Treatment for pharyngeal cancer consists of:
- Nasopharyngeal carcinoma. Treatment most often comprises a combination of radiation and chemotherapy. For recurrent cases, you might need surgery.
- Oropharyngeal cancer. Treatment often consists of surgery or radiation, with or without chemotherapy. Smaller tumors may be removed surgically without loss of throat function. At Mount Sinai, we often do these types of surgeries with the assistance of a surgical robot. Larger tumors can be removed surgically — for instance, if chemotherapy and radiation fail — but the surgeries require reconstruction of the throat and may affect speech and/or the ability to swallow.
- Hypopharyngeal cancer. Treatment is similar to that of laryngeal cancers. Standard treatments are radiation, chemotherapy, and/or surgery, often in combination. Surgery may involve removal of a portion of or the entire voice box, sometimes with reconstruction to restore swallowing function or voice. Even if your doctor removes all the cancer visible at the time of the surgery, some patients are given chemotherapy or radiation after surgery to kill any cancer cells that may remain.
If you require surgery as part of your treatment for pharyngeal cancer, your doctor will often emphasize reconstructive surgery. Reconstructive surgery is recommended to maintain function as well as appearance. During reconstructive surgery, your surgeon may use tissue from elsewhere in your body, such as your chest, forearm, thigh, shoulder, or abdomen, to replace tissue damaged during your pharyngeal cancer surgery.
Following your pharyngeal cancer treatment, you may find yourself affected by several physical impediments. These include poor lubrication of your mouth and throat, swallowing food or liquids without choking, and speech and movement disabilities in areas where your surgery was performed.
For this reason, speech therapists, swallow therapists, physical therapists, and occupational therapists will help you maintain an acceptable quality of life. Specialists in pain management may also help you during your recovery.
After treatment of pharyngeal cancer, your doctor will insist on monitoring you for signs of cancer recurrence as well as possible spread. Your doctor may request seeing you every one to three months during your first year to look for possible signs of tumor regrowth. This evaluation will include a thorough physical examination of your head and neck — examining the area of the tumor’s original position and checking your neck closely for possible spread to the lymph nodes. A careful schedule of imaging, often with PET-CT scan, will also be employed as ongoing surveillance for disease.
As time goes on, the frequency of these follow-up visits will decrease. As time goes on, tumors are less likely to recur. In general, the majority of tumors that return will do so within the first year of treatment. Most will return within the first 18 months.
Eventually, follow-up visits may be required only once or twice a year. During these visits, the greater concern is not the possibility of the original cancer coming back, but concern that a second cancer may develop in the head and neck region. This is especially true in patients who continue to use tobacco and alcohol after treatment.
If a new cancer, called a second primary cancer, were to occur, it would be important to identify it while it is small and often early-stage to achieve the best cure rate using the least invasive means of treatment. For these reasons, close follow-up care is essential after pharyngeal cancer treatment.