Throat (Pharynx and Larynx) Cancer Treatment in Delhi and Gurgaon | दिल्ली और गुडगाँव में गले के कैंसर का इलाज

What are the various parts of Throat?

Throat consists of 4 parts – Oropharynx, Nasopharynx, Hypopharynx and Larynx. The figure below shows the structures in throat, namely nasopharynx, oropharynx and larynx.

anatomy of pharynx showing nasopharynx oropharynx hypopharynx

 

Larynx (voice box) houses the vocal cords. It extends from epiglottis (superiorly) and continues into trachea inferiorly, as shown in the figure below.

larynx anatomy

 

 Oropharynx comprises the soft palate, tonsils, the base of the tongue, and oropharyngeal wall.

oropharynx anatomy

 

Nasopharyx extends from base of the skull to upper surface of soft palate (as shown in figure above). Below is a cross-section at the level of nasopharynx that shows parapharyngeal space and paranasal sinuses.

nasopharynx anatomy

 

What is the Staging and Treatment of Oropharyngeal Cancer?

Staging of Orophryngeal Cancer

TNM is the most commonly used system for staging oropharyngeal cancer.

T STAGING

Tis – Tumor present only in the superficial layer of the oropharynx.

T1 – Tumor </=2 cm in size.

stage T1-tumor size upto 2 cm

 

T2 – Tumor >2 cm but </=4 cm in size.

T2 stage-tumor size 2 cm to 4 cm

 

T3 – Tumor >4 cm in size or invades lingual surface of the epiglottis.

T3 stage - tumor size more than 4 cm

 

T4a – Tumor invades adjacent structures, such as larynx, hard palate, or mandible.

stage T4a - tumor invades hard palate

stage T4a-tumor invades larynx

stage T4a-tumor invades mandible

stage T4a-tumor invades medial pterygoid muscle

stage T4a-tumor invades tongue

 

T4b – Tumor of any size that invades pterygoid plates, lateral nasopharynx, or skull base and/or surrounds the carotid artery.

stage T4b-tumor invades lateral ptergoid muscle or pterygoid plates or carotid

stage T4b-tumor invades skull base

 

N STAGING

N0 – No involvement of nearby lymph nodes

N1 – Involvement of single ipsilateral lymph node measuring </=3 cm.

N1-single ipsilateral lymph node upto 3 cm

N2a – Involvement of single ipsilateral lymph node measuring >3 cm and </= 6 cm

N2a-single ipsilateral lymph node 3 cm to 6 cm

N2b – Involvement of multiple ipsilateral nodes, none >6 cm

N2b-multiple ipsilateral lymph nodes upto 6 cm

N2c – Involvement of bilateral/contralateral lymph nodes, all measuring <6 cm.

N2c - bilateral or contralateral lymph nodes upto 6 cm

N3 – Involvement of lymph nodes measuring >6 cm and/or significant extranodal involvement.

N3-lymph node more than 6 cm

N3-lymph node with extranodal extension

 

M STAGING

M0 – No spread to distant body parts M1 – Spread of the tumor to distant body parts   Oropharyngeal Cancer Staging Summary

STAGE TNM    
0 Tis N0 M0    
I T1 N0 M0    
II T2 N0 M0    
III T3 N0 M0    
  T1-3 N1 M0    
IVA T1-3 N2 M0    
  T4a N0-2 M0    
IVB Any T N3 M0    
  T4b Any N M0    
IVC Any T Any N M1    

 

Treatment of Oropharyngeal Cancer

Treatment depends on stage of the disease, location, HPV status, performance status of patient, patient’s preference, along with other factors. Treatment options based on stage are discussed below.

Stage I and II

For Stage I and II cancers, radiotherapy or surgical resection is usually preferred. Then depending on the presence of adverse prognostic factors,  surgery may be followed by radiation therapy with or without chemotherapy.

Stage III to IVB

Concurrent chemoradiation (induction chemotherapy may be required sometimes) is the preferred treatment in such cases. Surgical resection is also an option.

