Throat cancer refers to any cancer that develops in tissue of the pharynx, precisely in the nasopharynx (the uppermost part of the throat behind the nose), the oropharynx (the area of the throat at the back of the mouth) or the hypopharynx (the lower part of the pharynx).
In most cases, throat cancer associated with sore throat, difficulty breathing and swallowing. The disease can also be associated with cough and hoarseness. These signs do not mean you have throat cancer, but they are indicators. Therefore, it is important to see your doctor if you experience any of these symptoms for days. Earlier the cancer is diagnosed, more chances you have to survive. You can be cured from throat cancer, but the treatment often leaves large scar.
In addition, throat cancer often leads to cancers of the mouth, esophagus or lung. When the cancer is associated with lung cancer, chance of cure is very minimal. Approximately, 20% of patients, in whom one of these metastases is not found at the diagnosis, develop it in the months or years after the treatment.
Types of Throat Cancer
Depending on the types of cells involved, a throat cancer can be named:
- Nasopharyngeal cancer– a cancer that arises in the upper part of the throat behind the nose.
- Laryngopharyngeal cancer –also called hypopharyngeal cancer, laryngopharyngeal cancer is a type of throat cancer that begins in the hypopharynx, the bottom part of the throat, above the esophagus and windpipe (a tube-like portion of the respiratory tract that connects the larynx with the bronchial parts of the lungs).
- Oropharyngeal cancer –a cancer that begins in the middle portion of the throat behind the mouth, and includes:
- a) the back one-third of the tongue
- b) the soft palate
- c) the side and back walls of the throat
- d) And the tonsils.
- Glottic cancer – the formation of cancer cells begins in the glottis, the middle portion of the throat (larynx), precisely in the area where the vocal cords are located.
- Supraglottic cancer –a type of throat cancer develops in the larynx above the glottis.
- Subglottic cancer– in this type of throat cancer, the formation of cancer cells begins in the lower part of the throat (larynx) just below the vocal cords down to the top of the trachea, which takes air to the lungs.
Throat Cancer Statistics
Throat cancer is not rare in the US; about 24,000 people are diagnosed with throat cancer each year. The National Cancer Institute (NCI) has estimated that 9,920 men and 2,370 women were diagnosed with throat cancer in 2009; nearly 3,660 died of it.
Throat cancer is more frequent in men than women, especially in older men between 50 and 70 years old. The median age at diagnosis for throat cancer is 65 years of age. Percentages and ages of people diagnosed in 2002-2006 were approximately:
- 0% under age 20;
- 5% between 20 and 34;
- .4% between 35 and 44;
- 5% between 45 and 54;
- 7% between 55 and 64;
- 0% between 65 and 74;
- 1% between 75 and 84;
- 7% 85+ years of age.
Throat Cancer Causes
Your throat is part of your neck anterior to the spine, consisting of two main organs: the larynx and pharynx.
The larynx is located just after the junction of the pharynx. It is the intermediary between the pharynx and trachea. It contains the vocal cords. The larynx plays four main functions:
- swallowing of foods and other substances;
- blocking swallowed substances from returning;
- breathing, being an integral part of the airways;
- Production of vocal sounds.
The pharynx is a fibromuscular tube that extends from the back of the nasal cavity and mouth to the esophagus. It participates in four main functions:
All these functions are possible, thanks to thousands and thousands of cells that work synergistically in the throat. Every day, thousands of these cells naturally die (self-cell destruction or apoptosis) to be replaced by new healthy cells. Throat cancer occurs when there is abnormal and anomic cell proliferation in the tissue of the throat.
Although all the causes of throat cancer are not identified, its primary factor is smoking. The risk is even higher when smoking is associated with heavy alcohol consumption, another causative factor for throat cancer. It is estimated that heavy smokers have about 20 times more chance to die from cancer of the throat than non-smokers.
Tobacco contains toxic substances. Once in the aero digestive tract, tobacco smoke and the harmful substances directly alter the lining of the throat by changing the morphology of the tissue. Smoking increases the air temperature inside the larynx to 42 ° C. Persistence in this practice will lead to micro damage in the throat tissue, which sooner or later turn into cancer.
