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Throat Cancer

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Laryngeal Cancer

Oropharyngeal Cancer

Nasopharyngeal Cancer

Hypopharyngeal Cancer


Laryngeal Cancer

What is cancer of the larynx?

Cancer of the larynx (or voicebox) is a disease in which cancer (malignant) cells are found in the tissues of the larynx. The larynx is a short passageway shaped like a triangle that is just below the pharynx in the neck. The pharynx is a hollow tube about 5 inches long that starts behind the nose and goes down to the neck to become part of the esophagus, the tube that goes to the stomach. Air passes through the pharynx and then the larynx on the way to the windpipe (trachea) and into the lungs. Food passes through the pharynx on the way to the esophagus. The larynx has a small piece of tissue over it, called the epiglottis, to keep food from going into it or the air passages.

The larynx contains the vocal cords, which vibrate and make sound when air is directed against them. The sound echoes through the pharynx, mouth, and nose to make a personís voice. The muscles in the pharynx, face, tongue, and lips help people form words with sounds to make them understandable.

There are three main parts of the larynx:

  1. The glottis (the middle part of the larynx where the vocal cords are)
  2. The supraglottis (the tissue above the glottis)
  3. The subglottis (the tissue below the glottis). The subglottis connects to the trachea, which takes air to the lungs.

Cancer of the larynx is most commonly found in people who smoke. If a person has cancer of the larynx and smokes, smoking should be stopped.

A doctor should be seen if the following symptoms appear:

  • A sore throat that does not go away
  • Pain when swallowing
  • A change or hoarseness in the voice
  • Pain in the ear
  • A lump in the neck

If there are symptoms, a doctor will put a tube with a special light on the end of it down the patientís throat to look at the larynx. This is called laryngoscopy. If tissue that is not normal is found, the doctor will need to cut out a small piece and look at it under the microscope to see if there are any cancer cells. This is called a biopsy. The doctor will also feel the throat for lumps.

The chance of recovery (prognosis) depends on where the cancer is in the larynx, whether the cancer is just in the larynx or has spread to other tissues (the stage), and the patientís general state of health.

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Stages of cancer of the larynx

Once cancer of the larynx is found, more tests will be done to find out if cancer cells have spread to other parts of the body. This is called staging. A doctor needs to know the stage of the disease to plan treatment. In cancer of the larynx, the definitions of the early stages depend on where the cancer started. The following stages are used for cancer of the larynx:

Stage I

The cancer is only in the area where it started and has not spread to lymph nodes in the area or to other parts of the body (lymph nodes are small bean-shaped structures that are found throughout the body; they produce and store infection-fighting cells). The exact definition of stage I depends on where the cancer started, as follows:

Supraglottis

The cancer is only in one area of the supraglottis and the vocal cords can move normally.

Glottis

The cancer is only in the vocal cords and the vocal cords can move normally.

Subglottis

The cancer has not spread outside of the subglottis.

Stage II

The cancer is only in the larynx and has not spread to lymph nodes in the area or to other parts of the body. The exact definition of stage II depends on where the cancer started, as follows:

Supraglottis

The cancer is in more than one area of the supraglottis, but the vocal cords can move normally.

Glottis

The cancer has spread to the supraglottis or the subglottis or both. The vocal cords may or may not be able to move normally.

Subglottis

The cancer has spread to the vocal cords, which may or may not be able to move normally.

Stage III

Either of the following may be true:

  1. The cancer has not spread outside of the larynx, but the vocal cords cannot move normally, or the cancer has spread to tissues next to the larynx.
  2. The cancer has spread to one lymph node on the same side of the neck as the cancer, and the lymph node measures no more than 3 centimeters (just over 1 inch).

Stage IV

Any of the following may be true:

  1. The cancer has spread to tissues around the larynx, such as the pharynx or the tissues in the neck. The lymph nodes in the area may or may not contain cancer.
  2. The cancer has spread to more than one lymph node on the same side of the neck as the cancer, to lymph nodes on one or both sides of the neck, or to any lymph node that measures more than 6 centimeters (over 2 inches).
  3. The cancer has spread to other parts of the body.

Recurrent

Recurrent disease means that the cancer has come back (recurred) after it has been treated. It may come back in the larynx or in another part of the body.

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Treatment Option Overview

How cancer of the larynx is treated

There are treatments for all patients with cancer of the larynx. Three kinds of treatment are used:

  • Radiation therapy (using high-dose x-rays or other high-energy rays to kill cancer cells)
  • Surgery (taking out the cancer)
  • Chemotherapy (using drugs to kill cancer cells)

Radiation therapy uses high-energy x-rays to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external radiation therapy) or from putting materials that produce radiation (radioisotopes) through thin plastic tubes in the area where the cancer cells are found (internal radiation therapy). External radiation to the thyroid or the pituitary gland may change the way the thyroid gland works. The doctor may wish to test the thyroid gland before and after therapy to make sure it is working properly. Giving drugs with the radiation therapy to make the cancer cells more sensitive to radiation (radiosensitization) is being tested in clinical trials. Radiation given in several small doses per day (hyperfractionated radiation therapy) is also being tested in clinical trials. If smoking is stopped before radiation therapy is started, there is a better chance of surviving longer.

