyngeal cancer is usually curable in the early stages.
What causes pharyngeal cancer?
The exact cause of the pharyngeal cancer is not yet known, though there are some risk factors. Certain changes in a person's DNA can cause the cells in the pharynx to become cancerous. DNA is the chemical in each of our cells that makes up our genes - the instructions for how our cells function. It also can influence our risk for developing certain diseases, including some kinds of cancer.
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Here, you will find information about signs and symptoms, causes and risk factors, types, diagnosis, staging and prevention about pharyngeal cancer (throat cancer).
Some pharyngeal cancer symptoms are specific to the region in the pharynx where the cancer occurs.
Unabated sore throat
A lump in the back of the throat
Pain or blockage in one ear, persistent infections in one ear
Ringing in the ears, hearing difficulty, hearing loss
Voice changes, hoarseness
A stuffy feeling
Headache
Coughing
Difficult and painful swallowing
Unexplained weight loss
Nosebleeds or bloody discharge from nose
Stuffiness or blockage in the nose
Facial pain, unable to open mouth or move the jaw
Bulging eye, double vision
Otalgia
Coughing up bloody mucus
Drooling or blood-stained saliva
Bad breath, or halitosis
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A risk factor is anything that increases a person's chance of getting a disease such as cancer. Different cancers have different risk factors. Even if a person with pharyngeal cancer has a risk factor, it is very hard to know how much that risk factor may have contributed to the cancer.
Alcohol and tobacco usage represent major part of the risk factors, especially of cancers of the oral cavity, pharynx, oropharynx, hypopharynx, and larynx. People who use both tobacco and alcohol are at even more higher risk of developing these cancers than those people who use either one of them, i.e., tobacco or alcohol.
Infection with cancer-causing types of human papillomavirus (HPV), especially HPV type 16, particularly affects the tonsils or the base of the tongue.
Prolonged radiation exposure.
Occupational exposure to wood dust, asbestos and synthetic fabrics has also been associated with cancers of the pharynx region. Industrial exposure to wood or nickel dust or formaldehyde is also a risk factor.
Epstein-Barr virus is a risk factor for nasopharyngeal cancer and cancer of the salivary glands.
Medical history and physical exam: Most often this is the first step and information about the symptoms, possible risk factors, and any other medical problems will be collected.
The doctor would examine to look for possible signs and symptoms of pharyngeal cancer such as lumps, bumps or other changed areas on the head, face or neck, or problems with the nerves of the face and mouth. The doctor will look inside of the mouth and a complete head and neck exam might be done to look for any abnormal areas.
Blood tests
Imaging studies to determine if the tumor has invaded nearby tissues or other organs in the body.
a. Orthopantomography (panorex) is a panoramic X-ray of the upper and lower jaw. It shows a view from ear to ear and it helps determine if a tumor has grown into the jaw bone.
b. CT scan. A special type of X-ray that makes a series of detailed pictures, with different angles, of areas inside the mouth and neck. A computer is linked to the X-ray machine. A dye may be injected into a vein or swallowed in a pill to help highlight the organs or tissues on the X-ray. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.
c. MRI (magnetic resonance imaging). A machine that uses a magnet, radio waves, and a computer to make detailed pictures of areas inside the mouth and neck. This procedure is also called nuclear magnetic resonance imaging (NMRI).
d. PET scan. During a positron emission tomography scan (PET), a small amount of radioactive glucose (sugar) is injected into a vein. The scanner makes computerized pictures of the areas inside the body. Cancer cells absorb more radioactive glucose than normal cells, so the tumor is highlighted on the pictures.
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The staging system most often used for pharyngeal cancers is the TNM system, which is based on 3 key informations.
1. The extent of the tumor (T): How large is the main (primary) tumor and which, if any, tissues of the pharynx has it spread to?
2. The spread to nearby lymph nodes (N): Has the cancer spread to nearby lymph nodes?
3. The spread (metastasis) to distant sites (M): Has the cancer spread to distant organs such as the lungs?
Numbers or letters alongside or after T, N, and M provide more details about each of the above factors. Higher numbers mean the cancer is more advanced.
Avoiding risk factors and increasing protective factors may help prevent cancer.
Tobacco use: Using tobacco is the most common cause of pharyngeal cancer. The use of all types of tobacco, including cigarettes, pipes, cigars, and smokeless tobacco (snuff and chewing tobacco) can cause cancer of the pharynx.
Alcohol use: Alcohol usage is also an important risk factor for the pharyngeal cancer. The risk of pharyngeal cancer increases with the number of alcoholic drinks consumed per day.
The risk of pharyngeal cancer is higher in people who use both tobacco and alcohol than in those people who use only tobacco or only alcohol.
Betel quid or gutka chewing: Chewing betel quid or gutka (betel quid mixed with tobacco) has been shown to increase the risk of pharyngeal cancer. Betel quid contains areca nut, which is a cancer-causing substance. The risk of oral cavity, pharyngeal, and laryngeal cancer increases with how long and how often betel quid or gutka are chewed. The risk for oral cavity, pharyngeal, and laryngeal cancer is higher when chewing gutka than when chewing betel quid alone.
