Throat Cancer: Causes, Symptoms, Treatment

The throat is the muscular tube that connects the back end of the nose and mouth to the to the windpipe and esophagus (the tube that carries food from the mouth to the stomach). Throat cancer affects the organs that enable speaking, breathing, and swallowing. Here, the cancer usually begins in the flat cells lining the inner surface of the throat. The cells in these organs start growing abnormally at a rapid rate.

The cancerous or malignant tumor mostly originates in the vocal cords and later spreads to other parts of the throat. The other parts include larynx, pharynx, nasal and oral cavities, tongue, tonsils, and trachea. The process of spreading of cancer is referred to as metastasis. Throat cancer, like many other cancers, can spread from its place of origin to the surrounding organs. Gradually, it spreads to the other parts of the body like other larger organs, bones, blood vessels, and skin. 

The Types of Throat Cancer

Cancer that originates in the throat, irrespective of the exact location in the throat, is known as throat cancer or primary throat cancer. Malignant tumour or cancer that has its origin in some other body part and has gradually metastasized to the throat is not referred to as throat cancer. It can only be referred to as secondary throat cancer. 

At times, cancer of the throat may be diagnosed simultaneously with cancers of other body parts like esophagus, mouth, bladder, or lung. Some others may develop these cancers in the later stages. Individuals with a past history of smoking and/or alcoholism are at a higher risk of developing throat cancer. As mostly men are known to be smokers as compared to women, the incidence of this cancer is usually higher in men.

Throat cancer can be divided into various types based on the part of the throat where it originates.

The common throat cancer types are:

Oropharyngeal cancer

Oropharynx is located in the middle part of the throat, behind the mouth that includes tonsils. It also comprises the base of the tongue, the side walls of the throat, tonsils, and the soft palate, i.e. a part of the roof of the mouth. Cancer that begins here is called oropharyngeal cancer. 

This may manifest through symptoms like lump in the throat, difficulty to swallow, persistent or worsening soreness of throat, or ear ache. Infection with HPV (human papillomavirus) is one of the leading risks to this throat cancer type. 

Hypopharyngeal cancer 

Cancer in the lower part of the throat usually manifests through symptoms like prolonged or increasing difficulty in swallowing, ear ache, lumps in the throat, loss of weight, etc.

Laryngeal cancer

This is the cancer of the larynx or voice box or vocal cord. This is a tiny channel in front of the lower portion of the throat or pharynx. The cartilaginous larynx comprises the vocal cords that vibrate to produce sound when air clashes against it when we talk. The usual symptoms of this cancer are prolonged and increasing hoarseness of voice, noisy breathing, pain while swallowing, etc.

Glottic cancer

This starts in the epiglottis or the cartilage that covers the windpipe.

Supraglottic cancer

The cancerous cells originate in the upper part of the larynx and the epiglottis.

Tonsillar cancer

This is a cancer of the tonsils, located at the back of the throat.

Throat cancer is characterised by rapidly-growing abnormal cells of various parts of the throat, accumulating to develop into a malignant tumour. 

Symptoms

Throat cancer is often difficult to diagnose in the early stages of the disease. This is because its possible symptoms are very similar to other milder medical conditions of the throat like common cold and sore throat. Certain symptoms are typical of a particular throat cancer type than the others. There are a varied range of symptoms, all of which do not usually appear in every patient. 

Below are the possible throat cancer symptoms:

• Mouth sores or bleeding in the mouth
• Sore throat
• Difficulty and/or pain in swallowing
• Hoarseness of voice
• Long-lasting cough or coughing up blood
• Lumps in the neck
• Ear pain, hearing loss, or ringing in the ears
• Weight loss

Causes

Certain abnormalities in the cells of the throat due to genetic mutations cause these cells to grow at an unusually rapid rate. The cells continue growing beyond the expected lifespan of healthy cells. They accumulate to form a cancerous or malignant tumour in the throat. There is no conclusive evidence yet regarding the underlying cause of abnormalities in these cells.

Risk Factors

The known risk factors of the medical condition are:

• Smoking and chewing tobacco. Smoking is the single, most important risk factor. 
• Excessive consumption of alcohol
• Human papillomavirus (HPV), a sexually transmitted virus, which can be tramitted during oral sex
• Gastroesophageal reflux disease (GERD)
• Men are at a higher risk than women because more men have the habit of smoking and/or excessive drinking
• Individuals over the age of 55 years

Diagnosis

The diagnostic procedure for cancer of the throat follows a combination of physical examination, investigation of medical history, and lab tests. This is applicable when you have been experiencing certain symptoms. There can be certain instances when investigation of some other  diseases may lead to the diagnosis of throat cancer.

