Personalised treatments designed to fight cancer while minimising side effects.
Throat cancer generally refers to cancers that develop in the pharynx, the hollow muscular tube that runs from the back of the nose to the top of the oesophagus and windpipe. These cancers are part of the broader group of head and neck cancers.
Most throat cancers are squamous cell carcinomas, arising from the lining of the throat.
For clarity, this page focuses on cancers of the oropharynx and hypopharynx.
The nasopharynx (upper throat behind the nose) is discussed separately under Nasopharyngeal Cancer, as it differs in risk factors, presentation, and management.
Each area can develop cancer with different causes and patterns of spread.
In Singapore, cancers of the throat (pharynx) account for a relatively small proportion of all cancer diagnoses. However, they remain clinically significant due to their impact on swallowing, speech, and breathing.
Globally, the incidence of oropharyngeal cancer has been increasing, partly associated with infection by the Human Papillomavirus (HPV).
Risk factors vary depending on the location of the cancer within the throat.
In recent years, infection with the Human Papillomavirus (HPV), particularly HPV-16, has become an important cause of oropharyngeal cancer. HPV-associated cancers often occur in patients without a strong smoking history.
Hypopharyngeal cancer is more strongly associated with traditional risk factors such as tobacco use and heavy alcohol consumption. The combined use of tobacco and alcohol significantly increases the risk.
Symptoms depend on the tumour location within the throat (pharynx). This page focuses on cancers of the oropharynx and hypopharynx. Early symptoms may be subtle and can resemble common throat conditions.
Symptoms that persist beyond 2–3 weeks should be medically evaluated.
The diagnosis of throat cancer involves a combination of clinical evaluation, imaging studies and tissue biopsy. A definitive diagnosis requires microscopic examination of tumour tissue.
The doctor will assess:
A physical examination of the mouth and throat is performed, along with palpation of the neck to check for enlarged lymph nodes.
A flexible endoscopic examination (e.g., flexible nasopharyngolaryngoscopy) may be performed to assess the oropharynx, hypopharynx and adjacent structures.
This allows visualisation of the:
It helps identify abnormal growths, ulceration or asymmetry.
If cancer is suspected, imaging may be performed to assess tumour size and extent of spread:
The choice of imaging depends on clinical findings and staging requirements.
A biopsy is required to confirm the diagnosis.
For oropharyngeal cancers, tumour tissue may also be tested for HPV status, often using p16 immunohistochemistry and/or HPV-specific testing depending on institutional protocol.
Throat cancers of the oropharynx and hypopharynx are staged according to the AJCC (American Joint Committee on Cancer) 8th Edition TNM classification system.
Staging is based on:
Stage grouping is determined by combinations of T, N and M categories.
Oropharyngeal squamous cell carcinoma is staged differently based on p16 (HPV) status, as recognised in AJCC 8th Edition.
HPV-associated OPSCC has a distinct staging system reflecting its more favourable prognosis.
Nodal staging differs from HPV-negative disease and allows for more extensive nodal burden within earlier stage groups.
Staged according to conventional head and neck squamous cell carcinoma criteria:
Hypopharyngeal squamous cell carcinoma follows the conventional AJCC TNM staging system (8th Edition).
Hypopharyngeal cancers frequently present at advanced stage due to submucosal spread and late symptom onset.
Management of oropharyngeal and hypopharyngeal squamous cell carcinoma (SCC) is individualised and determined within a multidisciplinary tumour board setting. Treatment decisions are based on:
Treatment intent may be curative or palliative, depending on stage and patient factors.
For appropriately selected patients:
Adjuvant radiotherapy or concurrent chemoradiotherapy is recommended in the presence of high-risk pathological features (e.g., positive margins, extranodal extension).
Both primary radiotherapy and surgery-based approaches provide comparable oncologic outcomes in selected early-stage cases.
Standard treatment options include:
or
HPV-positive disease is staged differently but current standard treatment intensity remains similar outside of clinical trial settings. De-escalation strategies are not considered routine standard of care.
Management options may include:
Systemic therapy selection is guided by prior treatment exposure, performance status, and biomarker status where relevant.
Hypopharyngeal cancers frequently present at advanced stage.
Adjuvant therapy is guided by pathological risk factors.
Treatment options include:
Treatment selection depends on tumour extent, cartilage invasion, functional laryngeal status, and patient suitability for major surgery.
Management may include:
Palliative care plays an important role in advanced or incurable disease and may be integrated alongside active oncologic treatment.
Supportive measures may include:
Early palliative involvement may improve symptom control and quality of life.
At OncoCare Singapore, our multidisciplinary team includes medical oncologists, ENT and head & neck surgeons, radiation oncologists, radiologists, and pathologists. Patients are also supported by oncology nurses, dietitians, speech and swallowing therapists, and psycho-oncology counsellors. Together, they design a personalised treatment plan tailored to each patient’s needs.