Surgery is a common treatment of cancer of the larynx. A doctor may remove the cancer and part of the larynx using one of the following operations:

  1. A cordectomy takes out only the vocal cord.
  2. A supraglottic laryngectomy takes out only the supraglottis.
  3. A partial or hemilaryngectomy removes only part of the larynx.
  4. A total laryngectomy removes the entire larynx. During this operation, a hole is made in the front of the neck to allow the patient to breathe. This is called a tracheostomy. If cancer has spread to lymph nodes, the lymph nodes will be removed (lymph node dissection).
  5. Laser surgery may be used for very early cancers of the larynx. During laser surgery, a narrow, intense beam of light is used to cut out the cancer.

Chemotherapy uses drugs to kill cancer cells. Chemotherapy may be taken by pill, or it may be put into the body by a needle in a vein or muscle. Chemotherapy is called a systemic treatment because the drug enters the bloodstream, travels through the body, and can kill cancer cells throughout the body.

People with larynx cancer have a higher risk of getting other cancers in the head and neck area. Clinical trials of chemoprevention therapy are testing whether certain drugs can prevent second cancers from developing in the mouth, throat, windpipe, nose, or esophagus (the tube that connects the throat to the stomach).

Because the larynx helps with breathing and talking, a patient may need special help adjusting to the side effects of the cancer and its treatment. A patient may need to learn a new way of talking, or may need a special device to help with talking. The patientís doctor will consult with several kinds of doctors who can help determine the best treatment. Trained medical staff can also help the patient recover from treatment and adjust to new ways of eating and talking.

Treatment by stage

Treatment of cancer of the larynx depends on where the cancer is in the larynx, the stage of the disease, and the patientís age and overall health.

Standard treatment may be considered because of its effectiveness in patients in past studies, or participation in a clinical trial may be considered. Not all patients are cured with standard therapy and some standard treatments may have more side effects than are desired. For these reasons, clinical trials are designed to find better ways to treat cancer patients and are based on the most up-to-date information.

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Stage I Laryngeal Cancer

Treatment depends on where the cancer is found in the larynx.

If cancer is in the supraglottis, treatment may be one of the following:

  1. External beam radiation therapy
  2. Surgery to remove the supraglottis (supraglottic laryngectomy)
  3. Surgery to remove the larynx (total laryngectomy)

If the cancer is in the glottis, treatment may be one of the following:

  1. Radiation therapy
  2. Surgery to take out a vocal cord (cordectomy)
  3. Surgery to remove part of the larynx (hemilaryngectomy) or total laryngectomy
  4. Laser surgery

If the cancer is in the subglottis, treatment will probably be radiation therapy. In some cases, a hemilaryngectomy may be done.

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Stage II Laryngeal Cancer

Treatment depends on where the cancer is found in the larynx.

If the cancer is in the supraglottis, treatment may be one of the following:

  1. External-beam radiation therapy
  2. Surgery to remove the supraglottis (supraglottic laryngectomy) or the entire larynx (laryngectomy).
  3. Radiation therapy may be given after surgery.
  4. A clinical trial of several small doses of radiation per day (hyperfractionated radiation therapy).
  5. A clinical trial of chemoprevention therapy to prevent a second cancer in the mouth, throat, windpipe, nose, or esophagus.

If the cancer is in the glottis, treatment may be one of the following:

  1. Radiation therapy.
  2. Surgery to remove part of the larynx (hemilaryngectomy) or total laryngectomy.
  3. A clinical trial of several smaller doses of radiation per day (hyperfractionated radiation therapy).
  4. A clinical trial of chemoprevention therapy to prevent a second cancer in the mouth, throat, windpipe, nose, or esophagus.

If the cancer is in the subglottis, treatment may be one of the following:

  1. Radiation therapy.
  2. Surgery to remove part of the larynx (hemilaryngectomy) or total laryngectomy.
  3. A clinical trial of several smaller doses of radiation per day (hyperfractionated radiation therapy).
  4. A clinical trial of chemoprevention therapy to prevent a second cancer in the mouth, throat, windpipe, nose, or esophagus.

Clinical trials are evaluating the use of several smaller doses of radiation per day (hyperfractionated radiation therapy).

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Stage III Laryngeal Cancer

Treatment depends on where the cancer is found in the larynx.

If the cancer is in the supraglottis, treatment may be one of the following:

  1. Surgery to remove the cancer with or without radiation therapy.
  2. Radiation therapy. Surgery to remove the larynx (laryngectomy) may be needed if the cancer does not shrink after radiation.
  3. A clinical trial of several smaller doses of radiation per day (hyperfractionated radiation therapy).
  4. A clinical trial of chemotherapy followed by radiation therapy or chemotherapy combined with radiation therapy. Surgery to remove the larynx (laryngectomy) may be needed if the cancer does not shrink after chemotherapy and radiation.
  5. Clinical trials of chemotherapy, the use of drugs to make the cancer cells more sensitive to radiation (radiosensitizers), or new forms of radiation.
  6. Chemoprevention therapy to prevent a second cancer in the mouth, throat, windpipe, nose, or esophagus.

