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DONE BY : AHMAD TABA`AN ALA`NEZI
MARWAN MOHMMED ALKRENAWI
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The Pharynx Pharynx is tubular structure extending from base of
skull superiorly
to esophageal inlet inferiorly Pharynx composed of three distinct areas:
nasopharynx,oropharynx, and hypopharynx
Pharyngeal walls composed of superior, middle, and
inferior pharyngeal constrictor muscles
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What is Pharyngeal Cancer?
Cancer of the pharynx, more commonly known as the
throat, is also called pharyngeal cancer. It can developin any of the three regions of the pharynx:
The nasopharynx: The area behind the nose and theback of the throat, which is the hollow tube at the
upper part of the throat that starts behind the noseand runs down to the neck to become part of theesophagus (the tube that goes to the stomach).
The oropharynx: Consisting of the base of tongue,
the tonsillar region, soft palate, and back of themouth.
The hypopharynx: The bottom part of the throat.
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Types of Pharyngeal Cancer
Most head and neck cancers are squamous cellcarcinomas,
or tumors that develop in the tissue lining the holloworgans of the body.
Other tumor types include lymphoepithelioma,spindle cell carcinoma, undifferentiated carcinoma,
and cancers of the lymph nodes, called lymphoma(most often widespread non-Hodgkin's lymphoma).
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Common risk factors for pharyngeal cancer include:
Smoking or chewing tobacco
Alcohol abuse
High doses of radiation therapy, particularly in thehead or neck region
Exposure to asbestos or certain industrial chemicals
Aging (being 65 years or older)
Common Risk Factors for
Pharyngeal Cancer
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Pharyngeal Cancer Type-Specific
Risk Factors
In addition to the common risk factors for pharyngealcancer, there are risk factors specific to each type ofpharyngeal cancer:
Nasopharyngeal cancer Nasopharyngeal cancers are most common among
people of Chinese or Asian descent.
The Epstein-Barr virus (EBV), commonly known as
"mono," may increase the risk of certain cancers,including nasopharyngeal cancer.
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Oropharyngeal cancer
Risk factors common to oral cavity cancer, like
drinking mat (an herbal tea drink common in SouthAmerica)
The human papillomavirus (HPV) infection may be afactor in some cases of oropharyngeal cancer.
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Hypopharyngeal cancer
Nutritional deficiencies may increase the likelihood ofhypopharyngeal cancers.
Iron deficiencies may also be caused by Plummer-Vinson syndrome. Other nutritional deficiencies may
be related to a history of alcohol abuse. Plummer-Vinson syndrome is characterized by the
development of "esophageal webs," a disorder thatmakes it difficult to swallow (dysphagia). The lower
part of the pharynx (the hypopharynx) is where thesewebs would likely develop.
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enera aryngea ancerSymptoms
Symptoms may vary depending on the location and extentof the cancer in the pharynx, general symptoms ofpharyngeal cancer may include:
A persistent sore throat A lump in the nose or back of the mouth, throat, or neck
Ear pain A change in voice, or unusual hoarseness Trouble breathing, or feeling "stuffed up" Ringing in the ears Headaches A dull pain behind the sternum Coughing Painful or difficult swallowing (dysphagia) Unexplained weight loss
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Diagnosing Pharyngeal Cancer
Physical exam and history
Head, neck and chest X-rays
Endoscopy
Ultrasound
CT scan
MRI
PET scan (Positron Emission Tomography)ThisX-ray procedure uses a computer to generate detailedpictures of what is happening in your body forpharyngeal cancer diagnosis and treatment.
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Progression of Pharynx Cancer
This type of cancerous tumor spreads by
local extension and through the destruction ofadjacent tissue, with bony infiltration being a common
early finding. Cancerous tumors can invade the orbit (the eye), the
skull and the bones of the spinal cord.
Lymphatic invasion with spread to the cervical lymph
nodes is common at cancer diagnosis. Haematogenous spread to distant sites such as the
liver, bones, lungs and spleen may also have occured atthe time of cancer diagnosis.
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Nasopharyngeal tumors
Several types of tumors can develop in thenasopharynx. Some of these tumors are benign (non-cancerous), but others are malignant (cancerous).
Benign nasopharyngeal tumors
Benign tumors of the nasopharynx are fairly rare andtend to occur in children and young adults.
They include tumors or malformations of the vascularsystem, such as angiofibromas and hemangiomas, andbenign tumors of the minor salivary glands that arefound within the nasopharynx.
