Harvey's Garden

Pharyngeal carcinoma

2 min read

  • Epidemiology & Risk Factors
    • Tobacco & Alcohol: Major risk factors; synergistic effect (↑ risk when combined).
    • HPV (Human Papillomavirus):
      • Specifically HPV-16.
      • Strongly associated with Oropharyngeal cancer (tonsils, base of tongue).
      • Better prognosis compared to HPV-negative cancers.
    • EBV (Epstein-Barr Virus): Strongly associated with Nasopharyngeal Carcinoma (NPC).
    • Betel Nut: Chewing is a major risk factor in Southeast Asia.
    • Plummer-Vinson Syndrome: Associated with post-cricoid carcinoma (hypopharynx).
  • Pathology
    • Squamous Cell Carcinoma (SCC): >90% of cases.
    • Field Cancerization: Carcinogen exposure (smoking) creates a widespread field of genetically altered mucosa, leading to ↑ risk of second primary tumors.
  • Clinical Features
    • General:
      • Dysphagia, Odynophagia (“hot potato” voice).
      • Persistent sore throat.
      • Referred Otalgia: Pain mediated via CN IX (glossopharyngeal) or CN X (vagus).
      • Neck Mass: Often the presenting sign (cervical lymph node metastasis).
    • Nasopharyngeal Carcinoma (NPC) Specifics:
      • Demographics: Endemic in Southern China, Northern Africa, Inuits.
      • Presentation: Unilateral nasal obstruction, epistaxis, unilateral serous otitis media (adult with fluid in one ear = cancer until proven otherwise).
      • CN Involvement: Can invade cavernous sinus → deficits in CN III, IV, V, VI.
  • Diagnostics
    • Biopsy: Gold standard (via panendoscopy or fine-needle aspiration of neck mass).
    • Imaging: CT/MRI for staging (evaluating depth of invasion and nodal involvement).
    • HPV Testing: p16 immunohistochemistry for oropharyngeal tumors.
    • EBV Serology: IgA against viral capsid antigen (VCA) useful for screening NPC in endemic areas.
  • Treatment
    • Early Stage: Surgery or Radiation Therapy (XRT).
    • Advanced Stage: Chemoradiation (e.g., Cisplatin + XRT).
    • Cetuximab: EGFR inhibitor used in select cases.
  • Differential Diagnosis
    • Lymphoma (non-tender lymphadenopathy, B-symptoms).
    • Branchial cleft cyst (lateral neck mass in younger pts).
    • Thyroglossal duct cyst (midline neck mass, moves with swallowing).

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