Stage IVC

For Stage IVC cancer, chemotherapy, immunotherapy or targeted therapy are the treatment options. Radiation therapy or surgery may be employed as palliative treatment.  

What is the Staging and Treatment of Hypopharyngeal Cancer?

Staging of Hypophryngeal Cancer

TNM is the most commonly used system for staging hypopharyngeal cancer.

T STAGING

Tis – Tumor only in the superficial layer of the hypopharynx.

T1 – Tumor </=2 cm in size.

T1-tumor less than 2 cm

 

T2 – Tumor is >2 cm but </=4 cm in size.

T2-tumor 2 cm to 4 cm

T3 – Tumor is >4 cm in size or invades into the lingual surface of the epiglottis.

T3-tumor more than 4 cm

T4a – Tumor invades any of the adjacent structure, such as larynx, hard palate, or mandible.

T4a-tumor invades cricoid cartilage

T4a-tumor invades hyoid bone

T4a-tumor invades thyroid cartilage

 

T4b – Tumor invades pterygoid plates, lateral nasopharynx, or skull base and/or surrounds the carotid artery.

T4b-tumor encases carotid artery

T4b-tumor invades prevertebral fascia

 

N STAGING

Same as oropharyngeal cancer (as discussed above).  

M STAGING

M0 – No spread to distant body parts.

M1 – Tumor has spread to distant body part(s)  

 

Hypopharyngeal Cancer Staging Summary

STAGE TNM    
0 Tis N0 M0    
I T1 N0 M0    
II T2 N0 M0    
III T3 N0 M0    
  T1-3 N1 M0    
IVA T1-3 N2 M0    
  T4a N0-2 M0    
IVB Any T N3 M0    
  T4b Any N M0    
IVC Any T Any N M1    

 

Treatment of Hypopharyngeal Cancer

Treatment depends on stage of the disease, location, performance status of patient, patient’s preference, along with other factors. Treatment options based on stage are discussed below.

Stage I and II

For Stage I and II cancers, radiotherapy or surgical resection is usually preferred. Then depending on the presence of adverse prognostic factors,  surgery may be followed by radiation therapy with or without chemotherapy.

Stage III to IVB

Concurrent chemoradiation (induction chemotherapy may be required sometimes) is the preferred treatment in such cases. Surgical resection is also an option.

Stage IVC

For Stage IVC cancer, chemotherapy, immunotherapy or targeted therapy are the treatment options. Radiation therapy or surgery may be employed as palliative treatment.  

 

What is the Staging and Treatment of Laryngeal Cancer?

TNM is the most commonly used system for staging laryngeal cancer.

Larynx consists of 3 parts – Supraglottis, Glottis and Subglottis.

T staging is different for each of these.

N and M Staging is same as that for Oropharyngeal Cancer (as discussed above).  

 

Laryngeal Cancer Staging Summary

STAGE TNM    
0 Tis N0 M0    
I T1 N0 M0    
II T2 N0 M0    
III T3 N0 M0    
  T1-3 N1 M0    
IVA T1-3 N2 M0    
  T4a N0-2 M0    
IVB Any T N3 M0    
  T4b Any N M0    
IVC Any T Any N M1    

 

Treatment of Laryngeal Cancer

Treatment depends on stage of the disease, location, performance status of patient, patient’s preference, along with other factors. Treatment options based on stage are discussed below.

Stage I and II

For Stage I and II cancers, radiotherapy or surgical resection is usually preferred. Then depending on the presence of adverse prognostic factors,  surgery may be followed by radiation therapy with or without chemotherapy.

Stage III to IVB

Concurrent chemoradiation (induction chemotherapy may be required sometimes) is the preferred treatment in such cases. Surgical resection is also an option.

Stage IVC

For Stage IVC cancer, chemotherapy, immunotherapy or targeted therapy are the treatment options. Radiation therapy or surgery may be employed as palliative treatment.  

