Pharyngeal Cancer

What Is Pharyngeal Cancer?

Pharyngeal cancer, medically pharyngeal carcinoma, is the development of a malignant tumor in the pharynx area. The pharynx is anatomically divided into the nasopharynx, the oropharynx, and the hypo-/ laryngopharynx. The uppermost part is the nasopharynx, which connects the nasal cavity with the pharynx. This is followed by the oropharynx (= oral pharynx). This comprises the continuation of the oral cavity to the epiglottis. The oropharynx contains, among other things, the tonsils, parts of the tongue, and the palate. The lower part, which begins at the level of the epiglottis and merges with the esophagus, is the laryngopharynx (= lower pharyngeal space).

Often these malignant tumors arise from the oropharynx's surface cells, which is called oropharyngeal squamous cell carcinoma. This type of cancer has increased in recent years, and proportionally 2.5 times more men develop oropharyngeal carcinoma than women. The average age of onset is between 57 and 61 years.

What Are the Manifestations of Oropharyngeal Cancer?

Oropharyngeal carcinoma may be noticeable by the following symptoms: Sore throat, difficulty swallowing, such as painful or impaired swallowing, ear pain, or difficulty speaking. In addition, the tumor may cause a tight or lumpy feeling in the throat.

Because these symptoms are very nonspecific and can also be caused by a viral or bacterial infection as part of a cold, it often takes a long time for the diagnosis of throat cancer.

Risk Factors and Causes

There are three main risk factors and causes for developing oropharyngeal cancer today. The first two are alcohol and tobacco consumption, as both smoke and alcohol damage the surface cells of the oral pharynx, putting them at greater risk of malignant degeneration. The risk of developing oropharyngeal carcinoma if one consumes a lot of alcohol and tobacco is increased about 30 times.

The third risk factor is human papillomavirus (HPV) infection. In 70%- 80% of oropharyngeal cancers in North America and Europe, the cause is HPV infection. In the head and neck region, the virus type HPV-16 is primarily responsible for cancer development. Since HPV is transmitted primarily through minute mucosa lesions in the anogenital area and oral cavity, sexual contact with many partners and oral sex are risk factors, especially for oropharyngeal carcinoma.

How Is Pharyngeal Cancer Detected?

To diagnose pharyngeal cancer, an endoscopy of the pharynx is carried out in case of suspicion, and a sample of the tumor tissue (= biopsy) is taken. The tissue sample can examine the tumor about the stage and possible HPV genesis. In addition to the endoscopy, an ultrasound examination or a CT scan of the neck can also be obtained to evaluate the tumor spread and look for possible metastases.

Special staining of the tissue is used to determine if the tumor is associated with HPV infection. Immunohistochemistry is used to stain for a specific protein produced more frequently if the tumor has an HPV-associated origin.

Treatment Methods for Pharyngeal Cancer

Pharyngeal cancer can be treated by surgical removal of the tumor, radiation, chemotherapy, or a combination of these methods. Since the positional relationships of the various organs in the head and neck region are very complex and individualized for each patient, it must be weighed individually which form of therapy is suitable for the patient and which offers the most excellent chance of cure.

Pharyngeal Cancer Surgery

Primary surgical treatment is being used more and more frequently in Germany. For example, the tumor can be removed directly through the mouth with the help of a laser in a microsurgical procedure. This type of surgery is particularly suitable if the cancer is located at the tonsils or the base of the tongue. Such minimally invasive procedures offer many advantages over open surgery since, for example, no large skin incisions are necessary, and thus, among other things, problems with wound healing are avoided.

However, if the tumor is already extensive, open surgery, with access from the outside of the neck, may still be necessary.

In addition, there is now also the possibility of using surgical robots to remove the tumor in the oral pharynx.

If the tumor can be completely removed by surgery (R0 resection) and the cervical lymph nodes are either not yet affected, or the affected nodes could be removed entirely in the course of a cervical lymph node excision (N0 evidence), no subsequent radiation or chemotherapy is necessary.

Radiation Therapy for Pharyngeal Cancer

Radiation therapy (=radiatio) can either be added to surgery to destroy any remaining tumor cells or applied primarily without any previous surgery. Suppose the tumor is inoperable, for example. In that case, radiation therapy can also be combined with chemotherapy because it is located at an unfavorable site or has already progressed and grown into important tissue. This form of treatment is called radiochemotherapy.

Chances of Cure and Prognosis

About 60% of those affected generally survive the first five years after diagnosis. Whether the cancer development is related to HPV infection is an essential factor for the prognosis of oropharyngeal carcinoma. In general, it can be said that the prediction of HPV-positive patients is significantly better than that of HPV-negative patients.

For the HPV-positive group, the 5-year survival rate is about 80%, but for the HPV-negative group, it is only 40%-50%. This difference is based on biological reasons. For example, patients whose cancer is associated with HPV infection usually develop the disease relatively young and thus still have few concomitant diseases.

Which Doctors and Clinics are Experts in Pharyngeal Cancer?

Every patient who needs a doctor wants the best medical care. Therefore, the patient is wondering where to find the best clinic. As this question cannot be answered objectively, and a reliable doctor would never claim to be the best one, we can only rely on a doctor's experience.

We will help you find an expert for your condition. All listed doctors and clinics have been reviewed by us for their outstanding specialization in pharyngeal cancer and are awaiting your inquiry or treatment request.

Sources

• www.aerzteblatt.de/archiv/203112/Oropharynxkarzinome-Wenn-humane-Papillomviren-die-Tumorausloeser-sind
• www.msdmanuals.com/de-de/profi/hals-nasen-ohren-krankheiten/kopf-und-halstumoren/oropharyngeales-plattenepithelkarzinom
• www.hno.uni-kiel.de/hno/Klinikschwerpunkte/Tumorchirurgie.php