If the cancer is in the glottis, treatment may be one of the following:

  1. Surgery with or without radiation therapy.
  2. Radiation therapy. Surgery to remove the larynx (laryngectomy) may be needed if the cancer does not shrink after radiation.
  3. A clinical trial of several smaller doses of radiation per day (hyperfractionated radiation therapy).
  4. A clinical trial of chemotherapy followed by radiation therapy or chemotherapy combined with radiation therapy. Surgery to remove the larynx (laryngectomy) may be needed if the cancer does not shrink after chemotherapy and radiation.
  5. Clinical trials of chemotherapy, the use of drugs to make the cancer cells more sensitive to radiation (radiosensitizers), or new forms of radiation.
  6. Chemoprevention therapy to prevent a second cancer in the mouth, throat, windpipe, nose, or esophagus.

If the cancer is in the subglottis, treatment may be one of the following:

  1. Surgery to remove the larynx (total laryngectomy), some of the tissue around it, the thyroid gland while preserving the parathyroid glands located near the thyroid, and the lymph nodes in the neck. Surgery is usually followed by radiation therapy.
  2. Radiation therapy if a patient cannot have surgery.
  3. A clinical trial of several smaller doses of radiation per day (hyperfractionated radiation therapy).
  4. Clinical trials of chemotherapy, the use of drugs to make the cancer cells more sensitive to radiation (radiosensitizers), or new forms of radiation.
  5. Chemoprevention therapy to prevent a second cancer in the mouth, throat, windpipe, nose, or esophagus.

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Stage IV Laryngeal Cancer

Treatment depends on where the cancer is found in the larynx.

If the cancer is in the supraglottis, treatment may be one of the following:

  1. Surgery to remove the larynx (total laryngectomy) followed by radiation therapy.
  2. Radiation therapy. Surgery to remove the larynx (laryngectomy) may be needed if the cancer does not shrink after radiation.
  3. A clinical trial of several smaller doses of radiation per day (hyperfractionated radiation therapy).
  4. A clinical trial of chemotherapy followed by radiation therapy or chemotherapy combined with radiation therapy. Surgery to remove the larynx (laryngectomy) may be needed if the cancer does not shrink after chemotherapy and radiation.
  5. Clinical trials of chemotherapy, the use of drugs to make the cancer cells more sensitive to radiation (radiosensitizers), or new forms of radiation.
  6. Chemoprevention therapy to prevent a second cancer in the mouth, throat, windpipe, nose, or esophagus.

If the cancer is in the glottis, treatment may be one of the following:

  1. Total laryngectomy followed by radiation therapy.
  2. Radiation therapy. Surgery to remove the larynx (laryngectomy) may be needed if the cancer does not shrink after radiation.
  3. A clinical trial of several smaller doses of radiation per day (hyperfractionated radiation therapy).
  4. A clinical trial of chemotherapy followed by radiation therapy or chemotherapy combined with radiation therapy. Surgery to remove the larynx (laryngectomy) may be needed if the cancer does not shrink after chemotherapy and radiation.
  5. Clinical trials of chemotherapy, the use of drugs to make the cancer cells more sensitive to radiation (radiosensitizers), or new forms of radiation.
  6. Chemoprevention therapy to prevent a second cancer in the mouth, throat, windpipe, nose, or esophagus.

If the cancer is in the subglottis, treatment may be one of the following:

  1. Total laryngectomy, removal of the thyroid gland, and removal of some of the tissue around the larynx and the lymph nodes in the neck. Surgery is usually followed by radiation therapy.
  2. Radiation therapy if a patient cannot have surgery. Clinical trials are testing new ways of giving radiation therapy and the use of radiosensitizers.
  3. A clinical trial of several smaller doses of radiation per day (hyperfractionated radiation therapy).
  4. A clinical trial of chemotherapy and hyperfractionated radiation therapy given at the same time.
  5. Clinical trials of chemotherapy, the use of drugs to make the cancer cells more sensitive to radiation (radiosensitizers), or new forms of radiation.
  6. Chemoprevention therapy to prevent a second cancer in the mouth, throat, windpipe, nose, or esophagus.

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Recurrent Laryngeal Cancer

Treatment depends on the kind of treatment the patient had when first treated. If the patient had surgery alone, the patient may have surgery again or radiation therapy. If the patient had radiation therapy alone, additional radiation therapy or surgery may be considered. If the patient failed surgery and radiation therapy, clinical trials of chemotherapy may be given to relieve symptoms.

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Oropharynx

What is cancer of the oropharynx?

Cancer of the oropharynx is a disease in which cancer cells are found in the tissues of the oropharynx. The oropharynx is the middle part of the throat (also called the pharynx). The pharynx is a hollow tube about 5 inches long that starts behind the nose and goes down to the neck to become part of the esophagus (tube that goes to the stomach). Air and food pass through the pharynx on the way to the windpipe (trachea) or the esophagus. The oropharynx includes the soft palate (the back of the mouth), the base of the tongue, and the tonsils.

Cancer of the oropharynx most commonly starts in the cells that line the oropharynx.

A doctor should be seen if a person has a sore throat that does not go away, trouble swallowing, a lump in the back of the mouth or throat, a change in the voice, or pain in the ear.

If there are symptoms, a doctor will examine the throat using a mirror and lights. The doctor will also feel the throat for lumps. If tissue that is not normal is found, the doctor will need to cut out a small piece and look at it under the microscope to see if there are any cancer cells. This is called a biopsy.