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angiofibroma
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Oropharyngeal tumor
oropharyngeal cancers develop in the throat, justbehind the mouth
A few oropharyngeal cancers are benign, but causeproblems like breathing and swallowing difficulty
Erythroplakia, Leukoplakia
>90% oropharyngeal cancers are squamous cellcarcinomas, its rapidly growing and very danger.
surgically excised with radiation followup; when theyare more advanced, chemotherapy is also advised.
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Hypopharyngeal tumor not common but generally has a very poor prognosisAlmost all of them are SCC.
Malignant types:
-CA. of the piriform fossa in males
-post cricoid CA. IN FEMALS
vast majority of patients present with at least stage III
disease. history of heavy smoking and drinking, hoarsness of
voice.
asymptomatic neck mass, dysphagia
Radiation thera 18
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Malignant nasopharyngeal tumors
These tumors can invade surrounding tissues andspread to other parts of the body.
Nasopharyngeal carcinoma (NPC):This is by far themost common malignant tumor of the nasopharynx.
Three types of NPC: Keratinizing squamous cell carcinoma
Non-keratinizing carcinoma
Undifferentiated carcinoma
The undifferentiated form is most common, and ismost strongly associated with Epstein-Barrvirusinfection.
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General Stage Groupings for
Pharyngeal Cancer
Stage I Pharyngeal Cancer:The tumor is limited to one regionof the pharynx (nasopharynx, oropharynx or hypopharynx);tumors in oropharynx or hypopharynx are smaller than a peanut(2 cm). The cancer has not spread (M0) beyond its
origin.(Example: T1, N0, M0) Stage II Pharyngeal Cancer:The cancer may have grown into
another region of the pharynx or nearby soft tissues, or thecancer may have spread into nearby lymph nodes. The cancerhas not spread (M0) to distant sites.(Example: T2, N0, M0)
Stage III Pharyngeal Cancer:The cancer has grown beyondthe site of origin and may have spread into nearby soft tissues orlymph nodes.(Example: T3, N1, M0)
Stage IV Pharyngeal Cancer:The cancer may be any size andhas spread throughout the body.(Example: Any T, Any N, M1)
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Treatment Surgery
Surgery is the preferred treatment for most pharyngealcancers.
If the cancer is considered localized, surgery may beperformed if the tumor is considered surgicallyresectable and is likely to obtain clean surgical marginswhen the edges of the tissue removed do not containtumor cells.
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RadiotherapyBecause many types of pharyngeal cancers areadvanced at diagnosis and/or prone to recurrence andmetastasis, postoperative radiation therapy is oftenrecommended to improve clinical outcomes. This is
especially important in cases of higher-stage or largertumors, or evidence of local invasion or metastasis.
Radiotherapy may be used by itself or in combinationwith chemotherapy in cases where the tumor may betoo large to be surgically removed
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Radiotherapy is also used as the primary treatmentmodality in most cases of nasopharyngeal cancer
Radiotherapy may also be useful as palliativetreatment, i.e., to reduce symptoms such as pain andobstruction.
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Chemotherapy
Chemotherapy is sometimes used with radiation incases of pharyngeal cancer where the disease ismetastatic, unresectable and/or recurrent.
It may also be employed postsurgically (along withradiation) in late-stage or aggressive cancers.
Chemotherapy is rarely effective by itself in pharyngealcancer, but is instead a valuable part of amultimodality treatment approach.
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Immunotherapy in Advanced Nasopharyngeal Cancers
Because many nasopharyngeal cancers are associated
with Epstein-Barr virus (EBV) infection, animmunotherapeutic treatment was devised to targetthis virus. Investigators isolated T cells from the bloodof EBV-positive nasopharyngeal cancer patients, and
then modified the T cells to attack the EBV virus.
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Prognosis of Pharynx Cancer Pharynx cancer tends to grow silently with symptoms
of cancer often not evident until the cancerous diseaseis quite advanced.
The early the diagnosis the better the prognosis
Involvement of lymph nodes in the region isassociated with a poorer prognosis of the cancer.
In most cases, the 5 year survival rate is between 15%and 70%.
However, in some cancer patients the course ofpharynx cancer is more indolent with a long survivalrate even if the cancerous disease itself has beencontrolled but not cured.
Smoking and alcohol worsen the survival rate.
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THANK YOU
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