Pharyngeal Cancer Stage I

Pharyngeal cancer stage I is an early form of cancer that starts in the pharynx, the middle part of your throat. At this stage, the cancer is small and has not spread, which means there are several effective treatment options available.

Table of contents

• What is pharyngeal cancer stage I?
• Where does it occur?
• How is stage I defined?
• Treatment options
• The role of HPV

What is pharyngeal cancer stage I?

Pharyngeal cancer is a type of cancer that develops in the pharynx, which is the hollow tube in your neck that starts behind the nose and ends where the windpipe and esophagus begin. The pharynx is about 5 inches long and serves as a passageway for both air traveling to your lungs and food traveling to your stomach^[1].

Pharyngeal cancer can develop in three different parts of the pharynx. The middle section, called the oropharynx, is located beneath the nose area and includes the back part of your tongue, your tonsils, the soft palate at the back of the roof of your mouth, and the sides and walls of your throat^[1]. This is the most common location for pharyngeal cancer.

Most pharyngeal cancers are squamous cell carcinomas, which means they begin in the thin, flat cells that line the inside of the pharynx^[4]. Stage I represents an early stage of the disease, when the cancer is still small and has not spread to other parts of the body.

Where does it occur?

The oropharynx includes several specific areas where cancer can develop. These include the soft palate, which is the soft area at the back of the roof of your mouth, the side and back walls of the throat, the tonsils, and the back one-third of the tongue^[4].

Sometimes, a person can have more than one cancer at the same time in the oropharynx and in other parts of the mouth, nose, throat, voice box, windpipe, or esophagus^[4]. This is why healthcare providers carefully examine the entire area when diagnosing pharyngeal cancer.

How is stage I defined?

Doctors use a system called staging to describe how much cancer is in the body and where it is located when first diagnosed. This information helps your healthcare team plan the best treatment and estimate your outlook^[2].

In stage I oropharyngeal cancer, the tumor is 2 centimeters or smaller and has not spread to lymph nodes or other parts of the body^[2]. This is considered a localized cancer, meaning it is only in the oropharynx and has not spread to other areas^[2].

The staging system uses information from tests and examinations to determine the size of the tumor and whether cancer has spread. For oropharyngeal cancer, there are five stages, ranging from stage 0 to stage 4. Stage I is one of the earliest stages, which generally means the cancer is easier to treat^[2].

Treatment options

Stage I and stage II pharyngeal cancers are not very common, as most pharyngeal cancers are found at a later stage^[12]. However, when cancer is caught early, there are several effective treatment options available.

The main treatment approaches for early-stage pharyngeal cancer include radiation therapy, surgery, or a combination of chemotherapy and radiation therapy called chemoradiation^[12][13].

Radiation therapy uses high-energy beams to target and destroy cancer cells. For early-stage oropharyngeal cancer, external radiation therapy may be given to the tumor and to lymph nodes on both sides of the neck^[12]. This treatment approach can be effective while preserving the structure and function of the throat.

Surgery is another main treatment option for stage I pharyngeal cancer. The goal is to remove the tumor along with a margin of healthy tissue around it^[12]. In recent years, trans-oral robotic surgery (TORS) has become available as a less invasive surgical option for early-stage cancers^[13]. This approach uses robotic instruments inserted through the mouth to remove the tumor without making external incisions.

Chemoradiation combines chemotherapy drugs with radiation therapy given during the same time period. The chemotherapy makes the radiation more effective. The drug most commonly used is cisplatin^[12]. This approach is considered a main treatment for early-stage pharyngeal cancer.

Your healthcare team will suggest treatments based on your specific needs and work with you to develop a treatment plan^[12]. The choice of treatment depends on several factors, including the exact location of the tumor, your overall health and fitness, and your personal preferences.

The role of HPV

Many cases of oropharyngeal cancer are linked to infection with the human papillomavirus (HPV), particularly HPV type 16^[1][4]. HPV is a virus that can be passed from person to person.

Oropharyngeal cancers that contain HPV are called HPV-positive cancers. These cancers tend to have better rates of survival than cancers that don’t test positive for HPV^[2]. This is true even when HPV-positive cancers are more advanced when they are diagnosed.

Because HPV-positive oropharyngeal cancers have a better outlook, doctors have developed a different staging system specifically for people with HPV-related oropharyngeal cancer^[2][5]. In the HPV-positive staging system, stage I includes tumors that are not larger than 4 centimeters, and the cancer may have spread to one lymph node on the same side as the tumor^[2].

Healthcare providers test cancer cells for HPV because this information impacts treatment decisions and helps predict outcomes^[1]. Many trials are examining ways to reduce the intensity of treatment for HPV-positive early-stage cancers while maintaining good results and minimizing side effects^[13].