The chance of recovery (prognosis) depends on where the cancer is in the throat, whether the cancer is just in the throat or has spread to other tissues (the stage), and the patientís general state of health. After the treatment, a doctor should be seen regularly because there is a chance of having a second cancer in the head or neck region.

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Stages of cancer of the oropharynx

Once cancer of the oropharynx is found, more tests will be done to find out if cancer cells have spread to other parts of the body. This is called staging. A doctor needs to know the stage of the disease to plan treatment. The following stages are used for cancer of the oropharynx.

Stage I

The cancer is no more than 2 centimeters (about 1 inch) and has not spread to lymph nodes in the area (lymph nodes are small bean-shaped structures that are found throughout the body; they produce and store infection-fighting cells).

Stage II

The cancer is more than 2 centimeters, but less than 4 centimeters (less than 2 inches), and has not spread to lymph nodes in the area.

Stage III

Either of the following may be true:

  • The cancer is more than 4 centimeters.
  • The cancer is any size but has spread to only one lymph node on the same side of the neck as the cancer. The lymph node that contains cancer measures no more than 3 centimeters (just over one inch).

Stage IV

Any of the following may be true:

  • The cancer has spread to tissues around the oropharynx. The lymph nodes in the area may or may not contain cancer.
  • The cancer is any size and has spread to more than one lymph node on the same side of the neck as the cancer, to lymph nodes on one or both sides of the neck, or to any lymph node that measures more than 6 centimeters (over 2 inches).
  • The cancer has spread to other parts of the body.

Recurrent

Recurrent disease means that the cancer has come back (recurred) after it has been treated. It may come back in the oropharynx or in another part of the body.

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Treatment Option Overview

How cancer of the oropharynx is treated

There are treatments for all patients with cancer of the oropharynx. Three kinds of treatment are used:

  • Surgery (taking out the cancer).
  • Radiation therapy (using high-dose x-rays or other high-energy rays to kill cancer cells).
  • Chemotherapy (using drugs to kill cancer cells).

Hyperthermia (warming the body to kill cancer cells) is being tested in clinical trials.

Surgery is a common treatment of cancer of the oropharynx. A doctor may remove the cancer and some of the healthy tissue around the cancer. If cancer has spread to lymph nodes, the lymph nodes will be removed (lymph node dissection). A new type of surgery called micrographic surgery is being tested in clinical trials for early cancers of the oropharynx. Micrographic surgery removes the cancer and as little normal tissue as possible. During this surgery, the doctor removes the cancer and then uses a microscope to look at the cancerous area to make sure there are no cancer cells remaining.

Radiation therapy uses high-energy x-rays to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external radiation therapy) or from putting materials that produce radiation (radioisotopes) through thin plastic tubes in the area where the cancer cells are found (internal radiation therapy). External radiation to the thyroid or the pituitary gland may change the way the thyroid gland works. The doctor may wish to test the thyroid gland before and after therapy to make sure it is working properly. Giving drugs with the radiation therapy to make the cancer cells more sensitive to radiation (radiosensitization) is being tested in clinical trials. If smoking is stopped before radiation therapy is started, there is a better chance of surviving longer.

Chemotherapy uses drugs to kill cancer cells. Chemotherapy may be taken by pill, or it may be put into the body by a needle in the vein or muscle. Chemotherapy is called a systemic treatment because the drug enters the bloodstream, travels through the body, and can kill cancer cells throughout the body.

People with oropharyngeal cancer have a higher risk of getting other cancers in the head and neck area. Clinical trials of chemoprevention therapy are testing whether certain drugs can prevent second cancers from developing in the mouth, throat, windpipe, nose, or esophagus (the tube that connects the throat to the stomach).

Hyperthermia uses a special machine to heat the body for a certain period of time to kill cancer cells. Because cancer cells are often more sensitive to heat than normal cells, the cancer cells die and the cancer shrinks.

Because the oropharynx helps in breathing, eating, and talking, patients may need special help adjusting to the side effects of the cancer and its treatment. A doctor will consult with several kinds of doctors who can help determine the best treatment. Trained medical staff can also help patients recover from treatment and adjust to new ways of eating and talking. Plastic surgery, or help learning to eat and speak, may be needed if a large part of the oropharynx is taken out.

Treatment by stage

Treatment of cancer of the oropharynx depends on where the cancer is in the oropharynx, the stage of the disease, and the patientís age and overall health.

Standard treatment may be considered because of its effectiveness in patients in past studies, or participation in a clinical trial may be considered. Not all patients are cured with standard therapy and some standard treatments may have more side effects than are desired. For these reasons, clinical trials are designed to find better ways to treat cancer patients and are based on the most up-to-date information.

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Stage I Oropharyngeal Cancer

Treatment will be surgery to remove the cancer or radiation therapy.

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Stage II Oropharyngeal Cancer

Treatment will be surgery to remove the cancer or radiation therapy.

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Stage III Oropharyngeal Cancer

Treatment may be one of the following:

  1. Surgery to remove the cancer followed by radiation therapy.
  2. Radiation therapy.
  3. A clinical trial of chemotherapy followed by surgery or radiation therapy.
  4. A clinical trial of chemotherapy combined with radiation therapy.
  5. A clinical trial of new ways of giving radiation therapy.

