Throat Cancer

1 What is Throat Cancer (Laryngeal Cancer)?

Throat cancer refers to cancerous tumors which usually begin in the flat cells lining the interior of your throat. Throat is a muscular tube that begins behind the nose and ends in neck. 

There is a voice box just below the throat which is made of cartilage and contains the vocal cords that vibrate to make sound when you talk. Throat cancer can affect throat (pharynx), voice box (larynx) or tonsils.

2 Symptoms

Throat cancer is characterized by the following signs and symptoms:

When to see a Doctor?

Make an appointment with your doctor if you notice any new signs and symptoms that are persistent. Most throat cancer symptoms aren't specific to cancer.

3 Causes

Genetic mutations are responsible for the occurrence of throat cancer which causes the cells to grow in an uncontrolled manner. Thus a tumor can be formed due to accumulation of such abnormal cells. 

Types of throat cancer 

Throat cancer is a general term that applies to cancer which develops in the throat (pharyngeal cancer) or in the voice box (laryngeal cancer). 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.

4 Making a Diagnosis

Making a diagnosis of throat cancer (Laryngeal Cancer) is done by performing several tests.

If you are suspected to have cancer related to your throat, you are referred to otolaryngologist, or ENT specialist.  Following are some of the tests and procedure to diagnose throat cancer.

  • Endoscopy: Endoscopy is a diagnostic procedure which uses an endoscope –a special lighted scope with a tiny camera at the end for close observation which transmits images to a video screen. 
  • Laryngoscopy: This is a procedure carried out with another type of scope called laryngoscope which uses magnifying lens to help examine vocal cords. 
  • Biopsy: Tissue samples are collected by passing surgical instruments through the scope if abnormalities are found during an endoscopy or laryngoscopy which is then sent for laboratory analysis.
  • Imaging tests: X-ray, computerized tomography (CT), magnetic resonance imaging (MRI) and positron emission tomography (PET) are some of the imaging tests to   help determine the extent of cancer beyond the surface of your throat or voice box. 

Cancer staging 

Once throat cancer is diagnosed, it is important to determine the extent, or stage of the cancer as it helps determine the treatment modalities. There are four stages of throat cancer, each stage having its own criteria.

In general, stage I throat cancer indicates a presence of a small tumor confined to one area of the throat. Later stages indicate advancement of cancer, with stage IV being the most advanced.

5 Treatment

Treatment of throat cancer depends on various factors, such as:

  • the location and stage of throat cancer,
  • the type of cells involved,
  • overall health status,
  • personal preferences.

Following are some of the treatment modalities:

  • Radiation therapy: It uses ionizing radiations like X-rays to destroy cancer cells. Radiation therapy can be of two types which are as follows:
    • External beam radiation: The source of radiation is kept outside the body.
    • Internal radiation (brachytherapy): The source of radiation is a small radioactive seed placed inside the body, near the cancerous part.

Early stage throat cancer may be treated by radiation only. However, a combination of radiation therapy and chemotherapy or surgery may be necessary for advanced stages of the cancer. In very advanced throat cancers, radiation therapy may be used to alleviate the signs and symptoms.

  • Surgery: Depending upon the location and stage of throat cancer the types of surgical procedures may be considered for the treatment of throat cancer.

Following are the options available:

    • Surgery for early-stage throat cancer: Throat cancer in early stage is confined to the surface of the throat or the vocal cords that may be treated surgically by endoscopy.           The procedure involves insertion of a hollow endoscope into the throat or voice box through which special surgical tools or a laser   through is passed.  The cancer is scrapped off or cut out if the surgical tools are used. In case of laser, the superficial cancers are vaporized.  
    • Surgery to remove all or part of the voice box (larygectomy). For smaller tumors, only the part of your voice box that is affected by cancer is removed, leaving behind as much of the voice box as possible to preserve the ability to speak and breathe normally.  For larger, more-extensive tumors, removal of the entire voice box may be necessary. After which tracheostomy is done to connect the windpipe to a hole (stoma) in throat to allow breathing. If your entire larynx is removed, the ability to speak is lost. You can work with a speech pathologist to learn to speak or restore the speech without your voice box.
    • Surgery to remove part of the throat (pharyngectomy). Surgery for smaller throat cancers may be done to remove only small parts of your throat. Parts that are removed may be reconstructed to allow normal swallowing of food.
    • Surgery to remove more of your throat usually involves the removal of your voice box as well. Reconstruction of the throat may be required to allow normal swallowing. 
    • Surgery to remove cancerous lymph nodes (neck dissection).
    • Surgery to remove some or all of the lymph nodes may be recommended if the throat cancer has spread deep within the neck. People undergoing surgery are at risk for bleeding and infection.

