Throat cancer

What is throat cancer?

Throat cancer refers to cancerous tumors that develop in your throat (pharynx), voice box (larynx) or tonsils.

Your throat is a muscular tube that begins behind your nose and ends in your neck. Throat cancer most often begins in the flat cells that line the inside of your throat.

Your voice box sits just below your throat and also is susceptible to throat cancer. The voice box is made of cartilage and contains the vocal cords that vibrate to make sound when you talk.

Throat cancer can also affect the piece of cartilage (epiglottis) that acts as a lid for your windpipe. Tonsil cancer, another form of throat cancer, affects the tonsils, which are located on the back of the throat.

What are the symptoms of throat cancer?

Signs and symptoms of throat cancer may include:

• A cough
• Changes in your voice, such as hoarseness or not speaking clearly
• Difficulty swallowing
• Ear pain
• A lump or sore that doesn’t heal
• A sore throat
• Weight loss

What are the causes of throat cancer?

Throat cancer occurs when cells in your throat develop genetic mutations. These mutations cause cells to grow uncontrollably and continue living after healthy cells would normally die. The accumulating cells can form a tumor in your throat.

What are the types of throat cancer?

Throat cancer is a general term that applies to cancer that develops in the throat (pharyngeal cancer) or in the voice box (laryngeal cancer). The throat and the voice box are closely connected, with the voice box located just below the throat.

Though most throat cancers involve the same types of cells, specific terms are used to differentiate the part of the throat where cancer originated.

• Nasopharyngeal cancer begins in the nasopharynx — the part of your throat just behind your nose.
• Oropharyngeal cancer begins in the oropharynx — the part of your throat right behind your mouth that includes your tonsils.
• Hypopharyngeal cancer (laryngopharyngeal cancer) begins in the hypopharynx (laryngopharynx) — the lower part of your throat, just above your esophagus and windpipe.
• Glottic cancer begins in the vocal cords.
• Supraglottic cancer begins in the upper portion of the larynx and includes cancer that affects the epiglottis, which is a piece of cartilage that blocks food from going into your windpipe.
• Subglottic cancer begins in the lower portion of your voice box, below your vocal cords.

What are the risk factors of throat cancer?

Factors that can increase your risk of throat cancer include:

• Tobacco use, including smoking and chewing tobacco
• Excessive alcohol use
• A sexually transmitted virus called human papillomavirus (HPV)
• A diet lacking in fruits and vegetables
• Gastroesophageal reflux disease (GERD)

How is throat cancer diagnosed?

Following are the ways to diagnose throat cancer:

• Using a scope to get a closer look at your throat. Your doctor may use a special lighted scope (endoscope) to get a close look at your throat during a procedure called endoscopy. A tiny camera at the end of the endoscope transmits images to a video screen that your doctor watches for signs of abnormalities in your throat.Another type of scope (laryngoscope) can be inserted in your voice box. It uses a magnifying lens to help your doctor examine your vocal cords. This procedure is called laryngoscopy.
• Removing a tissue sample for testing. If abnormalities are found during an endoscopy or laryngoscopy, your doctor can pass surgical instruments through the scope to collect a tissue sample (biopsy). The sample is sent to a laboratory for testing. Your doctor may also order a sample of a swollen lymph node using a technique called fine-needle aspiration.
• Imaging tests. Imaging tests, including X-ray, computerized tomography (CT), magnetic resonance imaging (MRI) and positron emission tomography (PET), may help your doctor determine the extent of your cancer beyond the surface of your throat or voice box.

How throat cancer is treated?

Your treatment options are based on many factors, such as the location and stage of your throat cancer, the type of cells involved, your overall health, and your personal preferences. Discuss the benefits and risks of each of your options with your doctor. Together you can determine what treatments will be most appropriate for you.

Radiation therapy

Radiation therapy uses high-energy beams from sources such as X-rays and protons to deliver radiation to the cancer cells, causing them to die.

Radiation therapy can come from a large machine outside your body (external beam radiation), or radiation therapy can come from small radioactive seeds and wires that can be placed inside your body, near your cancer (brachytherapy).

For early-stage throat cancers, radiation therapy may be the only treatment necessary. For more-advanced throat cancers, radiation therapy may be combined with chemotherapy or surgery. In very advanced throat cancers, radiation therapy may be used to reduce signs and symptoms and make you more comfortable.

Surgery

The types of surgical procedures you may consider to treat your throat cancer depend on the location and stage of your cancer. Options may include:

• Surgery for early-stage throat cancer. Throat cancer that is confined to the surface of the throat or the vocal cords may be treated surgically using endoscopy. Your doctor may insert a hollow endoscope into your throat or voice box and then pass special surgical tools or a laser through the scope. Using these tools, your doctor can scrape off, cut out or, in the case of the laser, vaporize very superficial cancers.
• Surgery to remove all or part of the voice box (laryngectomy). For smaller tumors, your doctor may remove the part of your voice box that is affected by cancer, leaving as much of the voice box as possible. Your doctor may be able to preserve your ability to speak and breathe normally.For larger, more-extensive tumors, it may be necessary to remove your entire voice box. Your windpipe is then attached to a hole (stoma) in your throat to allow you to breathe (tracheotomy). If your entire larynx is removed, you have several options for restoring your speech. You can work with a speech pathologist to learn to speak without your voice box.
• Surgery to remove part of the throat (pharyngectomy). Smaller throat cancers may require removing only small parts of your throat during surgery. Parts that are removed may be reconstructed in order to allow you to swallow food normally.Surgery to remove more of your throat usually includes removal of your voice box as well. Your doctor may be able to reconstruct your throat to allow you to swallow food.
• Surgery to remove cancerous lymph nodes (neck dissection). If throat cancer has spread deep within your neck, your doctor may recommend surgery to remove some or all of the lymph nodes to see if they contain cancer cells.

Surgery carries a risk of bleeding and infection. Other possible complications, such as difficulty speaking or swallowing, will depend on the specific procedure you undergo.

Chemotherapy

Chemotherapy uses drugs to kill cancer cells.

Chemotherapy is often used along with radiation therapy in treating throat cancers. Certain chemotherapy drugs make cancer cells more sensitive to radiation therapy. But combining chemotherapy and radiation therapy increases the side effects of both treatments.

Discuss with your doctor the side effects you’re likely to experience and whether combined treatments will offer benefits that outweigh those effects.

Targeted drug therapy

Targeted drugs treat throat cancer by taking advantage of specific defects in cancer cells that fuel the cells’ growth.

As an example, the drug Cetuximab (Erbitux) is one targeted therapy approved for treating throat cancer in certain situations. Cetuximab stops the action of a protein that’s found in many types of healthy cells, but is more prevalent in certain types of throat cancer cells.

Other targeted drugs are available and more are being studied in clinical trials. Targeted drugs can be used alone or in combination with chemotherapy or radiation therapy.

Rehabilitation after treatment

Treatment for throat cancer often causes complications that may require working with specialists to regain the ability to swallow, eat solid foods and talk. During and after throat cancer treatment, your doctor may have you seek help for:

• The care of a surgical opening in your throat (stoma) if you had a tracheotomy
• Eating difficulties
• Swallowing difficulties
• Stiffness and pain in your neck
• Speech problems