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Stage IV Oropharyngeal Cancer

If the cancer can be removed by surgery, treatment may be one of the following:

  1. Surgery to remove the cancer followed by radiation therapy.
  2. Radiation therapy.
  3. A clinical trial of radiation therapy combined with chemotherapy.
  4. A clinical trial of new ways of giving radiation therapy.

If the cancer cannot be removed by surgery, treatment may be one of the following:

  1. Radiation therapy. Clinical trials are testing new ways of giving radiation therapy.
  2. A clinical trial of chemotherapy followed by surgery or radiation therapy.
  3. A clinical trial of radiation therapy given with chemotherapy or with drugs to make the cancer cells more sensitive to radiation therapy (radiosensitizers).
  4. A clinical trial of hyperthermia plus radiation therapy.

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Recurrent Oropharyngeal Cancer

Treatment may be one of the following:

  1. Surgery to remove the cancer.
  2. Radiation therapy.
  3. A clinical trial of chemotherapy.
  4. A clinical trial of hyperthermia plus radiation therapy.

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Nasopharyngeal Cancer

General Information About Nasopharyngeal Cancer

Nasopharyngeal cancer is a disease in which malignant (cancer) cells form in the tissues of the nasopharynx.

The nasopharynx is the upper part of the pharynx (throat) behind the nose. The pharynx is a hollow tube about 5 inches long that starts behind the nose and ends at the top of the trachea (windpipe) and esophagus (the tube that goes from the throat to the stomach). Air and food pass through the pharynx on the way to the trachea or the esophagus. The nostrils lead into the nasopharynx. An opening on each side of the nasopharynx leads into an ear. Nasopharyngeal cancer most commonly starts in the squamous cells that line the oropharynx (the part of the throat behind the mouth).

Ethnic background and exposure to the Epstein-Barr virus can affect the risk of developing nasopharyngeal cancer.

Risk factors may include the following:

  • Chinese or Asian ancestry.
  • Exposure to the Epstein-Barr virus: The Epstein-Barr virus has been associated with certain cancers, including nasopharyngeal cancer and some lymphomas.

Possible signs of nasopharyngeal cancer include trouble breathing, speaking, or hearing.

These and other symptoms may be caused by nasopharyngeal cancer or by other conditions. A doctor should be consulted if any of the following problems occur:

  • A lump in the nose or neck.
  • A sore throat.
  • Trouble breathing or speaking.
  • Nosebleeds.
  • Trouble hearing.
  • Pain or ringing in the ear.
  • Headaches.

Tests that examine the nose and throat are used to detect (find) and diagnose nasopharyngeal cancer.

The following tests and procedures may be used:

  • Physical exam of the throat: An exam in which the doctor feels for swollen lymph nodes in the neck and looks down the throat with a small, long-handled mirror to check for abnormal areas.
  • Nasoscopy: A procedure to look inside the nose for abnormal areas. A nasoscope (a thin, lighted tube) is inserted through the nose. Tissue samples may be taken for biopsy.
  • Neurological exam: A series of questions and tests to check the brain, spinal cord, and nerve function. The exam checks a personís mental status, coordination, and ability to walk normally, and how well the muscles, senses, and reflexes work. This may also be called a neuro exam or a neurologic exam.
  • Head and chest x-rays: An x-ray of the skull and organs and bones inside the chest. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.
  • MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI).
  • CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.
  • Laboratory tests: Medical procedures that test samples of tissue, blood, urine, or other substances in the body. These tests help to diagnose disease, plan and check treatment, or monitor the disease over time.
  • Biopsy: The removal of cells or tissues so they can be viewed under a microscope to check for signs of cancer.

Certain factors affect prognosis (chance of recovery) and treatment options.

The prognosis (chance of recovery) and treatment options depend on the following:

  • The stage of the cancer (whether it affects part of the nasopharynx, involves the whole nasopharynx, or has spread to other places in the body).
  • The type of nasopharyngeal cancer.
  • The size of the tumor.
  • The patientís age and general health.

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Stages of Nasopharyngeal Cancer

After nasopharyngeal cancer has been diagnosed, tests are done to find out if cancer cells have spread within the nasopharynx or to other parts of the body.

The process used to find out whether cancer has spread within the nasopharynx or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage in order to plan treatment. The results of the tests used to diagnose nasopharyngeal cancer are often also used to stage the disease.

The following stages are used for nasopharyngeal cancer:

Stage 0 (Carcinoma in Situ)

In stage 0 nasopharyngeal cancer, cancer is found in the lining of the nasopharynx only. Stage 0 cancer is also called carcinoma in situ.

Stage I

In stage I nasopharyngeal cancer, cancer is found in the nasopharynx only.

Stage II

Stage II nasopharyngeal cancer is divided into stage IIA and stage IIB as follows:

  • Stage IIA: Cancer has spread from the nasopharynx to the oropharynx (the middle part of the throat that includes the soft palate, the base of the tongue, and the tonsils), and/or to the nasal cavity.
  • Stage IIB: Cancer is found in the nasopharynx and has spread to lymph nodes on one side of the neck, or has spread to the area surrounding the nasopharynx and may have spread to lymph nodes on one side of the neck.

