Otolaryngology: Pharyngeal Cancer

Pharyngeal Cancer

Pathology

  • Squamous Cell Carcinoma – Most Common Malignant Tumor
  • Adenocarcinoma
  • Adenoid Cystic Carcinoma
  • Lymphoma
  • Rhabdomyosarcoma

General

  • Most Have Lymph Node Involvement by the Time of Diagnosis
  • May Be Associated with Epstein-Barr Virus (EBV) (57%)
    • Titers Can Be Used to Follow Treatment Response

Presentation

  • Nasopharynx:
    • Painless Neck Mass – Most Common Presenting Complaint (60%)
      • From Lymph Node Metastases
    • Nasal Obstruction
    • Nasal Pain
    • Hearing Loss
    • Referred Otalgia – Earache
  • Oropharynx:
    • Pain (Odynophagia/Otalgia)
    • Dysphagia
    • Obstructive Sleep Apnea/Snoring
    • Bleeding
    • Neck Mass

Lymph Node Spread

  • To Posterior Cervical Lymph Nodes:
    • Nasopharynx
    • Oropharynx
  • To Anterior Cervical Lymph Nodes:
    • Hypopharynx

Diagnosis

  • Initial Evaluation: Imaging (CT/MRI)
  • Definitive Diagnosis: Biopsy
    • Avoided for Juvenile Nasopharyngeal Angiofibroma (Hemorrhage Risk)

General Treatment

  • Early-Stage (Stage I-II): Radiation Therapy
    • May Consider Transoral Resection for Oropharyngeal Cancer
  • Advanced-Stage (Stage III-IV):
    • Nasopharyngeal Cancer: Chemoradiation Therapy (No Surgery)
    • Oropharyngeal Cancer:
      • Surgical Resection & Adjuvant Radiation Therapy (With/Without Chemotherapy)
      • Definitive Chemoradiation Therapy
    • *Basic Indications: > 4 cm, Positive LN or Bony Invasion

Juvenile Nasopharyngeal Angiofibroma (JNA)

Basics

  • Benign Vascular Tumor of the Nasopharynx
    • The Most Common Benign Tumor of the Nasopharynx
  • Mostly in Young Males (10-25 Years Old)
  • High Recurrence Rate (Up to 35%)

Presentation

  • Nasal Obstruction
  • Epistaxis
  • Nasal Mass
  • Nasal Pain

Diagnosis

  • Preliminary Diagnosis: CT/MRI
    • “Holman-Miller Sign” – Anterior Bowing of the Posterior Maxillary Wall
  • Avoid Biopsy (Risk Life-Threatening Hemorrhage)
  • Definitive Diagnosis Based on Pathology After Resection

Treatment

  • Primary Treatment: Surgical Resection
  • Strongly Consider Preoperative Angioembolization if Moderate-Large Size