Pharyngeal Cancer Stage III
Stage 3 pharyngeal cancer represents an advanced form of throat cancer where the tumor has grown larger or spread to nearby lymph nodes, requiring comprehensive treatment approaches that often combine multiple therapies.
Table of contents
What is Stage 3 Pharyngeal Cancer
Stage 3 pharyngeal cancer indicates that the cancer has grown beyond its original location in the throat. The pharynx, or throat, is a hollow tube about 5 inches long that starts behind the nose and ends where the windpipe and food tube begin[1]. At stage 3, the tumor has typically grown larger than 4 centimeters or has spread to nearby structures, or cancer cells have reached one or more lymph nodes in the neck[1].
The specific definition of stage 3 varies depending on which part of the pharynx is affected. For oropharyngeal cancer, stage 3 means the tumor is larger than 4 centimeters or has grown to the epiglottis, which is a flap of moveable cartilage in the throat that closes the voice box when you swallow. Alternatively, the cancer may have spread to one lymph node in the neck on the same side as the tumor, with the lymph node not larger than 3 centimeters[1].
Types of Pharyngeal Cancer
The pharynx has three main parts, and cancer can develop in any of them. The oropharynx is the middle part of the throat, located behind the mouth. It includes the soft palate at the back of the roof of the mouth, the tonsils, the back third of the tongue, and the side and back walls of the throat[1].
The hypopharynx is the lower part of the pharynx, located above the food tube and windpipe. When stage 3 cancer develops in this area, it typically means the tumor has not spread beyond the voice box but has caused a vocal cord to stop moving, or it has spread to nearby spaces and tissues[5].
Many oropharyngeal cancers are linked to infection with the human papillomavirus (HPV). Although HPV-related oropharyngeal cancer is often more advanced when diagnosed, it typically has better rates of survival than cancer in patients who don’t test positive for HPV. Because of this difference, doctors have developed a separate staging system for people with HPV-related oropharyngeal cancer[1].
Treatment Options
Treatment for stage 3 pharyngeal cancer usually involves a combination of different approaches. The healthcare team will suggest treatments based on individual needs and work with each patient to develop a personalized treatment plan[5].
Surgery
Surgery is one of the main treatments for stage 3 pharyngeal cancer. The goal is to remove the tumor along with a margin of healthy tissue around it. Surgery is especially important when the cancer has made it difficult to swallow or breathe[5].
The most common surgery is a laryngopharyngectomy with a neck dissection. A laryngopharyngectomy removes part or all of the voice box, part or all of the throat, and part of the food tube. A neck dissection removes the lymph nodes in the neck[5].
Other procedures may be done to help with breathing and nutrition. These include placement of a breathing tube, called a tracheostomy, to help you breathe, and placement of a feeding tube, usually a gastrostomy, to make sure you get enough nutrients. Surgery for pharyngeal cancer may affect your ability to speak and swallow. It may also affect your appearance. Reconstructive surgery is often done to improve the look and function of the mouth and neck as much as possible[5].
Chemoradiation
Chemoradiation is one of the main treatments for stage 3 pharyngeal cancer. In chemoradiation, chemotherapy is given during the same time period as radiation therapy. The chemotherapy makes the radiation more effective[5].
For stage 3 cancer, cisplatin is typically the chemotherapy drug given along with radiation to the tumor and lymph nodes on both sides of the neck[5].
Radiation Therapy
External radiation therapy is one of the main treatments for stage 3 pharyngeal cancer. Radiation therapy is usually given during the same time period as chemotherapy. Radiation therapy or chemoradiation may also be given after surgery[5].
Intensity-modulated radiation therapy (IMRT) is a specialized type of external radiation therapy. It may be used to lessen the damage to tissues around the tumor[5].
Chemotherapy
Chemotherapy may be given to shrink the tumor before surgery or radiation therapy for stage 3 pharyngeal cancer. The most common chemotherapy drug combination used is cisplatin and fluorouracil, also called 5-fluorouracil or 5-FU[5].
Immunotherapy
Immunotherapy may be offered for stage 3 pharyngeal cancer. Pembrolizumab may be given before surgery to remove the tumor. It is then given with radiation therapy, with or without cisplatin, and then continued by itself after radiation therapy is finished[5].
Outlook and Survival
The outlook for stage 3 pharyngeal cancer depends on several factors, including the specific location of the cancer, whether it is HPV-related, and the patient’s overall health. For oropharyngeal cancers, around 75 out of 100 people with stage 3 disease will survive their cancer for 5 years or more after diagnosis[23].
For mouth cancers, more than 55 out of 100 people with stage 3 disease will survive their cancer for 5 years or more after diagnosis[23].
Oropharyngeal cancers caused by HPV tend to have a better outlook than those not caused by HPV, even for stage 3 and 4 cancers. Smoking during radiation therapy affects the ability of the treatment to cure the cancer, so it is important to stop smoking before treatment. Your general health and fitness also affect survival. The fitter you are, the better you may be able to cope with your cancer and treatment[23].
While stage 3 pharyngeal cancer is challenging to cure, many patients achieve remission with early intervention and a comprehensive treatment plan. Continuous monitoring and care after treatment are essential for maintaining good health and preventing the cancer from coming back[18].
