Pharyngeal carcinoma

Source: OHCS pg 570

• Often advanced at presentation.
• M:F = 5:1.
• Histologically, 85% are squamous.
• Typical pt: Elderly smoker with sore throat, sensation of a lump, referred otalgia, and local irritation by hot and cold foods.
• Risk factors:
  - Chewing or smoking tobacco.
  - Alcohol alone is not a risk factor but is synergistic with smoking.
  - Oral HPV (especially HPV-16) infection.
• 30% of pharyngeal SCCs will have a second primary within 10y.
• 20% are LN positive at presentation.
• Hypopharyngeal tumours may give dysphagia, voice alteration, otalgia, stridor, throat pain; trismus is a late sign.
• Note any sign of premalignant conditions:
  - Leukoplakia.
  - Paterson-Kelly-Brown syndrome (Plummer-Vinson): Pharyngeal web associated with iron deficiency, glossitis, koilonychia: 2% risk post-cricoid ca.
• Imaging: MRI with STIR (short tau inversion recovery), contrast-enhanced CT.
• Rx: Surgery, sometimes with:
  - Jejunal flaps.
  - Tubed skin flaps (e.g. radial forearm or anterolateral thigh flaps).
  - Gastric pull-ups.
• Rx: Radiotherapy (e.g. intensity-modulated) may be used first line if the tumour is small. i.e. T1 (less than 2cm) or T2 (less than 4cm).
• T3 = >4cm, T4 = beyond oropharynx.