Treatment by Cancer Type

Treatment by Cancer Type

• Treatment by Cancer Type
• Thyroid Cancer
• Throat Cancer
• Oral Cancer
• Major Salivary Gland Cancer
• Laryngeal Cancer
• Sinus & Nasal Cancer
• Back to Head & Neck Cancer

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The throat, or pharynx (FAYR-inx), is a hollow tube that starts behind the nose and leads to the esophagus. As part of both the respiratory and the digestive systems, it functions as a passageway for air, food and liquid. It is divided into three parts: the nasopharynx (behind the nose); the oropharynx, which includes the soft palate (the back of the roof of the mouth), the base of the tongue and the tonsils; and the hypopharynx, which is the lowest portion of the throat. Throat cancer typically begins in the thin, flat squamous (SKWAY-mus) cells lining the mucous membranes.

The human papillomavirus (HPV) is linked to most oropharyngeal cancers. Nasopharyngeal cancer may be caused by the Epstein-Barr virus (EBV), particularly in people of Asian descent.

Treatment Options

As your doctor tailors your treatment plan, several factors will be considered during the process, including the region of the throat where the cancer occurs, whether the cancer is primary or recurrent, and the presence of certain biomarkers related to HPV. Check the staging table headlines carefully to find the ones that apply to you because different tables are used based on the HPV status and region of the throat where the cancer is located.

Throughout treatment, your doctor will try to preserve as much normal function as possible. One or more of the following options may be in your treatment plan.

Surgery is commonly used to treat oropharyngeal and hypopharyngeal cancers. It is rarely used for nasopharyngeal cancers because the area is difficult to reach. However, it may be used for nasopharyngeal cancer that does not respond to radiation therapy and to remove lymph nodes or other tissues in the neck. One or more of the following surgeries may be used.

Transoral robotic surgery (TORS) is an option for early-stage oropharyngeal cancers (especially those containing HPV+ tumors). It can be used to remove cancers from the tonsils or the back one-third of the tongue, called the base of the tongue. TORS may also be used to treat certain small hypo-pharyngeal cancers.

Radical tonsillectomy, also known as lateral oropharyngectomy, removes the tonsil as well as a cuff of tissue around the tonsil, including part of the soft palate, pharynx and base of the tongue.

Base of tongue resection removes the tumor from the back one-third of the tongue.

Partial pharyngectomy removes part of the pharynx (throat).

Laryngopharyngectomy removes tumors in the hypopharynx, the lowest part of the throat. This involves the removal of the larynx (voice box), including the vocal folds and pharynx. With this approach, a surgeon reconstructs the pharynx and creates a stoma for breathing (see Stoma Care, page 17.) This type of surgery is typically reserved for large tumors or those that fail nonsurgical treatment.

A neck dissection to remove lymph nodes may be performed.

Reconstructive surgery may be recommended to restore function or appearance and replace missing tissue. This surgery would take place at the same time the cancer is being removed (see Reconstruction & Rehabilitation).

Radiation therapy may be given alone or with chemotherapy (chemoradiation) as a first-line treatment for throat cancers in which surgery is not a good option.

External-beam radiation therapy (EBRT) is the most common type of radiation therapy used to treat throat cancers. It includes stereotactic radiation therapy, intensity-modulated radiation therapy (IMRT), and proton therapy, with IMRT being the most commonly used and well-researched.

Hyperfractionated radiation therapy, in which the radiation is given in smaller doses but more frequently, is an approach that may be used for certain cases of advanced throat cancer to improve the way the tumor responds to treatment.

Radiation with or without chemotherapy may also be recommended following surgery as adjuvant treatment for advanced stage cancers. This therapy may be used to eliminate any remaining cancer cells and to lower the risk of recurrence.

Drug therapy may be used alone or in combination with other therapies.

Chemotherapy given alone may be used to treat cancers that are not able to be removed surgically or that have returned (recurred). In this case, the goal of treatment may be to prevent growth instead of cure. It may be given after surgery with radiation therapy (chemoradiation) if the risk for recurrence is high. For nasopharyngeal cancers, additional chemotherapy may be given before starting chemoradiation treatment, also called neoadjuvant chemotherapy. Chemoradiation may be an option for the first treatment used.

Immunotherapy in the form of immune checkpoint inhibitors may be an option for treating certain recurrent or metastatic throat cancers. The doctor will test for the tumor’s PD-L1 expression, which may indicate whether the tumor could respond to immunotherapy. If expression is more than 1 percent, the tumor is considered to be PD-L1 positive and immunotherapy alone may be used. If PD-L1 is negative, immunotherapy and traditional chemotherapy are often combined for patients who have recurrent or metastatic cancer. It may also be used if the cancer continues to grow or spread during treatment with platinum-based chemotherapy.

Targeted therapy drugs may treat types of throat cancer that contain specific genetic abnormalities, proteins or growth factors. Epidermal growth factor receptor (EFGR) inhibitors are approved for oropharyngeal and hypopharyngeal cancers in combination with radiation therapy or chemotherapy.

TNM Classification for Oropharyngeal (HPV-) and Hypopharyngeal Cancers

*Extranodal extension (ENE) refers to cancer cells that have spread beyond the lymph node into surrounding tissues.

Staging Oropharyngeal (HPV-) and Hypopharyngeal Cancers

Illustrated Stages of Oropharyngeal (HPV-) Cancer

Illustrated Stages of Hypopharyngeal Cancer

Classifying & Staging Oropharyngeal (HPV+) Cancer

Illustrated Stages of Oropharyngeal (HPV+) Cancer

Classifying & Staging Nasopharyngeal Cancer

Used with permission of the American Joint Committee on Cancer (AJCC), Chicago, Illinois. The original and primary source for this information is the AJCC Cancer Staging Manual, Eighth Edition (2017) published by Springer Science+Business Media.

Illustrated Stages of Nasopharyngeal Cancer