Aerodigestive cancers: pharyngeal cancer

Cancers of the pharynx are malignant tumors that arise in the nasopharynx, oropharynx, or hypopharynx. In the United States, oropharyngeal carcinoma (OPC) is the most common, followed by nasopharyngeal carcinoma (NPC) and hypopharyngeal carcinoma (HPC), which is rare. Rates of tobacco-related OPC have declined in the past several decades, whereas rates of human papillomavirus (HPV)-related OPC have increased. Compared with HPV-negative tumors, HPV-positive OPC is associated with a better prognosis, and testing for HPV subtypes, particularly HPV-16 and HPV-18, should be obtained for patients with any squamous cell carcinoma of the oropharynx. NPC is strongly associated with Epstein-Barr virus (EBV); therefore, EBV detection has been used as a clinical marker of disease. Plasma cell-free circulating EBV DNA can be measured to monitor management benefit and detect recurrence. Although HPC is rare, it is associated with a poor prognosis and has the highest mortality rate of all head and neck cancers. Management of pharyngeal cancers is based primarily on site and stage. Studies are under way to evaluate the role of less aggressive management regimens for HPV-related cancers.