Possible complications of surgery are difficulty speaking or swallowing depending on the specific procedure you undergo. 

  • Chemotherapy: Chemotherapy involves the chemical drugs to destroy the cancer cells. Chemotherapy is often combined with radiation therapy to treat throat cancers. Certain chemotherapy drugs increases the sensitivity of cancer cells to radiation therapy. But the side effects of both treatment are increased when the combination of chemotherapy and radiation therapy is used.

 

  • Targeted drug therapy: Targeted drugs treat throat cancer by taking advantage of specific defects in cancer cells that fuel up the cells' growth. Cetuximab (Erbitux) is one targeted therapy which stops the action of a protein which is prevalent more in certain types of throat cancer cells than in healthy cells. Targeted drugs can also be combined with chemotherapy or radiation therapy for the treatment of throat cancer.

Rehabilitation after treatment

Treatment for throat cancer often causes complications which may require rehabilitation to regain the ability to swallow, eat solid foods and speak. Care of Stoma is necessary if tracheostomy was done.

6 Prevention

There are no known ways to prevent the occurrence of throat cancer, but following can be done to reduce the risk of throat cancer:

  • Abstinence from smoking. If you are a smoker, stop-smoking strategies, such as medication, nicotine replacement products and counseling may help you quit smoking.
  • Drink alcohol only in moderation, if at all. For women, moderate drinking means one drink a day and for men, no more than two drinks a day. 
  • Choose a healthy diet including lots of fruits and vegetables. the risk of throat cancer is reduced by the vitamins and antioxidants present in fruits and vegetables.
  • Protection from HPV.

Sexually transmitted infection human papillomavirus (HPV) are thought to cause some throat cancers. 

The risks of HPV can be reduced by:

  • Avoiding multiple sex partners 
  • Use of protective measures such as condoms during sexual intercourse 
  • Vaccination (HPV vaccine) is available for boys, girls, and young women and men.

7 Alternative and Homeopathic Remedies

There are no alternative remedies proven helpful in treating throat cancer. However, some complementary and alternative treatments such as acupuncture, massage therapy, meditation and relaxation techniques may be helpful in coping with the diagnosis and side effects of throat cancer treatment.

8 Lifestyle and Coping

Lifestyle modifications are necessary in order to cope with throat cancer (laryngeal cancer).

There is a close link between smoking and throat cancer. Smoking reduces the effectiveness of treatment, makes healing harder after surgery and increases the risk of having other cancers.

If you are a smoker, stop-smoking strategies, such as medication, nicotine replacement products and counseling may help you quit smoking

Drinking alcohol, particularly when combined with smoking or chewing tobacco, greatly increases the risk of throat cancer. Quitting drinking alcohol may help reduce the risk of a second cancer and also help tolerate your throat cancer treatments better.

Coping with the diagnosis of throat cancer can be tough and difficult as it affects a part of your body that is vital to everyday activities, such as breathing, eating and talking. 

Following measures may help feel in control and cope up with the difficult situation.

  • Learn enough about throat cancer to be more familiar with the disease , 
  • Take better care of yourself and make treatment decisions
  • Seek out sources of support may be a close friend or family member who is a good listener.
  • Consider joining a support group for people with cancer.
  •  Stay connected with American Cancer Society (ACS) or Support for People with Oral and Head and Neck Cancer. The ACS's Cancer Survivors Network offers online message boards and chat rooms that to stay connected with others having throat cancer.
  • Stay healthy during treatment. Avoid extra stress and get enough sleep to feel good. Do exercises and make yourself relaxed listening to music or reading a book. 
  • Attend follow-up appointments, every few months during the first two years after treatment, and then less frequently after to monitor your recovery and check for a cancer recurrence. 

9 Risks and Complications

Following are the factors that can increase your risk of throat cancer: 

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