Treatment for pharyngeal cancer depends on the location in the pharynx (nasopharynx, oropharynx, or hypopharynx), the size of the tumor, and extent/spread of the tumor to nearby tissues/structures. The following is a brief overview of treatment options for tumors in different parts of the pharynx:
The most common treatment for cancers in the nasopharynx is radiation therapy to the tumor and lymph nodes. Radiation may be administered to the lymph nodes as a preventative measure, even if no cancer is detected there. In more advanced cases, a combination of chemotherapy and radiation therapy may be the primary treatment. A neck dissection may also be considered to remove lymph nodes and nearby tissues/structures in the neck. Endoscopic surgery to remove the tumor may be an option for some patients who don’t respond to radiation therapy.
The primary treatment for oropharyngeal cancer is radiation therapy to the tumor and lymph nodes. Surgery followed by radiation therapy is another option that may be considered in some cases. In more advanced stages, the primary treatment is often a combination of chemotherapy and radiation therapy, radiation therapy plus targeted therapy, or surgery followed by chemoradiation. For metastatic disease, the doctor may recommend chemotherapy, clinical trials, or palliative treatments intended to shrink tumors and relieve symptoms.
The primary treatment for hypopharyngeal cancer is radiation therapy to the tumor and lymph nodes. Surgery followed by radiation therapy is another option that may be considered in some cases. In more advanced stages, the primary treatment is often a combination of chemotherapy and radiation therapy, radiation therapy plus targeted therapy, or surgery followed by chemoradiation. For metastatic disease, the doctor may recommend chemotherapy, clinical trials, or palliative treatments intended to shrink tumors and relieve symptoms.
The doctor may recommend any of the following treatments:
Surgery to remove the tumor and surrounding tissue is a common treatment for pharyngeal cancer. The doctor may be able to remove the tumor endoscopically, using only a thin flexible tool passed into the throat. However, other cases may require a surgical incision in the neck, jaw bone, or facial bones. In more extensive cases, the doctor may also need to surgically remove nearby structures that may be affected, including the tongue, jaw bone, roof of mouth, and larynx. The doctor may also perform a neck dissection, in which lymph nodes and tissue in the neck are removed. Some patients may need a tracheostomy or gastronomy tube in order to help them breathe and eat.
Radiation therapy uses waves of high energy rays produced by a machine to destroy cancer cells. Radiation therapy is often the primary treatment for early-stage oropharyngeal and nasopharyngeal tumors. Radiation therapy is also commonly given after surgery to kill any remaining cancer cells and prevent a recurrence. In locally advanced cases, radiation therapy may be combined with chemotherapy (chemoradiation) as the primary treatment. Radiation therapy may also be used to treat lymph nodes in the neck, even if they are cancer-free, or to shrink tumors and relieve symptoms in more advanced cases.
Proton beam radiation therapy
Proton therapy is an advanced type of radiation therapy that uses “protons” rather than X-ray “photons” to deliver radiation to the tumor. In conventional radiotherapy, the photon beams can deposit radiation and damage healthy cells as they pass through the body. Proton therapy deposits most of the radiation directly at the tumor site, resulting in less damage to healthy tissue and fewer side-effects.
Chemotherapy is the use of drugs to target rapidly growing cells in an effort to destroy cancer cells. Chemotherapy is often combined with radiation therapy (chemoradiation) to treat locally advanced tumors in the pharynx. Chemotherapy may also be given before or after surgery or radiation therapy, in order to shrink the tumor before these procedures, or kill any remaining cancer cells after these procedures. Chemotherapy may also be the primary treatment in very advanced cases.
Some cases of pharyngeal cancer contain cells that over-express certain proteins (EGFR protein) that cause the cancer to grow more aggressively. A form of biological therapy called monoclonal antibodies specifically targets these cells, preventing them from fueling cell growth.
Clinical trials allow patients to try a new treatment before it is available to the general public. In some cases, this may be a new drug that has not been used in humans before, or it may be a drug or drug combination that is not currently used for that specific type of cancer. Early phase clinical trials are often used to test side effects of a drug or drug combination, while later phase clinical trials are used to see how effective a new treatment might be for a certain type of cancer. Clinical trials allow doctors and researchers to improve the treatment of cancers with possibly more effective therapies. A clinical trial may be a new, groundbreaking drug or it may have no effect. It is important to talk with your doctor about the pros and cons of clinical trials for your particular situation.