Stage III

In stage III nasopharyngeal cancer, the cancer:

  • is found in the nasopharynx and has spread to lymph nodes on both sides of the neck; or
  • has spread into the soft tissues (oropharynx and/or nasal cavity) and to lymph nodes on both sides of the neck; or
  • has spread beyond the soft tissues into areas around the pharynx and to lymph nodes on both sides of the neck; or
  • has spread to nearby bones or sinuses and may have spread to lymph nodes on one or both sides of the neck.

Stage IV

Stage IV nasopharyngeal cancer is divided into stage IVA, stage IVB, and stage IVC as follows:

  • Stage IVA: Cancer has spread beyond the nasopharynx and may have spread to the cranial nerves, the hypopharynx (bottom part of the throat), areas in and around the side of the skull or jawbone, and/or the bone around the eye. Cancer may also have spread to lymph nodes on one or both sides of the neck, and the involved lymph nodes are smaller than 6 centimeters.
  • Stage IVB: Cancer has spread to lymph nodes above the collarbone and/or the involved lymph nodes are larger than 6 centimeters.
  • Stage IVC: Cancer has spread beyond nearby lymph nodes to other parts of the body.

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Recurrent Nasopharyngeal Cancer

Recurrent nasopharyngeal cancer is cancer that has recurred (come back) after it has been treated. The cancer may come back in the nasopharynx or in other parts of the body.

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Treatment Option Overview

There are different types of treatment for patients with nasopharyngeal cancer.

Different types of treatment are available for patients with nasopharyngeal cancer. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. Before starting treatment, patients may want to think about taking part in a clinical trial. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment.

Clinical trials are taking place in many parts of the country.

Three types of standard treatment are used:

Radiation therapy

Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated.

External radiation therapy to the thyroid or the pituitary gland may change the way the thyroid gland works. The doctor may test the thyroid gland before and after therapy to make sure it is working properly. Having a dentist evaluate dental health and correct any existing problems is particularly important before beginning radiation therapy.

Chemotherapy

Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping the cells from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the spinal column, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). The way the chemotherapy is given depends on the type and stage of the cancer being treated.

Surgery

Surgery is removing the cancer in an operation. Surgery is sometimes used for nasopharyngeal cancer that does not respond to radiation therapy. If cancer has spread to the lymph nodes, the doctor may remove lymph nodes and other tissues in the neck.

Other types of treatment are being tested in clinical trials. These include the following:

Biologic therapy

Biologic therapy is a treatment that uses the patientís immune system to fight cancer. Substances made by the body or made in a laboratory are used to boost, direct, or restore the bodyís natural defenses against cancer. This type of cancer treatment is also called biotherapy or immunotherapy.

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Treatment Options by Stage

Stage I Nasopharyngeal Cancer

Treatment of stage I nasopharyngeal cancer is usually radiation therapy to the tumor and lymph nodes in the neck.

Stage II Nasopharyngeal Cancer

Treatment of stage II nasopharyngeal cancer may include the following:

  • Chemotherapy combined with radiation therapy.
  • Radiation therapy to the tumor and lymph nodes in the neck.

Stage III Nasopharyngeal Cancer

Treatment of stage III nasopharyngeal cancer may include the following:

  • Chemotherapy combined with radiation therapy.
  • Radiation therapy to the tumor and lymph nodes in the neck.
  • Radiation therapy followed by surgery to remove cancer-containing lymph nodes in the neck that persist or come back after radiation therapy.
  • A clinical trial of chemotherapy before, combined with, or after radiation therapy.

Stage IV Nasopharyngeal Cancer

Treatment of stage IV nasopharyngeal cancer may include the following:

  • Chemotherapy combined with radiation therapy.
  • Radiation therapy to the tumor and lymph nodes in the neck.
  • Radiation therapy followed by surgery to remove cancer-containing lymph nodes in the neck that persist or come back after radiation therapy.
  • Chemotherapy for cancer that has metastasized (spread) to other parts of the body.
  • A clinical trial of chemotherapy before, combined with, or after radiation therapy.

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Treatment Options for Recurrent Nasopharyngeal Cancer

Treatment of recurrent nasopharyngeal cancer may include the following:

  • External radiation therapy plus internal radiation therapy.
  • Surgery.
  • Chemotherapy.
  • A clinical trial of biologic therapy and/or chemotherapy.

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Hypopharyngeal Cancer

General Information About Hypopharyngeal Cancer

Hypopharyngeal cancer is a disease in which malignant (cancer) cells form in the tissues of the hypopharynx.

The hypopharynx is the bottom part of the pharynx (throat). The pharynx is a hollow tube about 5 inches long that starts behind the nose, goes down the neck, and ends at the top of the trachea (windpipe) and esophagus (the tube that goes from the throat to the stomach). Air and food pass through the pharynx on the way to the trachea or the esophagus.

Most hypopharyngeal cancers form in squamous cells, the thin, flat cells lining the inside of the hypopharynx. The hypopharynx has 3 different areas. Cancer may be found in 1 or more of these areas.

Use of tobacco products and heavy drinking can affect the risk of developing hypopharyngeal cancer.

Risk factors include the following:

  • Smoking tobacco.
  • Chewing tobacco.
  • Drinking too much alcohol.
  • Eating a diet without enough nutrients.
  • Having Plummer-Vinson syndrome.

