DONE BY : AHMAD TABA`AN ALA`NEZI MARWAN MOHMMED ALKRENAWI

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

 What is Pharyngeal Cancer?

Cancer of the pharynx, more commonly known as the

throat, is also called pharyngeal cancer. It can develop in any of the three regions of the pharynx: The nasopharynx: The area behind the nose and the back of the throat, which is the hollow tube at the upper part of the throat that starts behind the nose and runs down to the neck to become part of the esophagus (the tube that goes to the stomach). The oropharynx: Consisting of the base of tongue, the tonsillar region, soft palate, and back of the mouth. The hypopharynx: The bottom part of the throat.
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Types of Pharyngeal Cancer

Most head and neck cancers are squamous cell

carcinomas, or tumors that develop in the tissue lining the hollow organs 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).

Common Risk Factors for Pharyngeal Cancer

Common risk factors for pharyngeal cancer include:

Smoking or chewing tobacco

Alcohol abuse High doses of radiation therapy, particularly in the

head or neck region Exposure to asbestos or certain industrial chemicals Aging (being 65 years or older)

Pharyngeal Cancer Type-Specific Risk Factors

In addition to the common risk factors for pharyngeal

cancer, there are risk factors specific to each type of pharyngeal 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.

 Oropharyngeal cancer
Risk factors common to oral cavity cancer, like

drinking mat (an herbal tea drink common in South America) The human papillomavirus (HPV) infection may be a factor in some cases of oropharyngeal cancer.

 Hypopharyngeal cancer Nutritional deficiencies may increase the likelihood of

hypopharyngeal cancers. Iron deficiencies may also be caused by PlummerVinson 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 that makes it difficult to swallow (dysphagia). The lower part of the pharynx (the hypopharynx) is where these webs would likely develop.

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General Pharyngeal Cancer Symptoms

Symptoms may vary depending on the location and extent

of the cancer in the pharynx, general symptoms of pharyngeal 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) This X-ray procedure uses a computer to generate detailed pictures of what is happening in your body for pharyngeal 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 of

adjacent 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 at the time of cancer diagnosis.
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Nasopharyngeal tumors
Several types of tumors can develop in the

nasopharynx. Some of these tumors are benign (noncancerous), but others are malignant (cancerous). Benign nasopharyngeal tumors Benign tumors of the nasopharynx are fairly rare and tend to occur in children and young adults. They include tumors or malformations of the vascular system, such as angiofibromas and hemangiomas, and benign tumors of the minor salivary glands that are found within the nasopharynx.
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angiofibroma

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Oropharyngeal tumor
oropharyngeal cancers develop in the throat, just

behind the mouth A few oropharyngeal cancers are benign, but cause problems like breathing and swallowing difficulty Erythroplakia, Leukoplakia
>90% oropharyngeal cancers are squamous cell

carcinomas, its rapidly growing and very danger. surgically excised with radiation followup; when they are more advanced, chemotherapy is also advised.

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Hypopharyngeal tumor
not common but generally has a very poor prognosis Almost 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 therapy

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 Malignant nasopharyngeal tumors These tumors can invade surrounding tissues and

spread to other parts of the body. Nasopharyngeal carcinoma (NPC): This is by far the most 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 is most strongly associated with Epstein-Barr virus infection.
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General Stage Groupings for Pharyngeal Cancer

Stage I Pharyngeal Cancer: The tumor is limited to one region

of 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 the cancer may have spread into nearby lymph nodes. The cancer has not spread (M0) to distant sites.(Example: T2, N0, M0) Stage III Pharyngeal Cancer: The cancer has grown beyond the site of origin and may have spread into nearby soft tissues or lymph nodes.(Example: T3, N1, M0) Stage IV Pharyngeal Cancer: The cancer may be any size and has spread throughout the body.(Example: Any T, Any N, M1)
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Treatment
Surgery

Surgery is the preferred treatment for most pharyngeal cancers. If the cancer is considered localized, surgery may be performed if the tumor is considered surgically resectable and is likely to obtain clean surgical margins when the edges of the tissue removed do not contain tumor cells.

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 Radiotherapy

Because many types of pharyngeal cancers are advanced at diagnosis and/or prone to recurrence and metastasis, postoperative radiation therapy is often recommended to improve clinical outcomes. This is especially important in cases of higher-stage or larger tumors, or evidence of local invasion or metastasis. Radiotherapy may be used by itself or in combination with chemotherapy in cases where the tumor may be too large to be surgically removed

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 Radiotherapy is also used as the primary treatment

modality in most cases of nasopharyngeal cancer Radiotherapy may also be useful as palliative treatment, i.e., to reduce symptoms such as pain and obstruction.

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 Chemotherapy

Chemotherapy is sometimes used with radiation in cases of pharyngeal cancer where the disease is metastatic, unresectable and/or recurrent. It may also be employed postsurgically (along with radiation) in late-stage or aggressive cancers. Chemotherapy is rarely effective by itself in pharyngeal cancer, but is instead a valuable part of a multimodality treatment approach.

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 Immunotherapy in Advanced Nasopharyngeal Cancers

Because many nasopharyngeal cancers are associated with Epstein-Barr virus (EBV) infection, an immunotherapeutic treatment was devised to target this virus. Investigators isolated T cells from the blood of EBV-positive nasopharyngeal cancer patients, and then modified the T cells to attack the EBV virus.

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 Pharynx cancer tends to grow silently with symptoms

Prognosis of Pharynx Cancer

of cancer often not evident until the cancerous disease is quite advanced. The early the diagnosis the better the prognosis Involvement of lymph nodes in the region is associated 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 of pharynx cancer is more indolent with a long survival rate even if the cancerous disease itself has been controlled but not cured. Smoking and alcohol worsen the survival rate.
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THANK YOU

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