How is Stage 4 throat cancer treated?
Stage 4 throat cancer is usually an advanced stage , locally extended, or metastatic form of hypopharyngeal or oropharyngeal cancer. It is extremely hard to treat as compared to earlier stages of the disease.
A multi-modality treatment approach is the standard option for locally advanced and locally extended stage 4 throat cancer patients.
The standard approach at this stage is chemoradiotherapy with radical intent. The advantage of radiation over surgery is the preservation of organ functions such as speech and respiration.
Surgical treatments for stage 4 cancers in this region require a more aggressive surgical approach, and surgery is generally recommended in patients who refuse to receive radiation, or in cases where radiation is specifically contraindicated by the doctor.
When surgery is performed as an initial treatment, it needs to be followed with adjuvant radiation with or without chemotherapy.
In metastatic throat cancers, the main intent of treatment is to provide palliative care.
Palliative radiotherapy or chemotherapy is done to provide relief from symptoms such as dysphagia, dyspnea, pain, bleeding, pressure effect or to slow down the progress of the disease.
Systemic treatments are more commonly applied where a tumour is found to be inoperable. If there are enlarged lymph nodes in the neck even after systemic treatment, surgery can be performed in order to remove these affected nodes (lymph node dissection).
The treatment of inoperable tumours in stage 4 throat cancer, is usually performed with radiation in combination with chemotherapy, or with the MAB drug Cetuximab. If a tumour shrinks enough as a result of such systemic therapies, surgeons may consider performing only a lymph node dissection.
Usually, in cases of stage 4 throat cancer, any form of treatment is aimed to stop or slow the rate of tumour growth and to relieve the patient of any painful symptoms that they may be experiencing at this stage.
Treatment of recurrent throat cancer
If cancer recurs or relapses in the same site as the site of origin, and if definitive radiation therapy was used the first time (during the initial line of treatment), then doctors may advise surgical treatments to treat the recurrence (provided the patient is in a condition that is healthy enough to undergo surgery).
Due to previous exposure to high-intensity radiation, external beam radiation therapy usually cannot be applied to the same site again. In such cases, internal radiation treatment (brachytherapy) can be used to control the growth of cancer in the site of primary origin. Alternatively, palliative chemotherapy is prescribed along with immunotherapy.
In cases where the patient was originally treated with surgery and then cancer recurred, doctors usually advise a regimen of systemic therapies and combination-radiotherapy treatments.