Possible signs of hypopharyngeal cancer include a sore throat and ear pain.

These and other symptoms may be caused by hypopharyngeal cancer or by other conditions. A doctor should be consulted if any of the following problems occur:

  • A sore throat that does not go away.
  • Ear pain.
  • A lump in the neck.
  • Trouble or pain with swallowing.
  • A change in voice.

Tests that examine the throat and neck are used to help detect (find) and diagnose hypopharyngeal cancer.

The following tests and procedures may be used:

  • Physical exam of the throat: An exam in which the doctor feels for swollen lymph nodes in the neck and looks down the throat with a small, long-handled mirror to check for abnormal areas.
  • Endoscopy: A procedure used to look at areas in the throat that cannot be seen with a mirror during the physical exam of the throat. An endoscope (a thin, lighted tube) is inserted through the nose or mouth to check the throat for anything that seems unusual. Tissue samples may be taken for biopsy.
  • CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.
  • MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI).
  • Head, neck, and chest x-rays: An x-ray of the head, neck, and organs and bones inside the chest. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.
  • Barium esophagogram: An x-ray of the esophagus. The patient drinks a liquid that contains barium (a silver-white metallic compound). The liquid coats the esophagus and x-rays are taken.
  • Esophagoscopy: A procedure to look inside the esophagus to check for abnormal areas. An esophagoscope (a thin, lighted tube) is inserted through the mouth and down the throat into the esophagus. Tissue samples may be taken for biopsy.
  • Bronchoscopy: A procedure to look inside the trachea and large airways in the lung for abnormal areas. A bronchoscope (a thin, lighted tube) is inserted through the nose or mouth into the trachea and lungs. Tissue samples may be taken for biopsy.
  • Biopsy: The removal of cells or tissues so they can be viewed under a microscope to check for signs of cancer.

Certain factors affect prognosis (chance of recovery) and treatment options.

Prognosis (chance of recovery) depends on the following:

  • The stage of the cancer (whether it affects part of the hypopharynx, involves the whole hypopharynx, or has spread to other places in the body). Hypopharyngeal cancer is usually detected in later stages because early symptoms rarely occur.
  • The patient's age, gender, and general health.
  • The location of the cancer.
  • Whether the patient smokes during radiation therapy.

Treatment options depend on the following:

  • The stage of the cancer.
  • Keeping the patient's ability to talk, eat, and breathe as normal as possible.
  • The patient's general health.

Patients who have had hypopharyngeal cancer are at an increased risk of developing a second cancer in the head or neck. Frequent and careful follow-up is important.

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Stages of Hypopharyngeal Cancer

After hypopharyngeal cancer has been diagnosed, tests are done to find out if cancer cells have spread within the hypopharynx or to other parts of the body.

The process used to find out if cancer has spread within the hypopharynx or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage of the disease in order to plan treatment. The results of some of the tests used to diagnose hypopharyngeal cancer are often also used to stage the disease.

The following stages are used for hypopharyngeal cancer:

Stage 0 (Carcinoma in Situ)

In stage 0, cancer is found only in the cells of the lining of the hypopharynx. Stage 0 cancer is also called carcinoma in situ.

Stage I

In stage I, the tumor is found in one area of the hypopharynx only and is 2 centimeters or smaller.

Stage II

In stage II, the tumor is either:

  • larger than 2 centimeters but not larger than 4 centimeters and has not spread to the larynx (voice box); or
  • found in more than one area of the hypopharynx or in nearby tissues.

Stage III

In stage III, one of the following is found:

  • The tumor is in only one area of the hypopharynx and is 2 centimeters or smaller; cancer has also spread to a single lymph node on the same side of the neck and the lymph node is 3 centimeters or smaller.
  • Cancer is in more than one area of the hypopharynx, is in nearby tissues, or is larger than 2 centimeters but not larger than 4 centimeters and is not in the larynx; cancer has also spread to a single lymph node on the same side of the neck and the lymph node is 3 centimeters or smaller.
  • The tumor is larger than 4 centimeters or has spread to the larynx; cancer may have spread to a single lymph node on the same side of the neck and the lymph node is 3 centimeters or smaller.

Stage IV

Stage IV is divided into stage IVA, IVB, and IVC as follows:

  • In stage IVA, the tumor:
    • can be any size and has spread to nearby soft tissue, connective tissue, the thyroid, or the esophagus; cancer may be found either in one lymph node on the same side of the neck (the lymph node is 3 centimeters or smaller) or in one or more lymph nodes anywhere in the neck (all of these lymph nodes are 6 centimeters or smaller); or
    • is in only one area of the hypopharynx, is 2 centimeters or smaller, and has also spread to one or more lymph nodes anywhere in the neck (all of these lymph nodes are 6 centimeters or smaller); or
    • is in more than one area of the hypopharynx, is in nearby tissues, or is larger than 2 centimeters but not larger than 4 centimeters and has not spread to the larynx; cancer has spread to one or more lymph nodes anywhere in the neck (all of these lymph nodes are 6 centimeters or smaller); or
    • is larger than 4 centimeters or has spread to the larynx; cancer has also spread to one or more lymph nodes anywhere in the neck (all of these lymph nodes are 6 centimeters or smaller).
  • In stage IVB, the tumor either:
    • has spread to nearby soft tissue, connective tissue, blood vessels, the thyroid, or the esophagus, and may have spread to lymph nodes of any size; or
    • is any size and has spread to lymph nodes that are larger than 6 centimeters.
  • In stage IVC, cancer has spread beyond the hypopharynx to other parts of the body.

