Pharyngeal Cancer Surgery Specialist in Ahmedabad

What is pharyngeal cancer?

The pharynx is a 12 to 13 centimetre muscular tube that begins behind the nose and ends at the top of the oesophagus and larynx. Pharyngeal cancer is a malignant tumour of its lining and is one of the main forms of throat cancer. The pharynx has three parts, and cancers of each behave so differently that they are effectively three diseases:

Symptoms of pharyngeal cancer

Symptoms depend on the site, but any of the following that persists for more than three weeks should prompt an examination:

• A painless lump in the neck, often the first sign of nasopharyngeal or HPV-related oropharyngeal cancer
• Persistent sore throat or pain on one side of the throat
• Difficulty or pain when swallowing, or food sticking
• The sensation of a lump in the throat
• Pain in one ear, with a normal ear examination
• Blocked nose, blood-stained nasal discharge or one-sided hearing loss (nasopharynx)
• Change in voice, or muffled "hot potato" speech
• Coughing up blood, weight loss, or noisy breathing

Swallowing difficulty in particular should never be attributed to age or stress without examination. Our article difficulty swallowing: could it be pharyngeal cancer? explains when to be concerned.

Causes and risk factors

Tobacco, in smoked and chewed forms, and alcohol are the traditional causes and remain dominant in hypopharyngeal cancer. HPV infection now accounts for a majority of oropharyngeal cancers in many populations and an increasing share in India; these cancers occur in younger, often non-smoking patients and respond unusually well to treatment. Epstein-Barr virus and dietary factors drive nasopharyngeal cancer. Poor nutrition, long-standing iron deficiency (Plummer-Vinson syndrome) and reflux also play a part. Read about the link between HPV and throat cancer.

Diagnosis and staging

1. 01

   Flexible nasopharyngolaryngoscopy

   A thin scope passed through the nose gives a complete view of all three parts of the pharynx in the clinic. Narrow-band imaging highlights early lesions.

2. 02

   Examination under anaesthesia with biopsy

   Precise mapping of the tumour and biopsy for histology. Oropharyngeal tumours are tested for p16 (HPV), which changes both staging and treatment.

3. 03

   Neck node assessment

   Ultrasound-guided fine-needle aspiration of any enlarged node. An unexplained neck lump with no obvious primary is investigated by examining the tonsil and tongue base, where small HPV cancers often hide. See neck lump with no obvious cause.

4. 04

   MRI, CT and PET-CT

   MRI gives the best view of the tongue base, tonsil and nasopharynx; CT of the neck and chest maps nodes and cartilage; PET-CT completes staging in advanced or node-positive disease.

Pharyngeal cancer treatment in Ahmedabad

Because the pharynx is essential for swallowing, treatment aims to eradicate the cancer while keeping the swallowing passage intact and functional. Dr. Parin Patel reviews each patient at a multidisciplinary tumour board at HCG Aastha Cancer Centre and recommends one of the following pathways.

Transoral robotic and laser surgery

Early oropharyngeal and selected hypopharyngeal cancers can be removed through the mouth, with no external incision, using transoral robotic surgery (TORS) or laser microsurgery. This allows early swallowing, a short stay and, in many cases, a reduced dose of radiotherapy afterwards or none at all. Dr. Patel is a trained robotic surgeon and offers TORS for suitable tumours.

Open surgery with reconstruction

Advanced hypopharyngeal cancers, and cancers that recur after radiotherapy, may need partial or total pharyngectomy, sometimes together with laryngectomy. The swallowing tube is rebuilt in the same operation using a free flap from the thigh or forearm, or a segment of the bowel, so that oral eating can resume. See our reconstructive surgery page.

Neck dissection

Pharyngeal cancers spread to the neck early, and a selective or comprehensive neck dissection is performed with the primary surgery or, after chemoradiotherapy, if a node persists on PET-CT. The rationale is set out in neck lymph node removal in throat cancer surgery.

Radiotherapy and chemotherapy

Chemoradiotherapy is the standard first-line treatment for nasopharyngeal cancer and for many oropharyngeal and hypopharyngeal cancers, preserving the pharynx and larynx. It is also given after surgery when there are high-risk features. Intensity-modulated radiotherapy limits the dose to the salivary glands and swallowing muscles. Surgery is then held in reserve for any residual or recurrent disease.

Why Dr. Parin Patel

• Fellowship-trained Head, Neck and Skull Base Surgical Oncologist and Robotic Surgeon, with more than thirteen years of experience
• Transoral robotic and laser surgery for early pharyngeal cancer, and complex pharyngeal reconstruction for advanced disease
• Skull base fellowship at Tata Memorial Centre, valuable for nasopharyngeal and high hypopharyngeal tumours
• Consultant at HCG Aastha Cancer Centre with on-site radiotherapy, chemotherapy and rehabilitation
• Every case planned at a multidisciplinary tumour board

Read more on the about page and in our complete patient guide to choosing a throat cancer doctor in Ahmedabad.

Recovery and swallowing rehabilitation

After transoral surgery most patients swallow within one to two days and go home within a week. After chemoradiotherapy, the throat is sore and swallowing is difficult for several weeks; a temporary feeding tube protects nutrition, and daily swallowing exercises started before treatment shorten recovery. After open pharyngeal reconstruction, oral feeding resumes once the flap has healed, typically at two to three weeks. Dry mouth, taste change and neck stiffness improve over months with specific therapy.

Our rehabilitation programme and the articles throat cancer and swallowing: understanding dysphagia and recovery and nutrition challenges in throat cancer explain what to expect and how to prepare.

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