What is the Staging and Treatment of Nasopharyngeal Cancer?

Staging of Nasophryngeal Cancer

TNM is the most commonly used system for staging nasopharyngeal cancer.

T STAGING

T1 – Tumor limited to the nasopharynx, or extends to oropharynx and/or nasal cavity.  

T1-tumor confined to nasopharynx

 

T1-extends to nasal cavity

 

T1-extends to oropharynx

 

T2 – Tumor invades para-pharyngeal space, and/or an adjacent structure such as medial pterygoid, lateral pterygoid, or prevertebral muscles.

T2-extends to parapharyngeal space

 

T3 – Tumor invades skull base, cervical vertebra, pterygoid structures, and/or paranasal sinuses.

T3-extends to skull base

 

T3-invades paranasal sinuses

 

T3-invades pterygoid structures

 

T4 – Tumor invades cranium, cranial nerves, hypopharynx, orbit, parotid gland, and/or extensive invasion beyond the lateral pterygoid muscle.

T4-extends to hypopharynx

 

T4-intracranial extension 

N STAGING

N0 – No involvement of nearby lymph nodes

N1 – Involvement of cervical lymph node(s) on one side and/or retropharyngeal lymph node(s) with lymph nodes measuring </=6 cm.

N1-unilateral upto 6 cm nodes or retropharyngeal nodes

 

N2 – Involvement of cervical lymph node(s) one both sides and/or retropharyngeal lymph node(s) with lymph nodes measuring </=6 cm.

N2-bilateral cervical lymph nodes upto 6 cm

 

N3a – Involvement of cervical lymph node(s) on one or both sides with lymph nodes measuring >6 cm.

N3a-cervical lymph nodes upto-6 cm

 

N3b – Cervical lymph node involvement below cricoid cartilage

N3b-cervical lymph nodes below cricoid cartilage

 

M STAGING

M0 – No spread of tumor to distant sites M1 – Spread of the tumor to distant body parts   Nasopharyngeal Cancer Staging Summary

STAGE TNM    
I T1 N0 M0    
II T2 N0-1 M0    
  T0-1 N1 M0    
III T3 N0-2 M0    
  T0-2 N2 M0    
IVA Any T N3 M0    
  T4 N0-2 M0    
IVB Any T Any N M1    

 

Treatment of Nasopharyngeal Cancer

Treatment depends on stage of the disease, performance status of patient, patient’s preference, along with other factors. Treatment options based on stage are discussed below.

Stage I

Radiation therapy is the preferred treatment for stage I disease.

Stage II to IVA

Concurrent chemoradiation is the preferred treatment in these cases. Chemotherapy may be given before and/or after chemoradiation.

Stage IVB

Chemotherapy is the preferred treatment. Radiation therapy may be required for palliation or relief of symptoms.

 

What is the role of Targeted Therapy in Treatment of Throat (Pharynx and Larynx) Cancer?

Targeted therapy is designed to target a specific alteration/mutation and produce anticancer effect by selectively modifying a target key to the growth of cancer cells.

Read more about the targeted therapy for throat cancer here.

 

What is the role of Immunotherapy in Treatment of Throat (Pharynx and Larynx) Cancer?

Immunotherapy acts by stimulating the body’s immune system to kill or retard the growth of cancer cells.

Read more about the Immunotherapy for throat cancer here.

 

Best Throat (Pharynx and Larnx) Cancer Specialist in Delhi

Dr Sunny Garg is a renowned Medical Oncologist in New Delhi with an experience of more than 6 years of treating throat cancer patients. He has practiced in leading cancer hospitals in Delhi, and currently practicing at Manipal Hospital, Dwarka.

He is well versed with Immunotherapy, Targeted therapy, and Chemotherapy for Throat Cancer treatment and also general supportive care for patients. He works in close collaboration with surgical and radiation oncologists, oncopathologists, nuclear medicine, and genetic counselors for comprehensive cancer care for the patients.

Call +91 9686813020 for appointment.