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Recurrent Hypopharyngeal Cancer

Recurrent hypopharyngeal cancer is cancer that has recurred (come back) after it has been treated. The cancer may come back in the hypopharynx or in other parts of the body.

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Treatment Option Overview

There are different types of treatment for patients with hypopharyngeal cancer.

Different types of treatment are available for patients with hypopharyngeal cancer. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. Before starting treatment, patients may want to think about taking part in a clinical trial. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment.

Choosing the most appropriate cancer treatment is a decision that ideally involves the patient, family, and health care team.

Three types of standard treatment are used:

Surgery

Surgery (removing the cancer in an operation) is a common treatment for all stages of hypopharyngeal cancer. The following surgical procedures may be used:

  • Laryngopharyngectomy: Surgery to remove the larynx (voice box) and part of the pharynx (throat).
  • Partial laryngopharyngectomy: Surgery to remove part of the larynx and part of the pharynx. A partial laryngopharyngectomy prevents loss of the voice.
  • Neck dissection: Surgery to remove lymph nodes and other tissues in the neck.

Even if the doctor removes all the cancer that can be seen at the time of the surgery, some patients may be given chemotherapy or radiation therapy after surgery to kill any cancer cells that are left. Treatment given after the surgery, to increase the chances of a cure, is called adjuvant therapy.

Radiation therapy

Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated.

Radiation therapy may be more effective in patients who have stopped smoking before beginning treatment. External radiation therapy to the thyroid or the pituitary gland may change the way the thyroid gland works. The thyroid gland may be tested before and after therapy to make sure it is working properly.

Chemotherapy

Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping the cells from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the spinal column, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). The way the chemotherapy is given depends on the type and stage of the cancer being treated.

Chemotherapy may be used to shrink the tumor before surgery or radiation therapy. This is called neoadjuvant chemotherapy.

Other types of treatment are being tested in clinical trials.

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Treatment Options by Stage

Stage I Hypopharyngeal Cancer

Treatment of stage I hypopharyngeal cancer may include the following:

  • Laryngopharyngectomy and neck dissection with or without high-dose radiation therapy to the lymph nodes of the neck.
  • Partial laryngopharyngectomy with or without high-dose radiation therapy to the lymph nodes on both sides of the neck.

Stage II Hypopharyngeal Cancer

Treatment of stage II hypopharyngeal cancer may include the following:

  • Laryngopharyngectomy and neck dissection. High-dose radiation therapy to the lymph nodes of the neck may be given before or after surgery.
  • Partial laryngopharyngectomy. High-dose radiation therapy to the lymph nodes of the neck may be given before or after surgery.
  • Chemotherapy given during or after radiation therapy or after surgery.
  • A clinical trial of chemotherapy followed by radiation therapy or surgery.

Stage III Hypopharyngeal Cancer

Treatment of stage III hypopharyngeal cancer may include the following:

  • Radiation therapy before or after surgery.
  • Chemotherapy given during or after radiation therapy or after surgery.
  • A clinical trial of chemotherapy followed by surgery and/or radiation therapy.
  • A clinical trial of chemotherapy given at the same time as radiation therapy.
  • A clinical trial of surgery followed by chemotherapy given at the same time as radiation therapy.

Treatment and follow-up of stage III hypopharyngeal cancer is complex and is ideally overseen by a team of specialists with experience and expertise in treating this type of cancer. If all or part of the hypopharynx is removed, the patient may need plastic surgery and other special help with breathing, eating, and talking.

Stage IV Hypopharyngeal Cancer

Treatment of stage IV hypopharyngeal cancer that can be treated with surgery may include the following:

  • Radiation therapy before or after surgery.
  • A clinical trial of chemotherapy followed by surgery and/or radiation therapy.
  • A clinical trial of surgery followed by chemotherapy given at the same time as radiation therapy.

Surgical treatment and follow-up of stage IV hypopharyngeal cancer is complex and is ideally overseen by a team of specialists with experience and expertise in treating this type of cancer. If all or part of the hypopharynx is removed, the patient may need plastic surgery and other special help with breathing, eating, and talking.

Treatment of stage IV hypopharyngeal cancer that cannot be treated with surgery may include the following:

  • Radiation therapy.
  • Chemotherapy given at the same time as radiation therapy.
  • A clinical trial of radiation therapy with or without chemotherapy.

Follow-up to check for recurrence should include careful head and neck exams once a month in the first year after treatment ends, every 2 months in the second year, every 3 months in the third year, and every 6 months thereafter.

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Treatment Options for Recurrent Hypopharyngeal Cancer

Treatment of recurrent hypopharyngeal cancer may include the following:

  • Surgery.
  • Radiation therapy.
  • Chemotherapy.
  • A clinical trial of chemotherapy.

Follow-up to check for recurrence should include careful head and neck exams once a month in the first year after treatment ends, every 2 months in the second year, every 3 months in the third year, and every 6 months thereafter.

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Throat Cancer