Throat Cancer Risk factors
Many risk factors are suspected in the development of throat cancer; the most common include:
- Poor dental hygiene ;
- Age– throat cancer mainly affects people between 50 and 70 years;
- Sex –men are nearly ten times more victim of throat cancer than women;
- Chemicals– exposure to sulfuric acid fumes and asbestos, toxic vapors of organic substances/chemicals can lead to occurrence of throat cancer.
- Diet– eating a diet rich in hot, irritating and acidic foods, but low in fruits and vegetables increases your risk of throat cancer.
- Gastroesophageal Reflux Disease (GERD)– prolonged irritation associated with chronic gastroesophageal reflux can cause the development of cancers of the esophagus and larynx.
- Throat Injury– if you abuse your vocal cords (if you’re a singer for example), you can develop benign polyps in your throat, which can become cancerous if not treated.
- Alcohol– a moderate consumption of alcohol is safe; heavy consumption, however, can double your risk of developing cancer of the throat. When alcohol is associated with tobacco, the risk is considerably increased.
- Human papillomavirus– it is shown in some studies that chronic infection with HPV can cause formation of cancerous cells in the throat. . Without effective treatment, the virus will bind to the larynx and causes later formation of tumors called laryngeal papillomas, which can develop into cancer.
- Weakened immune system– if your immune system is weakened, you are susceptible to be a victim of many types of cancers including throat cancer. Factors that can weaken your immune system are numerous, the most common include:
- a) HIV/ SIDA
- b) stress
- c) Poor diet
- d) malnutrition
- e) taking immunosuppressive drugs after an organ transplant
- f) Cancer treatments such as chemotherapy and radiation.
Throat Cancer Symptoms
Depending on the location of the tumor, a throat cancer may be completely asymptomatic for months or years. In addition, the signs and symptoms of throat cancer tend to vary depending on the location of the tumor in your throat. Generally you will experience at least one of the following symptoms if you have throat cancer:
- weight loss
- ear pain
- difficulty breathing
- sore throat
- difficult or painful swallowing
- hoarseness for more than two weeks
- alteration of voice quality
- Feeling of having a foreign body in the throat.
Throat Cancer Complications
Throat cancer is often subject of complications; complications may be due to either the cancer itself or its treatment. Some throat cancer complications include:
Metastasis – the cancer can spread into nearby tissues of the throat such as mouth and cervical lymph nodes, or more distantly sites such as the lungs.
Airway obstruction – if you have throat cancer, the tumor can block your airways and make breathing difficult. Besides the cancer, the treatment itself can cause respiratory problems. If you had a total removal of the larynx, you will need a tracheostomy to maintain respiration.
Deformation of the throat and neck – if you have had surgery which involved removal of the tumor and surrounding tissue, this can lead to some distortion of the throat and neck. Not only the operation may make the movement of your neck difficult, a tracheostomy may leave a permanent opening (stoma) in your neck.
Difficulty eating – in most cases, after surgery, you will have difficulty swallowing foods of a certain consistency. In addition, if you had radiotherapy treatment, you may experience difficulty chewing or opening your mouth widely.
Loss of voice – removal of the larynx can affect your vocal chords and prevent you from speaking normally. Today, there are methods used to help patients facing these problems:
- Esophageal speech(or voice) – this alternate method allows you to vocalize without the oscillation in your vocal cords; it involves swallowing air and expelling it to produce sounds. Esophageal speech is the basic method to replace the normal voice; however, you will need a speech therapist at the beginning to help you become familiar with the technique.
- Tracheoesophageal (TE) voice prosthesis– this technique involves placing a small valve between the trachea and esophagus. It allows you to produce TE speech by shunting air from the lungs into the esophagus, which vibrate the esophageal tissue. This medical device is usually recommended by a laryngologist or a speech-language pathologist for voice rehabilitation following a total laryngectomy.
