What is pharynx cancer?
When the tumoral cells are located in the pharynx tissues, it is a pharynx cancer.
The pharynx is a tube-shaped organ which starts behind the nose and goes down the throat until the oesophagus. This organ includes the soft palate, which is the back of the mouth, the base of the tongue and the amygdales. Its function is allowing the entrance of air into the trachea and of food into the oesophagus.
Pharynx cancer includes nasopharynx cancer (superior part of the throat behind the nose), oropharyx cancer (middle part of the pharynx) and hypopharynx cancer (the lower part of the pharynx including the pyriform sinuses).
Which are the symptoms of pharynx cancer?
The symptoms depend on the localisation and extension of the tumour:
- Nasal obstruction
- Epistaxis (ear bleeding)
- Blocked ear
Alteration of the sound of the voice
Blood in saliva
- Painful swallowing (the pain may irradiate to the ear)
- Alteration of the sound of the voice
- Hoarseness, if it already affects a vocal cord.
- Breathing difficulties.
In all cases a nodule (lump) may appear on the neck.
How is it diagnosed?
The specialist will introduce a tube topped with a camera through the mouth or the nose to observe the larynx (laryngoscope). If any anomalous tissue is found, a fragment will be extracted (biopsy) and a pathologist will examine it to confirm the presence of cancerous cells. The neck will also be palpated in search of nodules.
Pharynx cancer staging
- Stage I: Tumour smaller than 2 cm without lymphatic metastasis.
- Stage II: Tumour between 2 and 4 cm without metastasis.
- Stage III: Tumour bigger than 4 cm, or smaller with metastasis.
- Stage IV: The cancer has spread towards the tissues surrounding the pharynx; lymphatic ganglions may or not be affected.
Which are the treatments?
Nasopharynx tumours will be treated with chemo-radiotherapy.
Small oropharynx and hypopharynx tumours will be treated with surgery if possible, as long as the resection required by the tumour does not entail the impossibility of restoring deglutition (swallowing).
In these cases the use of CO2 laser transoral microsurgery facilitates the removal of tumours with less loss of healthy tissues and usually does not need sectioning the jaw, practicing tracheotomy or rebuilding the defect created using the usual flaps, which shortens the postoperative period and leaves less after-effects.
The neck ganglions will be treated by regular surgical dissection. In most of the cases it will be convenient a complementary chemo-radiotherapy after 3-4 weeks to increase the percentage of recovery.
When the tumour is very advanced and its resection may endanger deglutition, chemo-radiotherapy will be applied. In case of partial persistence of the tumour CO2 laser transoral microsurgery will be performed to remove it.
Microsurgery through the mouth requires a long formation: the surgeon, first of all, needs to have mastered traditional open surgery in case the tumour is not accessible through the mouth (anatomic problems, extension of the tumour to vital tissues, etc.).
The surgeon must also develop their abilities in the use of the surgical microscope with highly amplified images that help to tell the healthy tissues apart from the tumoral tissues (which allows to sear the tumour adjusting with more precision the resection of the surrounding healthy tissues). This surgery requires a learning curve (with a gradual increase of the difficulty of the case): the more experience and ability the surgeon possesses, the more complicated cases that surgeon will be able to solve.
In some cases the surgical removal of the tumour must be needed, including all or part of the vocal cords (laryngectomy). Many patients also need deglutition therapy after the treatment in order to help them get used to the changes in the structure of their throat.
What must the patient do once the treatment is over?
Once the treatment is over the patient must have periodic checks made in order to detect relapses as soon as possible in order to treat them immediately.
Imaging techniques performed by the oncologist may be needed alongside with the usual medical explorations.
Dr. Máiz has a wide experience in the treatment of pharynx tumours both by conventional surgery and CO2 laser transoral microsurgery.
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