ABSTRACT
Soft palate, tongue base, tonsils, tonsillar fossae and pillars, and the posterior pharyngeal wall from the level of the vallecula to the level of the soft palate
2. Hypopharynx
Postericoid area, pyriform sinus, and posterior pharyngeal wall
Extends from the vallecula to the lower border of the cricoid cartilage
3. Nasopharynx
Posterosuperior wall from junction of the hard and soft palate to the skull base
Lateral wall including fossa of Rosenmu¨ller, torus, and orifice of the Eustachian tube
Inferior wall at superior surface of the soft palate
B. Most Frequent Sites of Tumor Involvement
1. Oropharynx-tonsils, then base of tongue
2. Hypopharynx-pyriform sinus
3. Nasopharynx-posterior
C. Lymphatic Drainage
1. Oropharynx-upper deep cervical chain, posterior triangle, and retropharyngeal nodes can be involved
2. Hypopharynx-jugulodigastic nodes, posterior triangle, and retropharyngeal nodes can be involved
3. Nasopharynx-retropharyngeal nodes
D. Neural Involvement
1. Otalgia is secondary to referred pain from the lingual, glossopharyngeal, or vagus nerves
2. Cavernous sinus extension of nasopharyngeal mass with cranial nerve II, IV, V, VI effects
3. Horner’s syndrome with involvement of the cervical sympathetic chain
IV. DIAGNOSIS
A. Physical Exam
1. Thorough head and neck exam
2. Biopsy of mass or fine needle aspiration of lymph node
B. Radiographic Evaluation
CT scan to determine extent of disease and to provide radiographic diagnosis of nonpalpable adenopathy
C. Oropharynx Cancers
Present with neck mass, odynophagia, or otalgia
D. Hypopharynx Cancers
Present with neck mass, throat pain, odynophagia, or otalgia
E. Nasopharynx Cancers
Present with neckmass, otologic symptoms or nasal symptoms, cranial nerve involvement at advanced stages
V. ETIOLOGY
A. Oropharynx
Associated with tobacco and alcohol use and Plummer-Vinson syndrome
B. Hypopharynx
Associated with tobacco and alcohol use, gastric reflux
C. Nasopharynx
Associated with Epstein-Barr virus and environmental factors like nitrosamines, polycyclic hydrocarbons, and nickel
VI. HISTOLOGY
A. Oropharynx and Hypopharynx
95% are squamous cell carcinomas (SCC)
B. Nasopharynx
Histologic types are:
SCC Nonkeratinizing
VII. TREATMENT
A. Oropharynx
1. Radiation therapy, including necks for T1 and T2 tumors
2. Surgery and radiation for T3 and T4 tumors
3. Surgical approaches include transoral,mandibular swing, composite resection, and pharyngotomy; glossectomy with laryngectomy, laryngoplasty, or suspension to prevent aspiration
B. Hypopharynx
1. Radiation therapy or partial laryngopharyngectomy for T1 and T2 tumors
2. Combined surgery and radiation with total laryngectomy/partial pharyngectomy for T3 and T4 tumors
3. Esophagectomy required if esophageal involvement is present
C. Nasopharynx
1. Chemotherapy and radiation therapy
2. Neck dissection for persistent neck disease
3. Surgical resection is via a craniofacial approach for persistent disease, with application of brachytherapy
VIII. 5-YEAR SURVIVAL
A. Oropharynx
1. Stage I and II-80%
2. Stage III-50%; base of tongue carries worse prognosis
B. Hypopharynx
Overall survival is 40%
C. Nasopharynx
1. Poor survival with SCC type and skull base involvement-10%
2. Nonkeratinizing and undifferentiated cancers50%