- Electrolarynx– this is an electronic device used to produce clearer speech by those who have lost their original voicebox, usually due to cancer of the larynx. Held near the skin of the throat or the corner of the mouth, the device produces a mechanical voice that helps the wearer communicate in a comfortable and familiar way.
Throat Cancer Diagnosis
Your doctor will question you about your medical history and your family’s. He will then do a physical examination to examine your throat. During the examination, he will use a special lighted scope called endoscope to visualize tissues of your throat searching for signs indicating cancer. Even if he finds vivid signs of the disease, he cannot conclude you have cancer, they are simply indicators. Therefore, to confirm the diagnosis, he will perform other medical procedures, which can include:
- Laryngoscopy– the purpose of this test is to visualize the back of your throat, including your larynx and vocal cords. During the procedure, the doctor passes a narrow tube with a lens (laryngoscope) through your nose or your mouth to be able to see the upper part of the larynx. To prevent discomfort, you can be slightly anesthetized.
- Chest X- ray –this imaging technique can be performed to check if the tumor has spread into your lungs. In fact, if you have shortness of breath, persistent cough, pain in the chest, or chest trauma, a chest x-ray may be the first imaging technique recommended by your doctor.
- CT scan– this radiographic exam allows your doctor to detect abnormalities in your throat by submitting your neck to an x-ray beam. This test is very important in the diagnosis of throat cancer; it creates precise images which helps your doctor to detect not only the cancer but also metastases, in case there is any. However, as for x-ray, repeated exposure to radiation can be harmful.
- Magnetic resonance imaging (MRI)– MRI is another technique often used in the diagnosis of throat cancer. It allows your doctor to visualize the tissues of your neck and detect abnormalities in your throat: inflammation, malignant growth (cancer), etc.
- Biopsy– a biopsy is the major procedure to confirm the presence of cancer cells in your throat. It involves taking sample from the suspected tumor for laboratory analysis. Sample obtained will be examined under microscope in search of cancer cells. The sampling is done through endoscopy under general anesthesia, or through a thin needle that is inserted into your neck.
Throat Cancer Stages
Once it is confirmed that you have throat cancer, your doctor will determine the stage of the tumor; Staging is very important to determine the prognosis and the treatment you should undergo. In general, the stage of a throat cancer is determined from its size and degree of spread within your body.
The stage of throat cancer is often identified by Roman numerals: I, II, III and IV. A higher stage indicates lower chances of survival.
- Carcinoma in situ –the cancer has not invaded the tissue of your throat; your surgeon can remove the tumor without causing physiological damage;
- Stage I– the tumor has invaded the tissue of the throat, but has not spread into surrounding tissue.
- Stage II– at stage 2, the cancer has invaded surrounding tissue, but has remained in the region of the throat.
- Stage III– the cancer has spread beyond the surrounding tissues to reach nearby lymph nodes.
- Stage IV– at this final stage, the tumor has not only invaded the nearby lymph nodes but also distant sites in the body such as the lungs.
Throat Cancer Treatment
Your doctor will consider the extension of the tumor along with your age and your general health to determine the treatment most appropriate and effective to fight it. In general, earlier the cancer is diagnosed, more chance you have to survive.
Throat cancer can be treated with surgery, radiotherapy, and/or chemotherapy; sometimes a combination of these treatments is used. However, the treatment of choice for early-stage throat cancer is radiation therapy. If the cancer is advanced, but operable, your health care provider can combine the radiation with surgery and /or chemotherapy.
If surgery can be performed, your surgeon will perform one of these surgical operations:
- Laryngectomy– during this surgical procedure, your surgeon removes part or the entire larynx, and makes a sort of opening in your neck so you can breathe. This will damage your vocal cords; however, there are several solutions that can help you speak or communicate with others. In fact, the majority of throat cancer victims having had a laryngectomy manage to communicate well with others as before the surgery (see complications for details).
- Pharyngectomy– this is a major surgery consists of removing the pharynx, in whole or in part. In case you have a localized or early stage throat cancer, your surgeon can perform a partial pharyngectomy; in advanced throat cancer, however, a total pharyngectomy is often performed to remove the tumor completely.
