Comprehensive Endoscopic Management of Superficial Pharyngeal Cancer – From Detection and Diagnosis to Treatment and Surveillance

Traditionally, pharyngeal cancer was detected at an advanced stage, as examinations were usually performed only after symptoms such as pain or dysphagia appeared. Consequently, it was considered a malignancy with a poor prognosis. However, recent advances in image-enhanced endoscopy (IEE) have facilitated the early detection of superficial pharyngeal cancers. The combination of IEE and magnifying endoscopy enables both the detection and detailed characterization of lesions, including assessment of malignancy and invasion depth. Due to the anatomically complex structure of the pharyngolaryngeal region, en bloc resection using snare-based endoscopic mucosal resection has been difficult. However, the development of endoscopic submucosal dissection (ESD) and endoscopic laryngopharyngeal surgery has made en bloc resection technically possible. Successful pharyngeal ESD requires careful planning, including consideration of intubation route, laryngoscope positioning, and choice of devices. Tumor thickness ≥1000 µm and positive lymphovascular invasion are pathological risk factors for lymph node metastasis. However, no consensus exists regarding the need for additional adjuvant chemotherapy. After pharyngeal ESD, close follow-up is essential, focusing on lymph node metastasis and metachronous cancers. Lymph node metastasis may require dissection or radiotherapy, while metachronous lesions can often be treated endoscopically. A multidisciplinary approach is essential for effective management of superficial pharyngeal cancer.