From endoscopic diagnosis to curative treatment: superficial pharyngeal cancer

Superficial pharyngeal cancers are frequently missed during routine endoscopy and remain challenging to diagnose, even with image advances such as digital chromoendoscopy. Endoscopic submucosal dissection (ESD) has emerged as a minimally invasive, organ-preserving, therapeutic option. Pharyngeal ESD, however, requires awareness of specific anatomical and technical considerations, including narrower working space, thinner pharyngeal wall, proximity to vascular and neural structures, and the risk of airway impairment during the procedure.

A 71-year-old male patient had previously undergone subtotal esophagectomy for esophageal squamous cell carcinoma (SCC). On follow-up endoscopy, after examination of the oral cavity and pharynx, a subtle flat lesion with minimal erythema was identified on the posterior wall of the oropharynx, extending distally to the hypopharynx and right piriform sinus, mildly brownish on virtual chromoendoscopy with preserved loop-like vessels. Biopsy confirmed high-grade dysplasia, and ESD was performed.

Histopathology confirmed in situ SCC with free margins. The patient recovered uneventfully and was discharged after 2 days. Endoscopic follow-up revealed cicatricial retraction, and the patient remained asymptomatic.

Careful inspection of the oral cavity and pharynx should be incorporated into routine endoscopy in patients at high risk for SCC, because early detection may allow curative treatment with minimally invasive endoscopic technique.