Pharyngeal Cancer
Pharyngeal cancers span the nasopharynx, oropharynx and hypopharynx — three regions with markedly different aetiology, viral associations and biology.
Disease categories
Major disease categories
- Nasopharyngeal carcinoma
- Oropharyngeal carcinoma
- Hypopharyngeal carcinoma
Molecular
Molecular considerations
Epstein–Barr virus association is characteristic of nasopharyngeal carcinoma. HPV is central in the oropharynx. Hypopharyngeal disease generally follows the head and neck squamous cell carcinoma profile.
Markers commonly discussed in pharyngeal cancer
- EBV DNA (nasopharyngeal)
- p16 / HPV (oropharyngeal)
- PD-L1
- TP53
Not exhaustive, and not every marker is assessed in every patient. Which of these is relevant depends on the individual case and should be discussed with the treating team.
Testing
Genomic testing considerations
Subsite-appropriate viral and molecular testing.
Germline
Germline considerations
Considered where family history or presentation suggests it.
Molecular monitoring
ctDNA and liquid biopsy considerations
Plasma EBV DNA is an established area of research and practice interest in nasopharyngeal carcinoma.
Single-cell & computation
Single-cell and algorithmic approaches
Single-cell sequencing in head and neck cancer is used to characterise immune exclusion and the stromal compartment, both of which vary substantially between tumours that look similar histologically. Single-cell DNA analysis contributes to field-change questions — whether a second lesion is a recurrence or an independent primary, which clonal analysis can often settle. Algorithm work includes HPV integration site analysis, deconvolution of immune composition from bulk expression, and viral circulating-DNA trajectory modelling.
Decisions
Treatment decision questions
Questions worth raising with a treating team when a decision is being made:
- Is the subsite recorded precisely?
- Has the relevant viral association been assessed for that subsite?
Resistance
Resistance and recurrence questions
- Has viral marker monitoring been considered where relevant?
Trials
Clinical trial considerations
Subsite and viral status materially affect the relevant trial landscape.
When a precision oncology review may help
A review is most useful where the standard pathway has been exhausted or where the picture is more complicated than a protocol accounts for — rare presentations, treatment resistance, complex or apparently contradictory molecular findings, or a decision between several defensible options.
The output is a structured analysis and a set of questions for the treating team. It is not treatment, and it does not replace the treating oncologist.