- Neck dissection –neck dissection is sometimes practiced when the cancer has spread to the tissue of the neck; the goal of the surgery is to remove cancerous lymph nodes.
Radiation Therapy (radiotherapy)
Radiotherapy is a therapeutic method commonly used to treat throat cancer. It consists of using ionizing radiation to kill cancer cells in order to shrink or eliminate the tumor. If you have an early stage (stage 1 and even 2) throat cancer, radiation therapy may be the ideal choice; in fact, many of throat cancer diagnosed early treated solely by radiotherapy. In addition, unlike surgery, radiation therapy has no or less permanent physiological effects; it does not damage your vocal cords; that is, the quality of your voice does not change.
However, radiotherapy is sometimes associated with temporary side effects:
- sore throat
- voice change (temporary)
- mouth sores
- sensitivity of the mouth and gums
- lower production of saliva (dry mouth)
- redness and dryness of the skin
- Loss of taste or smell.
Throat Cancer Chemotherapy
Chemotherapy involves using powerful chemical agents (drugs) to slow down or stop the uncontrolled reproduction of cancerous cells. Chemotherapy is not always practical in the treatment of throat cancer; it is necessary if the cancer has spread elsewhere or if the cancer is aggressive. Unlike radiotherapy, chemotherapy drugs circulate throughout your body and affect all organs. While attacking cancer cells, chemotherapy drugs also damage healthy cells that multiply rapidly, which often causes side effects:
- decreased appetite
- hair loss
- nausea and vomiting
- Mouth sores.
Throat Cancer Survival Rates
The prognosis of throat cancer depends on the stage of the tumor at diagnosis. Earlier the cancer is diagnosed, better prognosis it has. In fact, throat cancer can be cured in 90% of cases when detected and treated early.
Five-year survival rate of a cancer that has spread into surrounding tissues or lymph nodes is about 60%. Five-year survival rate of a throat cancer recur after total laryngectomy is in general less than 60%.
However, survival rates vary by age and race. The overall 5-year relative survival rate for 1999-2005 was 61.6%. Five-year relative survival rates by race and sex were:
- 0% for white men;
- 6% for white women;
- 6% for black men;
- 1% for black women
Death rates by races
The age-adjusted death rate was 1.3 per 100,000 men and women per year. These rates are based on patients who died in 2002-2006 in the US. In general, death rates by race include:
- All Races: 2.3 per 100,000 men and 0.5 per 100,000 women
- White: 2.1 per 100,000 men and 0.5 per 100,000 women
- Black: 4.7 per 100,000 men and 0.7 per 100,000 women
- Asian/Pacific Islander: 0.7 per 100,000 men and 0.1 per 100,000 women
- American Indian/Alaska Native: 1.9 per 100,000 men …
- Hispanic: 1.9 per 100,000 men and 0.2 per 100,000 women
Throat Cancer Prevention
While it is not always easy to prevent cancer; you can, however, reduce your risk. To prevent the occurrence of any cancer, including throat cancer, it is important to live a healthy lifestyle, and live in a healthy environment.
Several factors can cause formation of cancerous cells in your body. In the case of throat cancer, tobacco and alcohol are the primary causes. Eliminate them in your life is dramatically reduce your risk of becoming a victim of throat cancer.
Some risk factors such as age, sex and genetic are impossible to change; others causative factors, however, can be prevented. If you want to prevent throat cancer and many other cancers, you need to:
- treat any gastroesophageal reflux before it becomes chronic
- keep your immune system healthy
- use an air purifier if you live in an industrial or an high pollution environment
- stop smoking and avoid second-hand tobacco smoke;
- tell your doctor or dentist of any change in your oropharyngeal cavity that indicates cancer.
- eat foodsrich in vitamin A (such as liver) or take a vitamin A supplement
- adopt a healthy diet – a diet contains 5 to 10 servings of fruits and vegetables a day may help prevent throat cancer.
- exercise regularly
- maintain a healthy weight
- limit your alcohol consumption;
- reduce your exposure to ultraviolet (UV) radiation from the sun or artificial tanning devices, such as tanning beds
- Perform safe sex.
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