Tumors of The Pharynx
Cancers of the Pharynx (Throat/Tonsil)
The throat is important for many reasons. Speech and swallowing are its most important function. Benign and malignant tumors of the throat destroy the lining and the deep muscle tissue and no matter what the treatment is we cannot undo that. But most patients can still be very functional. Benign tumors are usually excised with surgery. Some rare tumors may occasionally be observed and followed closely in certain select patients. For cancers, the most common is squamous cell carcinoma. As for all squamous cell carcinomas, radiation and surgery are the treatment modalities that have the potential to cure them. Chemotherapy may help radiation work better in advanced cancers or in non-surgical candidates. HPV (human papillomavirus) has been implicated as a causative factor in an increasing number of cancers of the pharynx (throat) and tonsils. HPV positive cancers have a better prognosis. Squamous cell carcinoma of the throat and tonsils are potentially curable in many cases if it has not spread outside the head and neck region. We perform imaging (PET scan, CT, MRI) to determine if it has.
Generally, cancers involving pharynx and tonsils are usually treated with chemotherapy and radiation and surgery is reserved only for cases where it does not work. The reason for this is the cure rate is equivalent but the expected side effects of chemoradiation are better than those of surgery for cancers at this site. TORS (robotic surgery) did show some early promise but long-term side effect profile does not seem to be very different than chemoradiation alone without any surgery. Radiation therapy is generally given daily as on outpatient five days a week for 6-8 weeks (exact amount determined by radiation oncology). Chemotherapy if given is done intermittently again on an outpatient basis. Surgery focuses on two things equally: removing the cancer and reconstruction. Much of the time we can remove these tumors through the mouth and avoid external scars. Occasionally, there is a need to make incisions around the chin or neck to access the tumor. Once the cancer is removed, we then focus on reconstruction. You must have separation of the throat (contains food, saliva, bacteria) from the sterile deep underlying neck tissues. We try to close the lining tissues on itself but, if there is not enough tissue then, depending on how much tissue is needed, we will bring in tissue (a transplant where tissue with its blood supply is brought into the head and neck to provide healthy tissue with a blood supply) from somewhere else in the body. The site of the tissue transplanted depends on the volume needed and could be from the forearm, chest wall, back skin or thigh skin. Often it is necessary to remove some lymph nodes from the neck or parotid region (neck dissection and parotidectomy respectively) due to the risk of spread to these areas.
The cure rate obviously will improve as the cancer is picked up earlier. Immunotherapy has had an increasing but not perfectly well-defined role as an adjunctive treatment. Most patients are able, once healed, to eat by mouth and speak.