Personal history of head and neck cancer: A personal history of head and neck cancer increases the risk of oral cavity, pharyngeal, and laryngeal cancer.
HPV infection: Being infected with certain types of HPV, especially HPV type 16, increases the risk of oral cavity and oropharyngeal cancer. HPV infection is spread mainly through sexual contact.
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How Pharyngeal Cancer is treated?
When diagnosed with pharynx cancer, it is important to know the benefits as well as the risks and side effects of each mode of treatment. There are ways to treat pharynx cancer depending on the type and stage of the cancer. It is also dependent on many other factors such as age, overall health, and other unique features or criteria.
Radiation and chemotherapy forms the mainstay of treatment in pharyngeal cancers and surgery is usually adviced after radiotherapy fails.
Several types of operations can be used to treat pharyngeal cancers. Depending on where the cancer is and the stage, different operations may be used to remove the cancer. In most cases, surgery is only required if the tumor returns after chemoradiation therapy.
1. Transoral laser microsurgery: If the tumor is small, the surgeon can perform transoral laser microsurgery. The laser is on a small metal scope (tube). The patient is given anesthesia before the surgery begins. The laser is inserted into the mouth and the beam from the laser is used to excise the tumor, and one centimeter (2.5 inches) of tissue around it.
Larger tumors require a traditional incision with a scalpel.
2. Tumor resection: The entire tumor and an edge of the normal-looking tissue around is removed. The margin of normal tissue is taken out to reduce the chance of any cancer cells being left behind.
3. Mandibulectomy: For removal of the jaw bone the surgeon removes all or part of the jaw bone. This operation may be needed if the tumor has grown into the jaw bone.
If bone does not need to be cut all the way through, then the operation, also known as a partial-thickness mandibular resection or marginal mandibulectomy is performed where only part or a piece of jaw bone is removed.
4. Robotic surgery: Increasingly, trans-oral robotic surgery (TORS) is being used to remove cancers of the pharynx.
5. Laryngectomy (removal of the voice box): Rarely though sometimes even the voice box may also be removed during the operation to remove the cancer. Removal of the larynx is called a laryngectomy.
6. Neck dissection: Cancers of the pharynx most often spread to the lymph nodes in the neck. If the lymph nodes in the neck are affected, a neck dissection may be needed to remove the nodes. Removing of these lymph nodes and also the other nearby tissues is called a neck dissection or lymph node dissection and is done at the same time as the surgery to remove the main tumor. The goal is to remove lymph nodes proven to contain cancer.
a. In a partial or selective neck dissection only a few lymph nodes are removed.
b. For a modified radical neck dissection, most lymph nodes on one side of the neck between the jaw bone and collarbone are removed, as well as some muscle and nerve tissue.
c. In a radical neck dissection, nearly all nodes on one side, as well as even more muscles, nerves, and veins are removed.
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Radiation therapy uses high-energy x-rays or particles to destroy cancer cells or slow their rate of growth. Radiation therapy can be used in many ways to treat pharyngeal cancers.
Radiation therapy, including intensity modulated radiation therapy, stops cancer cells from dividing and slows the growth of the tumor. Radiotherapy also destroys cancer cells and can shrink or eliminate tumors. Intensity modulated radiation therapy allows the use of more effective radiation doses with fewer side effects than conventional radiotherapy techniques.
The use of anti-cancer drugs to treat cancer is chemotherapy. For pharyngeal cancers, the drugs are given into a vein, which allows them to enter the bloodstream and reach cancer that has spread throughout the body.
Chemotherapy is prescribed for different reasons:
1. Together with radiotherapy as an alternative to surgery called chemoradiation.
2. To slow the growth of a tumor and control symptoms when the cancer cannot be cured is called palliative treatment
Chemotherapy combined with radiation therapy is known as chemoradiation and is the most common treatment. In most cases, surgery is only required if the tumor returns after chemoradiation therapy.
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With more study and research newer drugs have been developed which specifically target the cancer known as targeted therapy. They work differently and are known to have lesser severe side effects.
As the name suggests immunotherapy is the use of medicines that help a person's own immune system find and destroy cancer cells. It can be used to treat some pharyngeal cancer.
Immune checkpoint inhibitors, an important part of the immune system is its ability to keep itself from attacking normal cells in the body. Cancer cells sometimes use these checkpoints to avoid being attacked by the immune system. But, newer drugs that target these checkpoints hold a lot of promise as cancer treatments.
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Treatments for pharyngeal cancer are intended to remove or to destroy the cancer cells or slow their growth, though in the process maintaining a patient's quality of life is also an important treatment goal. Palliative treatments can help ease symptoms from the cancer treatment, or in some cases palliative treatment play an even larger role, helping to keep the person comfortable and maintain a good quality of life when in few advanced stages cancer cannot be treated.
Pain is a significant concern for many people with cancer.
Nutrition is another important concern for people with pharyngeal cancers. Both the cancer and its treatment can make it hard to swallow.
There are many other ways the doctor can help the patient maintain quality of life and help control symptoms.