11 - pharyngeal tumors

8/13/2019 11 - Pharyngeal Tumors

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DONE BY : AHMAD TABA`AN ALA`NEZI

MARWAN MOHMMED ALKRENAWI


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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

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What is Pharyngeal Cancer?

Cancer of the pharynx, more commonly known as the

throat, is also called pharyngeal cancer. It can developin any of the three regions of the pharynx:

The nasopharynx: The area behind the nose and theback of the throat, which is the hollow tube at the

upper part of the throat that starts behind the noseand runs down to the neck to become part of theesophagus (the tube that goes to the stomach).

The oropharynx: Consisting of the base of tongue,

the tonsillar region, soft palate, and back of themouth.

The hypopharynx: The bottom part of the throat.

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Types of Pharyngeal Cancer

Most head and neck cancers are squamous cellcarcinomas,

or tumors that develop in the tissue lining the holloworgans 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).

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Common risk factors for pharyngeal cancer include:

Smoking or chewing tobacco

Alcohol abuse

High doses of radiation therapy, particularly in thehead or neck region

Exposure to asbestos or certain industrial chemicals

Aging (being 65 years or older)

Common Risk Factors for

Pharyngeal Cancer

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Pharyngeal Cancer Type-Specific

Risk Factors

In addition to the common risk factors for pharyngealcancer, there are risk factors specific to each type ofpharyngeal 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.

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Oropharyngeal cancer

Risk factors common to oral cavity cancer, like

drinking mat (an herbal tea drink common in SouthAmerica)

The human papillomavirus (HPV) infection may be afactor in some cases of oropharyngeal cancer.

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Hypopharyngeal cancer

Nutritional deficiencies may increase the likelihood ofhypopharyngeal cancers.

Iron deficiencies may also be caused by Plummer-Vinson 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 thatmakes it difficult to swallow (dysphagia). The lower

part of the pharynx (the hypopharynx) is where thesewebs would likely develop.

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enera aryngea ancerSymptoms

Symptoms may vary depending on the location and extentof the cancer in the pharynx, general symptoms ofpharyngeal 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)ThisX-ray procedure uses a computer to generate detailedpictures of what is happening in your body forpharyngeal 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 ofadjacent 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 atthe time of cancer diagnosis.

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Nasopharyngeal tumors

Several types of tumors can develop in thenasopharynx. Some of these tumors are benign (non-cancerous), but others are malignant (cancerous).

Benign nasopharyngeal tumors

Benign tumors of the nasopharynx are fairly rare andtend to occur in children and young adults.

They include tumors or malformations of the vascularsystem, such as angiofibromas and hemangiomas, andbenign tumors of the minor salivary glands that arefound within the nasopharynx.

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angiofibroma

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Oropharyngeal tumor

oropharyngeal cancers develop in the throat, justbehind the mouth

A few oropharyngeal cancers are benign, but causeproblems like breathing and swallowing difficulty

Erythroplakia, Leukoplakia

>90% oropharyngeal cancers are squamous cellcarcinomas, its rapidly growing and very danger.

surgically excised with radiation followup; when theyare more advanced, chemotherapy is also advised.

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Hypopharyngeal tumor not common but generally has a very poor prognosisAlmost 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 thera 18


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Malignant nasopharyngeal tumors

These tumors can invade surrounding tissues andspread to other parts of the body.

Nasopharyngeal carcinoma (NPC):This is by far themost 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 ismost strongly associated with Epstein-Barrvirusinfection.

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General Stage Groupings for

Pharyngeal Cancer

Stage I Pharyngeal Cancer:The tumor is limited to one regionof 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 thecancer may have spread into nearby lymph nodes. The cancerhas not spread (M0) to distant sites.(Example: T2, N0, M0)

Stage III Pharyngeal Cancer:The cancer has grown beyondthe site of origin and may have spread into nearby soft tissues orlymph nodes.(Example: T3, N1, M0)

Stage IV Pharyngeal Cancer:The cancer may be any size andhas spread throughout the body.(Example: Any T, Any N, M1)

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Treatment Surgery

Surgery is the preferred treatment for most pharyngealcancers.

If the cancer is considered localized, surgery may beperformed if the tumor is considered surgicallyresectable and is likely to obtain clean surgical marginswhen the edges of the tissue removed do not containtumor cells.

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RadiotherapyBecause many types of pharyngeal cancers areadvanced at diagnosis and/or prone to recurrence andmetastasis, postoperative radiation therapy is oftenrecommended to improve clinical outcomes. This is

especially important in cases of higher-stage or largertumors, or evidence of local invasion or metastasis.

Radiotherapy may be used by itself or in combinationwith chemotherapy in cases where the tumor may betoo large to be surgically removed

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Radiotherapy is also used as the primary treatmentmodality in most cases of nasopharyngeal cancer

Radiotherapy may also be useful as palliativetreatment, i.e., to reduce symptoms such as pain andobstruction.

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Chemotherapy

Chemotherapy is sometimes used with radiation incases of pharyngeal cancer where the disease ismetastatic, unresectable and/or recurrent.

It may also be employed postsurgically (along withradiation) in late-stage or aggressive cancers.

Chemotherapy is rarely effective by itself in pharyngealcancer, but is instead a valuable part of amultimodality treatment approach.

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Immunotherapy in Advanced Nasopharyngeal Cancers

Because many nasopharyngeal cancers are associated

with Epstein-Barr virus (EBV) infection, animmunotherapeutic treatment was devised to targetthis virus. Investigators isolated T cells from the bloodof EBV-positive nasopharyngeal cancer patients, and

then modified the T cells to attack the EBV virus.

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Prognosis of Pharynx Cancer Pharynx cancer tends to grow silently with symptoms

of cancer often not evident until the cancerous diseaseis quite advanced.

The early the diagnosis the better the prognosis

Involvement of lymph nodes in the region isassociated 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 ofpharynx cancer is more indolent with a long survivalrate even if the cancerous disease itself has beencontrolled but not cured.

Smoking and alcohol worsen the survival rate.

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THANK YOU

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11 - pharyngeal tumors

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