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Throat Cancer

Clinical OncologyOtolaryngologyGeneral Surgery

The throat means the muscular tube behind the nose and neck. Throat cancer (or pharyngeal cancer) broadly refers to the growth of flat cells in this area.

Throat cancer (or pharyngeal cancer) is a type of head and neck cancer that broadly refers to the growth of flat cells in the throat area. It is a malignant disease where cancerous cells form in the tissues of the pharynx. Specific categories include:

Nasopharyngeal Cancer	Grows in the throat near the nasal cavity.
Oropharyngeal Cancer	Grows in the throat connecting to the oral cavity, including the tonsils.
Hypopharyngeal Cancer	Grows in the lower part of the throat, above the oesophagus and trachea.
Glottic Cancer	Grows in the vocal cord area and is the most common type of throat cancer.

The symptoms of throat cancer are very similar to oral cancer, including difficulty swallowing, ear pain, persistent swelling, and sudden weight loss. Additionally, suppose you experience prolonged coughing or vocal cord issues such as hoarseness or unclear speech. In that case, it may indicate throat cancer, and you should consult a doctor as soon as possible.

Common symptoms include:

Throat Pain: Persistent throat pain or discomfort may be a symptom of throat cancer.
Difficulty Swallowing: Experiencing difficulty swallowing or a sensation of something stuck.
Voice Changes: Changes in voice, such as hoarseness or huskiness, may be due to affected vocal cords.
Coughing or Coughing Blood: Long-term coughing or coughing with blood may indicate throat cancer.
Ear Pain: Throat cancer may cause ear pain or ear ringing.
Difficulty Breathing: The presence of a lump in the throat area may lead to difficulty breathing.
Lump or Swelling: Feeling a lump or swelling in the neck.
Lousy Breath: Unexplained lousy breath.
Headache: Headaches may accompany certain conditions.
Weight Loss: Unexplained weight loss may be a symptom.

Factors

Like oral cancer, throat cancer originates from genetic mutations in cells, causing uncontrolled growth while healthy cells gradually die, leading to the formation of tumours. However, the exact causes of these genetic mutations are not fully understood. The medical community generally identifies the following risk factors:

Smoking: Smoking is a significant risk factor for throat cancer. Harmful substances and chemicals in tobacco can damage throat tissues, increasing the risk of cancer.
Alcohol: Excessive alcohol consumption is associated with an increased risk of throat cancer. The trouble is even higher when alcohol is used in conjunction with smoking.
Human Papillomavirus (HPV) Infection: Infection with certain types of HPV, especially HPV 16 and 18, is linked to an increased risk of throat cancer. It is a sexually transmitted virus.
Oral Health: Poor oral hygiene, dental problems, and chronic oral inflammation may be associated with throat cancer.
Genetic Factors: Genetic variations and a family history of throat cancer may increase an individual's risk.
Diet Habits: A diet lacking in nutritious foods such as vegetables and fruits and excessive intake of salt, red meat, and processed meats may be associated with an increased risk of throat cancer.
Occupational Exposure: Prolonged exposure to certain chemicals and hazardous substances in industrial environments may increase the risk of developing throat cancer.

Suppose a doctor suspects that a patient may have throat cancer. In that case, various tests will be conducted to confirm further the presence of cancer cells, their location, volume, and other details within the patient's body. The diagnostic methods a doctor might use are generally similar to those for oral cancer and include:

Endoscopic Examination: A flexible tube with a miniature camera and light source is inserted into the patient's mouth to examine the interior of the throat for any abnormalities. Another line called a laryngoscope, equipped with a magnifying lens, may also be used to investigate the condition of the patient's vocal cords.
Biopsy: If any abnormalities are detected through endoscopy or laryngoscopy, the doctor may arrange for further examination. A small tissue sample is taken from the patient's throat for laboratory analysis to determine the presence of cancer cells.
Imaging Tests: To better understand the development of the tumour or assess the effectiveness of treatment, the doctor may use different imaging techniques to obtain detailed images from inside the patient's body.
- CT Scan: Uses X-rays to create detailed images of internal soft tissues, providing information about the tumour's volume, location, and whether it has spread to nearby tissues, lymph nodes, or the lungs.
- MRI: Similar to CT scans, it uses radio waves and strong magnetic fields to produce detailed images of soft tissues inside the patient's body, allowing visualization of whether cancer cells have spread to the neck, brain, and spinal cord.
- PET-CT Scan involves injecting a radioactive sugar substance into the patient's body. Scanning with PET examines the distribution of radiation to determine whether cancer cells have spread to other locations.

Staging

Staging of throat cancer is typically based on factors such as tumour size, invasion of nearby tissues, lymph node involvement, and the presence of distant metastasis. Here is a general staging system for throat cancer:

Stage I	The tumour is small, possibly not invading tissues outside the throat. No spread to lymph nodes or other areas.
Stage II	The tumour may be slightly larger but still confined to the throat. No spread to lymph nodes or other areas.
Stage III	The tumour is more extensive and may have invaded tissues outside the throat. It may be spread to nearby lymph nodes, but distant metastasis has not occurred.
Stage IV	Further divided into IV-A and IV-B stages: IV-A: The tumour has invaded nearby tissues and may have spread to nearby lymph nodes. IV-B: The cancer may have invaded nearby tissues and could have spread to distant lymph nodes or other distant organs, including the lungs.