Let’s take a closer look at the process:

Physical examination

Based on the symptoms explained by you, the doctor will physically examine you thoroughly. In case certain signs have prolonged for a considerable period and have only got aggravated with time, he/she is expected to study these symptoms more thoroughly.

Your doctor may use a special mirror or sometimes a “scope” to look down your throat. During this procedure, they might take a sample of tissue (i.e. a biopsy) from the area that looks like cancer.

Your doctor may also inquire about the frequency of these symptoms, whether they recur, the length of time for which you have been suffering from them, etc.

Investigation of personal and family medical history

Your doctor is likely to ask you about your personal and family medical history. This will help him/her evaluate whether your present symptoms may be an underlying cause of other personal or genetic disorders. Make sure that you take your medical documents of doctors’ prescriptions and medical tests for your doctor to analyse them closely.

Drug and Medication History

You can also expect your doctor to investigate about the drugs that you might be taking presently or in the recent past. While the doctor would be able to access the history of prescribed medications from your prescriptions, you have to inform him/her about other drugs that you might be taking now or have taken recently. These medications include non-prescription or OTC (over-the-counter) drugs, herbals, vitamins, and supplements.

There are certain drugs that may have adverse side effects and lead to the development of symptoms that you are experiencing now. Hence, it is essential for your doctor to investigate your medications to analyse whether these may interact with your present symptoms. Based on his/her medical evaluation, he/she will suggest some diagnostic tests. 

Tests

CT scan

Computer tomography or CAT scan is an imaging test that produces more images of internal organs than an ordinary X-ray. This often proves to be more effective in detecting cancer.

MRI scan

Magnetic resonance imaging is also a non-invasive procedure like a CT scan. This makes the use of magnetic fields and radio waves and strong magnets to create two-dimensional images of organs. These imaging tests are essential for finding the exact location of the tumour (if any) and detect the extent of metastasis. It is also capable of identifying the stage of cancer and whether the tumour can be surgically removed. 

Biopsy

If the imaging tests find abnormalities, the doctor may recommend a biopsy of the throat. This is a minimally invasive procedure that involves collecting a small part of tissue from the affected site for further analysis. This is usually effective in confirming the prevalence of cancer.

Treatment

The treatment is determined by various factors like the age of the patient, personal medical history, extent of the cancer, etc. 

The treatment options are:

Radiation therapy: This is effective in destroying cancer cells and soothing pain when the cancer is in the early stages. 

Surgery: This is another line of treatment that the doctor can suggest in the early stages of the medical condition. Surgical intervention may involve partial or complete removal of the organ or tissue in which the cancer has originated. This inhibits the cancer from metastasizing to other organs. 

Surgery, if advised in the later stages, involves complete removal of the larynx or pharynx. Below are the types of surgeries for cancer of the throat, differing on the basis of the origin of the abnormal cells:

• Laryngectomy – Surgical removal, partial or complete, of the larynx is called laryngectomy, the most common type of surgery for throat cancer. 
• Pharyngectomy – Surgical removal of a part or the entire pharynx is called pharyngectomy. 
• Neck dissection – This surgery can be required if the cancer has metastasized to the lymph nodes, located beyond the larynx and pharynx. In this surgery, the lymph nodes believed to be affected by cancer are surgically removed. Radiation therapy may be conducted after the surgery to destroy remaining cancer cells. 

Chemotherapy

This includes the administration of heavy-dose drugs to destroy circulating cancer cells, advised during advanced stages. This is generally advised in combination with radiation therapy and surgery, unless the cancer is in very advanced stages. The incidences of a cure for throat cancer due to HPV is often slender.

Reconstructive surgery

Patients who have undergone pharyngectomy may need surgery to reconstruct the pharynx. Pharynx is the channel that connects the throat to the digestive tract. A reconstructive surgery of the pharynx may be required to enable food to pass through. The following are the usually recommended treatments as per the stages:

• Stage 0: Throat cancers have not become invasive. The condition can usually be treated by removing the tissue from the affected site because the tumor is not yet invasive. 
• Stage I or II: Radiation therapy and/or surgery may be advised.
• Stage III or IV: In these stages, a combination of radiation therapy, surgery, chemotherapy and even palliative treatment may be advised. 

The line of treatment that will be suitable for the patient solely depends on the expert discretion of the medical professionals.

Lifestyle Changes

Below are the lifestyle changes patients should strictly follow to reduce the risk of recurrence:

• Quit smoking
• If you drink alcohol, limit its quantity
• Use condoms during oral sex to prevent the transmission of HPV

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