Throat Cancer

What is Throat Cancer

Throat cancer refers to a malignant tumour that develops in the throat. In common usage the throat refers to either the pharynx or the larynx (voice box).

The larynx is a 5-inch long muscular tube that begins behind your nose and ends at the base of your neck at the top of your swallowing tube or oesophagus. The voice box or larynx is just below your Adam’s apple and the thyroid cartilage.

Types of Throat Cancer

Throat Cancer

Throat cancers are usually subdivided into those that develop in the throat (pharyngeal cancers) or those that develop in the voice box (laryngeal cancers). The throat and voice box are closely connected with the voice box (or larynx) sitting just below the throat (pharynx). More specific terms to describe the types of throat cancer include:

  • Nasopharyngeal cancers- beginning in the nasopharynx, that part of your throat that sits just behind your nose.
  • Oropharyngeal cancers- tumours beginning in the oropharynx, that part of your throat that is right behind the opening of your mouth and the back of your tongue.
  • Hypopharyngeal cancers- a tumour beginning in the hyopharynx, the lower part of your throat just above the top of the oesophagus and the trachea.
  • Laryngeal cancers- laryngeal cancers are divided into glottis cancers- supra and sub glottis, which are those that begin on the vocal fold.
  • Supraglottic cancers- those cancers that begin in the upper part of the larynx and include the laryngeal ventricles, the false vocal cords and the epiglottis.
  • Subglottic cancers- those that begin in the lower part of your voice box, that part below the level of the true vocal folds and the top of your trachea.

Signs and Symptoms of Throat Cancer

Signs and symptoms of throat cancer may include:

  • Cough
  • Change in voice such as hoarseness or raspiness
  • Difficulty swallowing
  • Ear pain
  • Lump or sore in the neck that does not heal
  • Breathing difficulties
  • Blood stained phlegm
  • Weight loss
  • Sensation of something permanently stuck in the throat

If you have any of these symptoms for more than 2 weeks, you should see your doctor and if there is any doubt you should be referred to a specialist Otolaryngologist Head and Neck Surgeon.

Causes of Throat Cancer

Although the exact course of throat cancer is unknown, tobacco products are thought to play a significant role in about 80% of cases. Risk factors include:

  • Tobacco use including smoking or chewing of tobacco
  • Regular and heavy consumption of alcohol
  • Poor dental hygiene
  • Sexually transmitted virus called human papilloma virus or HPV
  • A diet lacking in fruit and vegetables
  • Exposure to asbestos or irradiation
  • Family history of cancer, that is say a genetic predisposition

How to Diagnose Throat Cancer?

The diagnosis of throat cancer is usually made by a specialist Otolaryngologist Head and Neck Surgeon. If you have any of the symptoms alluded to above and you see your general practitioners they will, if they have any concerns or suspect the presence of throat cancer, refer you to a specialist urgently. The specialist will undertake a number of procedures including:

  • Complete medical history
  • Physical examination which may include using a mirror to examine the voice box
  • Flexible Fiberoptic Endoscopy where a small camera tip is passed through the nose to have a look at the pharynx, the larynx and the upper oesophagus
  • Video stroboscopy- the use of high-speed light attached to the camera to look for subtle changes in the movement of vocal folds.
  • Biopsy, taking a small sample of suspected malignant tissue for laboratory examination
  • Imaging tests which may included x-ray, ultrasound, computerized tomography (CT scan), Magnetic Resonance Imaging (MRI scan), position emission tomography (PET) scan, plus or minus specific blood tests

Once throat cancer is diagnosed the next step is to determine the extent or stage of the disease. Knowing the stage accurately is important in determining treatment options and likely outcomes.

Throat Cancer Staging

The staging of throat cancer is characterised by Roman Numerals from I-IV. Each sub-type throat cancer has its own criteria for each stage. IN general, Stage I throat cancer indicates a smaller tumour confined to one area of the throat. Later stage or larger tumours are indicated by higher staging with IV being the most advanced.

Stage I - the cancer is small and found only in the area where it started. It has not spread to lymph nodes or to other parts of the body.

Stage II - the cancer remains confined to the larynx or pharynx and has not spread to nearby lymph nodes. The exact definition of this stage depends on where the cancer started.

Stage III - one of these two conditions exist:

  1. The cancer is larger than Stage II and involves more structures. If the cancer is in the larynx and the vocal cords cannot move normally, or the cancer has spread to tissues next to the larynx.
  2. The cancer has spread to one lymph node on the same side of the neck as the cancer and the lymph node measures no more than 3cm (just over 1 inch).

Stage IV- any of the following may be true- the cancer is very large and involves several structures extensively, the cancer has spread to more than one lymph node on the same side of the neck as the cancer, the lymph nodes on one or both sides of the neck or to any lymph node that measures more than 6 cm (over 2 inches), or the cancer has spread to distal parts of the body.

Throat Cancer Treatment

The standard treatment for most cases of throat cancer involves surgery and radiation therapy, either alone or in combination. The exact treatment for an individual case depends on the size and site of the tumour, the general health of the patient, and the patient’s informed decision making after appropriate consultation with specialist surgeons and radiotherapists preferably in a combined Clinic setting.

Each case is assessed individually. A specialist Otolaryngologist Head and Neck Surgeon carefully evaluates every case to determine the optimal surgical approach to manage the cancer, if that is the modality chosen. The type of surgery depends on the cancer’s size and location. Small tumours found relatively early may be removed through an endoscope passed through the mouth to the cancer/ Medium to large tumours may require removal of all or part of the voice box. When the entire voice box must be removed (total Laryngectomy), Surgeons will connect the windpipe to the neck via a stoma or hole through which the person breathes and this is known as a Tracheotomy. Small cancers can often be removed by removing only part of the voice box in an operation called a partial Laryngectomy.

The Team Approach

It is important to note that throat cancers are ideally managed by a team which looks after the physical and psychological aspects of the patient, to discuss treatment options and allow the patient to partake in the decision making process. After treatment there are certain side effects that are likely to occur and which are discussed preoperatively to optimize the postoperative outcome. These include nausea, scarring and deformity, speech and swallowing problems requiring expert speech therapy, problems with diet and weight loss that require the regular input of a dietician, social and psychological problems pertaining to altered sense of body image including possible breakdown in relationships, sometimes inability to work. These require the input of trained social workers, psychologist and clinical nurse consultants.

The diagnosis of throat cancer is not a death sentence. Overall treatment results for all stages of throat cancer are good and continue to improve. Prevention is best achieved by not smoking. If you smoke-quit, if you don’t smoke, don’t start. Drink alcohol only in moderation, if at all. For women and older adults, this means no more than 1 drink a day. For men, moderate drinks means no more than 2 drinks a day. Choose a healthy diet full of fruit and vegetables. The vitamins and anti-oxidants in fruits and vegetables may reduce your risk of throat cancer. Particularly eat a variety of colourful fruits and vegetables.

Exercise caution around chemicals and avoid breathing hazardous chemical fumes. If you have any symptoms or any concerns see your doctor early and ensure that you get appropriate, urgent referral to a Specialist Otolaryngologist/Head and Neck Surgeon.