During the staging process, doctors consider various factors, including imaging studies, tissue biopsy results, and lymph node examination. This staging helps formulate personalized treatment plans, including surgery, radiation therapy, chemotherapy, etc., to provide the most suitable treatment for the patient's condition.

The above tests and classifications guide doctors in determining the most suitable treatment plan based on the patient's health condition. Generally, the treatment approaches for throat cancer include:

Radiation Therapy
Radiation therapy involves using high-energy rays, such as X-rays or protons, to target cancer cells within the patient's body. Depending on the patient's needs, it can be administered externally or internally. External radiation therapy requires the patient to lie down while a large machine emits X-rays, targeting the location of the cancerous tumour, taking a few minutes. Internal radiation involves placing radioactive material-containing needles into the cancer cells under general anaesthesia, taking several days to complete. After radiation therapy, patients may experience side effects such as skin pain, throat pain, loss of taste, and reduced appetite, which are considered normal. However, if these conditions persist, patients should seek medical attention. Radiation therapy may not be the optimal solution for all throat cancer patients. For some early-stage patients, receiving radiation therapy alone may be sufficient to eliminate cancer cells. In contrast, for some advanced cases, radiation therapy may only serve as a soothing method to relieve symptoms, as complete eradication of the tumour may be challenging.
Surgical Procedure
Surgery provides a direct approach to removing cancerous tumours within the patient's body, especially for early-stage patients with small tumour volumes still on the surface of the throat or vocal cords without spreading. Doctors may place a hollow endoscope into the patient's throat and emit a laser or other specially designed materials through the small hole to destroy cancer cells. In cases where the tumour has spread from the throat to nearby lymph nodes, doctors may need to remove the involved lymph nodes along with the tumour.
Chemotherapy
Chemotherapy involves using drugs to eliminate cancer cells, administered orally or delivered through the patient's bloodstream to reach the entire body to target tumours. For throat cancer, chemotherapy is often combined with radiation therapy. Patients should be aware that chemotherapy may reduce normal blood cells, leading to side effects such as inflammation, fatigue, vomiting, oral pain, etc. Seeking medical advice is recommended if discomfort persists.
Targeted Therapy
Targeted therapy is a treatment approach aimed at substances that promote cancer cell growth. Cetuximab is the most commonly targeted drug for throat cancer. It can combat a protein particularly active in specific throat cancer cells, thereby inhibiting cancer cell growth. Ongoing clinical studies are exploring additional potential targeted drugs.

revention

Like oral cancer, the exact genetic mutations leading to throat cancer are unclear. The medical community has not identified a foolproof method to eliminate the risk of developing cancer. However, they have identified some approaches that may help reduce the risk, including:

Refusing or quitting any form of tobacco use.
Avoiding alcohol consumption; if alcohol is consumed, moderating the amount.
Maintaining a diet rich in fruits and vegetables.
Taking precautions during sexual activities to reduce the risk of HPV virus infection.
Receiving HPV vaccination as a preventive measure against oral cancer caused by the HPV virus.

FAQ

Throat cancer grows in the soft palate, back of the tongue, and tonsils, while oral cancer grows in places like the lips, language, and hard palate. Indeed, their locations are very close, so their causes, risk factors, and treatment methods are generally similar. Patients should seek professional advice from a doctor based on their conditions.

As mentioned in the text, symptoms of throat cancer may not necessarily be caused by cancer, such as difficulty swallowing, toothache, and facial swelling, which can be common discomforts. Therefore, if you notice these symptoms, there is no need to worry overly. However, if the situation persists or worsens, seeking medical attention promptly is advisable to ensure the optimal time for treatment is present.

It is expected to feel emotionally down after a cancer diagnosis but to achieve the best treatment outcomes; patients should follow the doctor's instructions and alleviate their condition through appropriate treatment plans. Additionally, patients should maintain a healthy lifestyle, quit smoking, and avoid excessive alcohol consumption and other unhealthy habits related to throat cancer. If necessary, communicating with family and friends to help them understand your situation and feelings can assist you in overcoming difficulties.

Both surgery and radiation therapy can affect the movement of the mouth, tongue, and throat, causing difficulty in eating, which is a normal phenomenon. Patients can try soft foods such as scrambled eggs and cheese, avoiding spicy and salty foods. As the tissues heal, swelling will gradually subside, and patients can return to a regular diet. However, if difficulty in eating persists, patients should consult a doctor to understand the reasons behind it.

Since throat cancer directly involves the vocal cords, it inevitably affects a patient's ability to speak. However, in most cases, the impact is temporary and mild, such as having difficulty pronouncing one or two sounds accurately. Once the body's tissues recover, the patient's speaking ability should generally return to normal. If these issues do not improve, patients should promptly seek advice from a doctor or a speech therapist for professional guidance.