Throat Cancer

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Overview

Throat cancer happens when the cells in the throat (pharynx) and voice box (larynx) start dividing uncontrollably, leading to the development of a tumour. Throat cancers are one of the most common head and neck cancers in India. It is also one of the cancers that progresses quickly, and therefore, early detection is crucial.

Types

Throat cancers are categorised into the following types depending on the exact location of the tumour growth:

1. Nasopharyngeal Cancers: This cancer type forms in the region right behind the nose.
2. Oropharyngeal Cancers: Oropharyngeal cancers arise from the throat region behind the mouth – including tonsils.
3. Hypopharyngeal Cancers: These cancers form in the lower part of the throat – above the windpipe.
4. Glottic Cancers: Glottic cancers or vocal cord cancers arise from the cells in the vocal cord.
5. Supraglottic Cancers: Supraglottic cancers form in the region above the voice box (larynx) – including the epiglottis and area above the vocal cords.
6. Subglottic Cancers: These cancers may start in the lower region of the larynx, right below the vocal cords.

Tobacco consumption is found to be the biggest risk factor for throat cancers among Indians. Quitting tobacco is one of the effective ways to reduce throat cancer risk.

Symptoms

A throat ulcer is one of the early symptoms of throat cancer. It is important to not ignore any symptoms, and bringing these symptoms to the physician’s attention supports early detection and timely treatment. Following are the common symptoms of throat cancers:

Unexpected hoarseness or a change in voice
Sore throat or throat pain
Having a lump in your throat
Coughing all the time
Coughing up blood
Swallowing difficulties
Earache
Foul breath
Speech problems, such as a lisp
Breathing difficulties
Frequent urge to clear the throat
Unintentional weight loss

Courses

The reasons for the mutation that leads to throat cancer are not clear. However, factors that can increase the risk of throat cancer include:

Tobacco Consumption: Tobacco use, including smoking and chewing tobacco increases throat cancer risk.
Excessive Alcohol Consumption: Excessive alcohol use increases throat cancer risk.
HPV Infection: Studies have found that chronic HPV infection may increase the risk of developing throat cancer.
Gender: The risk of throat cancer is up to 5 times higher among men than women.
Age: The risk of developing throat cancer increases with age.
Ethnicity: Individuals belonging to African-American ethnicity are at a higher risk of developing throat cancer.

Other risk factors include exposure to harmful chemicals, poor food habits, etc.

Diagnosis

There are different methods available for the detection and diagnosis of throat cancers. Following are the majorly used testing methods available for throat cancer diagnosis:

a. Physical Examination and Medical History Assessment: One of the first things that doctors do, when a patient presents himself/herself with throat cancer symptoms is to assess the patient’s medical history and conduct a thorough physical examination. During the physical exam, the doctor checks the throat region for the presence of lumps or any other abnormalities.

b. Endoscopy: Endoscopy is recommended in order to assess the extent of the tumour growth. During the procedure, a thin lighted tube with a video camera is inserted into the patient’s throat. At times, the doctor may also collect the biopsy sample during this procedure.

c. Imaging Tests: Imaging tests, such as MRI, PET/CT scans, etc., provide additional information on the tumour size, stage, location and grade. These tests also help in treatment planning and therapy monitoring during the treatment.

d. Biopsy: During this procedure, a small sample of the tissue is collected from the suspected region and examined under the microscope for the presence of cancerous cells. A biopsy is the most preferred method to receive a definitive diagnosis of throat cancer.

Treatment

a. Radiation Therapy: Radiation therapy is one of the common treatment modalities recommended for throat cancers. For those throat cancers that have not spread to lymph nodes or nearby organs, radiotherapy may be the only treatment recommended.

During radiation therapy, high-energy X-rays or proton beams are delivered to the tumour in order to destroy the tumour cells.

Radiation may be delivered externally through a radiation source (external beam radiation therapy) or internally by placing a radiation source inside or very close to the tumour (brachytherapy).

