Nasopharynx

The most common treatment for cancers in the nasopharynx is radiation therapy to the tumor and lymph nodes. Radiation may be administered to the lymph nodes as a preventative measure, even if no cancer is detected there. In most cases except for very early stages, a combination of chemotherapy and radiation therapy is generally the primary treatment. A neck dissection may also be considered to remove lymph nodes and nearby tissues/structures in the neck after radiation if a mass is still present after treatment. Endoscopic or Robotic surgery to remove the tumor may be an option for some patients who don't respond to radiation therapy.

Oropharynx

Oropharynx (p16+/HPV+): There are two equal treatments for HPV-related oropharyngeal cancer: either transoral robotic surgery (TORS) or radiation with or without chemotherapy. As the treatment options have been able to cure these tumors with excellent success rates, patients are generally free to choose the treatment option which is best for them. For metastatic disease, the doctor may recommend chemotherapy, clinical trials, or palliative treatments intended to shrink tumors and relieve symptoms.

Oropharynx (p16-/HPV): The primary treatment for oropharyngeal cancer not related to HPV is generally more aggressive as the cure rates are generally much poorer. If the tumors can be removed surgically without major impact to the throat function (such as Transoral Robotic Surgery), then patients may choose this option. Surgery in HPV-negative tumors is routinely followed by radiation, or chemotherapy and radiation, regardless of stage or pathology report. In cases where surgery is neither acceptable nor offered, concurrent chemotherapy and radiation therapy to the tumor and lymph nodes provides reliable cure rates. For metastatic disease, the doctor may recommend chemotherapy, clinical trials, or palliative treatments intended to shrink tumors and relieve symptoms.

Hypopharynx

The primary treatment for hypopharyngeal cancer is radiation therapy to the tumor and lymph nodes. Surgery followed by radiation therapy is another option that may be considered in some cases. In more advanced stages, the primary treatment is often a combination of chemotherapy and radiation therapy, radiation therapy plus targeted therapy, or surgery followed by chemoradiation. For metastatic disease, the doctor may recommend chemotherapy, clinical trials, or palliative treatments intended to shrink tumors and relieve symptoms.

Surgery

Surgery to remove the tumor and surrounding tissue is a common treatment for pharyngeal cancer. The doctor may be able to remove the tumor endoscopically, using only a thin flexible tool passed into the throat or with the use of robotic surgical systems. In such cases, most patients are able to recover without the need for tracheostomy or gastrostomy tubes. However, other cases may require a surgical incision in the neck, jaw bone, or facial bones. In more extensive cases, the doctor may also need to surgically remove nearby structures that may be affected, including the tongue, jaw bone, roof of mouth, and larynx. The doctor may also perform a neck dissection, in which lymph nodes and tissue in the neck are removed. Some patients may need a tracheostomy or gastronomy tube in order to help them breathe and eat.

Radiation therapy

Radiation therapy uses waves of high energy rays produced by a machine to destroy cancer cells. Radiation therapy is often the primary treatment for early-stage oropharyngeal and nasopharyngeal tumors. Radiation therapy is also commonly given after surgery to kill any remaining cancer cells and prevent a recurrence. In locally advanced cases, radiation therapy may be combined with chemotherapy (chemoradiation) as the primary treatment. Radiation therapy may also be used to treat lymph nodes in the neck, even if they are cancer-free, or to shrink tumors and relieve symptoms in more advanced cases.

Proton beam radiation therapy

Proton therapy is an advanced type of radiation therapy that uses “protons” rather than X-ray “photons” to deliver radiation to the tumor. In conventional radiotherapy, the photon beams can deposit radiation and damage healthy cells as they pass through the body. Proton therapy deposits most of the radiation directly at the tumor site, resulting in less damage to healthy tissue and fewer side-effects.

• Please see Understanding Proton Therapy to learn more.

Chemotherapy

Chemotherapy is the use of drugs to target rapidly growing cells in an effort to destroy cancer cells. Chemotherapy is often combined with radiation therapy (chemoradiation) to treat locally advanced tumors in the pharynx. Chemotherapy may also be given before or after surgery or radiation therapy, in order to shrink the tumor before these procedures, or kill any remaining cancer cells after these procedures. Chemotherapy may also be the primary treatment in very advanced cases.

Biological Therapy/Immunotherapy

Some cases of pharyngeal cancer contain cells that over-express certain proteins (EGFR protein) that cause the cancer to grow more aggressively. A form of biological therapy called monoclonal antibodies specifically targets these cells, preventing them from fueling cell growth.

Immune checkpoint inhibitors are a form of immunotherapy that help keep the immune system active in its fight against cancer. They work by preventing the immune response from shutting down too early, allowing it more time to target and destroy cancer cells.

In the treatment of nasopharyngeal cancer, immune checkpoint inhibitors are currently approved for use only in stage IV disease. They may be given alone or in combination with other treatments such as surgery, radiation therapy, or additional cancer medications.

Clinical Trials

Clinical trials allow patients to try a new treatment before it is available to the general public. In some cases, this may be a new drug that has not been used in humans before, or it may be a drug or drug combination that is not currently used for that specific type of cancer. Early phase clinical trials are often used to test side effects of a drug or drug combination, while later phase clinical trials are used to see how effective a new treatment might be for a certain type of cancer. Clinical trials allow doctors and researchers to improve the treatment of cancers with possibly more effective therapies. A clinical trial may be a new, groundbreaking drug or it may have no effect. It is important to talk with your doctor about the pros and cons of clinical trials for your particular situation.