Cancer of the pharynx

This is the medical name for cancer of the throat.

The pharynx runs from the back of the throat down to the oesophagus and is divided into three sections. These are:

• Nasopharynx
• Oropharynx
• Laryngopharynx

The nasopharynx is the section of the throat which runs from the nasal passages to the uvula (back of the throat).

The oropharynx includes the base of the tongue, uvula, tonsils and epiglottis. It encompasses the back of the throat.

The laryngopharynx is the area beneath the oropharynx which includes the larynx and vocal cords. It includes these structures and the opening to the oesophagus.

Cancer can develop in any of these sections.

Cancer of the pharynx –also known as pharyngeal cancer can occur in any of these areas of the throat. It is more common in people who smoke and/or drink large amounts of alcohol which are the main risk factors.

Causes of cancer of the pharynx

This is a fairly rare form of cancer and especially in people who do not smoke or drink to excess. Experts are not 100% sure what causes this type of cancer although they have identified the following risk factors:

• Smoking
• Family history
• Poor or unhealthy diet
• Viruses
• Repeated ear, nose and throat infections
• Exposure to pollutants or chemicals, e.g. wood dust

These are also risk factors for many other types of cancer.

Symptoms of cancer of the pharynx

Some people experience one or more symptoms whereas others find that they do not experience any symptoms. Some people have symptoms which are very similar to a cold or flu.

The main symptom is a sore throat. This may not automatically mean that you have pharyngeal cancer and can be the sign of another condition. But if this or any other symptoms persist for more than a couple of weeks then see your GP.

Symptoms to look out for include:

• Difficulty in eating or swallowing
• A feeling of something lodged in your throat
• A growth in your neck
• Coughing
• Increased phlegm especially when coughing
• Nosebleeds or blood stained discharge
• Hearing loss
• Build up of fluid within the ear
• Numb feeling in the lower part of your face
• Hoarseness/change in quality of voice
• Headache
• Stuffy nose
• Pain in the neck, ears or jaws
• Swollen lymph glands in the neck

These symptoms will vary depending upon which part of your pharynx is affected. If for example, your nasopharynx is affected by a tumour then you may experience a change in the tone or pitch of your voice or it becomes deeper (or ‘croaky’).

To re-iterate: if you have any of these symptoms then do not assume that you have cancer of the pharynx. These symptoms could indicate another, less serious condition and happen to be very similar to those for pharyngeal cancer.

But, we would advise you to see your GP as soon as possible. He or she will be able to rule out cancer – if this is the case, or if he/she suspects cancer then will refer you to a cancer specialist.

The earlier cancer is detected the better so it is important to get these symptoms checked sooner rather than later.

Diagnosing cancer of the pharynx

The process starts with your GP. He/she will examine your throat and ask you about your health in general. He or she will also ask questions about your lifestyle and your medical history.

The next step is that of referral to a specialist. This will involve you meeting with him/her to discuss your cancer, undergoing a series of tests and then arranging a treatment plan.

The specialist will examine you before arranging a series of tests. These will include X-rays and blood tests. You will also undergo any of the following:

• Panendoscopy
• Nasendoscopy
• Biopsy
• Fine needle aspiration

(Source: Cancer Research UK: nasopharyngeal cancer)

Panendoscopy

This is the name given to a procedure in which the specialist has a closer look at your throat and neck using a panendoscope.

A panendoscope is a series of connected tubes with a light and camera mounted at one end and an eyepiece for the specialist at the other. You will be given a general anaesthetic before this tube is inserted into your nose and passed down your throat.

This enables the specialist to have a close look at the upper part of your airways. If there are any suspicious looking growths in your throat then he/she will take a biopsy.

Nasendoscopy

This is a type of endoscope which is passed into your throat via your nose. It is inserted into your nasal passages and passed down into your throat to enable the specialist to closely examine it.

This can be a rigid or flexible telescope (tubes) which has a light and camera attached to one end. This allows the specialist a detailed view of your throat and any tumours that are present.

Your throat will be numbed with a local anaesthetic spray beforehand which makes this insertion easier.

Biopsy

A biopsy is a procedure performed during nasendoscopy or panendoscopy. It involves the removal of a small sample of tissue from the tumour which is then sent to a laboratory for analysis.

Fine needle aspiration

This is carried out if your specialist suspects that your cancer has spread to your lymph nodes in your neck. He or she will insert a thin needle into the growth (lump) to remove a sample of cells and tissue. This sample is then forwarded to the laboratory to see if they are cancerous.

Other tests include:

• Bone scan
• MRI scan
• CT scan

A chest X-ray may be performed if your specialist suspects that your cancer has spread to your lungs. However, this is a rare occurrence unless your cancer is at an advanced stage.

Bone scan

A bone scan is another option although this tends to be performed only if the cancer is at an advanced stage. It is carried out if there is the likelihood of the cancer having spread to your bones.

MRI/CT scans

MRI and CT scans are both effective ways of detecting cancer. They use magnetism or X-rays to obtain a cross section of images of the throat. These images are detailed and show an accurate representation of the throat and any tumours that may be present.

They can also show if the cancer has spread to the lymph nodes in the neck.

Results of these tests

This can be an anxious time. It is natural to feel at edge during this time so it may help to discuss this with someone close to you. Your partner, a member of your family or a close friend can provide a sympathetic ear and moral support.

You may prefer to talk to a counselling service or a cancer support group.

It usually takes a week for the results to come back. Once they have done so your specialist will ask you to return to the hospital to discuss them with you. This discussion will also include formulating a treatment plan for you.

Treatment for cancer of the pharynx

With any treatment for cancer you will be placed in the hands of a multi-disciplinary team. This team will include a cancer specialist, surgeons, dieticians, cancer nurses etc and is responsible for your care.

They will devise a suitable course of treatment depending upon the type of cancer you have (which part of the pharynx it is in), your age, general health and fitness and the stage of your cancer.

A word about stages of cancer: this term is used to describe the extent of your cancer. So when applied your cancer it means how far the cancer has spread. These stages range from 0 to 4.

Stage 0 is early stage cancer whereas stage 4 is an advanced stage of cancer.

The care team may recommend a combination of treatments or a single treatment depending upon your cancer.

Treatment options include:

• Surgery
• Chemotherapy
• Radiotherapy

In some cases you may have a combination of chemotherapy and radiotherapy: in others situations you may have chemotherapy by itself or radiotherapy by itself.

Both of these can be used before and/or after surgery. They are used to destroy cancer cells, help shrink a tumour or prevent the spread of the disease.

Chemotherapy and radiotherapy are more commonly used than surgery. Surgery is an option but does not tend to be performed very often due to the fact that certain areas of the throat are difficult to access. This increases the chance of complications.

If this surgery is performed then it is usually in cases where the cancer has spread to the lymph nodes or has returned following radiotherapy.

If you have surgery then bear in mind that you may require more than one operation. One procedure will be performed to remove the tumour and others to reconstruct the area of the throat to help you to breathe or swallow.

The care team will discuss all aspects of your treatment with you. This includes the pros and cons of all procedures.