Radiation therapy may be combined with other treatment modalities, namely surgery and chemotherapy in order to increase the overall effectiveness of the treatment.

b. Surgery: There are different surgical procedures recommended depending on the stage of the disease:

Wide Local Excision: Wide local excision is recommended for early-stage throat cancers that have not spread to lymph nodes. During this procedure, the tumour and a small portion of healthy tissues surrounding it are removed. This procedure may also be performed endoscopically.
Laryngectomy: During the laryngectomy, a part of the voice box (partial laryngectomy) or the entire voice box (radical laryngectomy). In the case of radical laryngectomy, after the removal of the voice box, the windpipe is later attached to a hole created in the throat (stoma) in order to support seamless breathing. This procedure can affect the patient’s ability to speak; however, patients can seek a speech pathologist’s support to learn to speak without the voice box.
Pharyngectomy: A part of the throat (partial pharyngectomy) or the entire throat (radical pharyngectomy) is removed depending on the extent of the disease. This procedure may be followed by reconstructive surgery in order to restore the structure and functioning of the affected organ.
Neck Dissection: If the throat cancer has spread to the nearby lymph nodes, neck dissection or the removal of cancerous lymph nodes may be recommended. Neck dissection may be performed during the main surgery itself.

Surgery is often combined with other treatment methods like chemotherapy and radiation therapy for better clinical outcomes. These treatments help in shrinking the tumour size before the surgery and destroying the residual cells after.

c. Chemotherapy: During chemotherapy, strong anti-cancer drugs are used to destroy the cancer cells. It is a systemic therapy that is recommended to shrink the tumour size before the surgery (neoadjuvant chemotherapy), and to destroy the residual cancer cells after the surgery (adjuvant chemotherapy).

d. Targeted Drug Therapy: Although not one of the main lines of treatment for throat cancer, targeted therapy is recommended in rare cases. This treatment approach targets the specific vulnerabilities associated with cancer cells in order to halt the growth of cancer cells and stop them from dividing.

e. Immunotherapy: Not used often, immunotherapy offers promising outcomes in a few cases of throat cancers. Cancer cells produce specific proteins, which help them hide from immune cells. This treatment approach stimulates one’s own immune system to identify and attack these cancer cells.

Frequently Asked Questions

1. Are throat cancers treatable?

Yes, throat cancers are treatable. In most cases, positive clinical outcomes and leading a disease-free life are possible. However, it also depends on the stage at which the disease has been diagnosed.

Early-stage throat cancers are much easily treated, while advanced stage cancers need a much more comprehensive treatment plan that could include more than one treatment modality.

Early detection is the key to winning over any cancer, and therefore, it is important to not ignore any symptoms. If any abnormal symptom related to the throat lasts for more than two weeks, it should be brought to the physician’s attention.

2. What causes throat cancers?

Throat cancer is associated with a number of risk factors. Tobacco and alcohol are the two most common causes of throat cancer; both may be highly harmful to the throat and are responsible for the majority of incidence globally.

Another risk factor is HPV, or Human Papillomavirus infection, which is considered to be causing an increase in occurrences of throat cancer lately.

3. What are the potential side effects of throat cancer treatment?

Treatment for throat cancer can have a variety of adverse effects, including changes in voice and trouble swallowing, depending on the therapy. Surgical removal of the vocal cords is a common cause of voice alterations. Hoarseness is another side effect of radiation therapy.

Difficulty swallowing that can range from chronic dry mouth to an inability to swallow anything, including saliva, is another side effect of throat cancer treatment. Impaired speech, trouble eating, swelling, facial deformity, lack of appetite, and changes in taste are all common side effects.

Most of these side effects wear off over time; if patients have difficulties managing their side effects, they can seek medical attention. Rehabilitation is an important part of throat cancer management, and most of the side effects are addressed during this stage.

4. If I quit tobacco, can I reduce my throat cancer risk?

Yes, tobacco consumption is one of the biggest risk factors for throat cancer, and therefore, quitting tobacco can reduce your throat cancer risk.

5. How can I prevent throat cancer?

Although you cannot completely prevent throat cancers, there are a few measures that you can take in order to reduce your throat cancer risk:

Never smoke and if you already do, quit smoking.
Reduce your alcohol consumption.
Have healthy food habits – ensure your diet has fruits and vegetables.
Protect yourself against HPV infection. Consider HPV vaccination, which reduces your HPV infection and thereby throat cancer risk, remarkably.