What is throat cancer?
Cancer is a class of diseases in which abnormal cells multiply and divide uncontrollably in the body. These abnormal cells form malignant growths called tumors. Throat cancer refers to cancer of the voice box, the vocal cords, and other parts of the throat, such as the tonsils and oropharynx.
Throat cancer is often grouped into two categories: pharyngeal cancer and laryngeal cancer. Pharyngeal cancer forms in the pharynx. This is the hollow tube that runs from behind your nose to the top of your windpipe. Laryngeal cancer forms in the larynx, which is your voice box.
Throat cancer is relatively uncommon when compared to other cancers. The National Cancer Institute estimates 1.1 percent of adults will be diagnosed with pharyngeal cancer within their lifetime. An estimated 0.3 percent of adults will be diagnosed with laryngeal cancer within their lifetime.
Types of throat cancer
There are several types of throat cancer. Although all throat cancers involve the development and growth of abnormal cells, your doctor has to identify your specific type to determine the most effective treatment plan. The two primary types of throat cancer are:
- Squamous cell carcinoma: Throat cancer of the flat cells lining the throat. It’s the most common throat cancer in the United States.
- Adenocarcinoma: Throat cancer of the glandular cells. This type of laryngeal cancer is rare.
Along with these two main types, throat cancer can be broken into two additional types. One type is pharyngeal cancer, which develops in the neck and throat. This includes:
- nasopharynx cancer (upper part of the throat)
- oropharynx cancer (middle part of the throat)
- hypopharynx cancer (bottom part of the throat)
The other type is laryngeal cancer, which affects the larynx or voice box.
Recognizing potential signs of throat cancer
It can be difficult to detect throat cancer in its early stages. Common signs and symptoms of throat cancer include:
- a change in your voice
- trouble swallowing (dysphagia)
- weight loss
- sore throat
- constant need to clear your throat
- persistent cough (may cough up blood)
- swollen lymph nodes in the neck
- ear pain
Make a doctor’s appointment if you have any of these symptoms and they do not improve after two to three weeks.
Causes and risk factors for throat cancer
Men are more likely to develop throat cancer than women. Certain lifestyle habits increase the risk of developing cancer of the throat, including:
Throat cancer is also associated with certain types of human papillomavirus infections (HPV). HPV is a sexually transmitted virus. HPV infection is a risk factor for certain oropharyngeal cancers, according to the Cancer Treatment Centers of America.
Throat cancer has also been linked to other types of cancers. In fact, some people diagnosed with throat cancer are diagnosed with esophageal, lung, or bladder cancer at the same time. This is typically because cancers often have the same risk factors, or because cancer that begins in one part of the body can spread throughout the body in time.
Diagnosing throat cancer
At your appointment, your doctor will ask about your symptoms and medical history. If you’ve been experiencing symptoms such as a sore throat, hoarseness, and persistent cough with no improvement and no other explanation, they may suspect throat cancer.
To check for throat cancer, your doctor will perform a direct or an indirect laryngoscopy or will refer you to a specialist for the procedure. A laryngoscopy gives your doctor a closer view of your throat. If this test reveals abnormalities, your doctor may take a tissue sample from your throat (called a biopsy) and test the sample for cancer.
Your doctor may recommend one of the following biopsies:
- Conventional biopsy: Your doctor makes an incision and removes a sample piece of tissue. This type of biopsy is performed in the operating room under general anesthesia.
- Fine needle aspiration (FNA): Your doctor inserts a thin needle directly into a tumor to remove sample cells.
- Endoscopic biopsy: Your doctor inserts a thin, long tube through your mouth, nose, or an incision and removes a tissue sample using an endoscope.
Staging throat cancer
If your doctor finds cancerous cells in your throat, they will order additional tests to identify the stage, or the extent, of your cancer. The stages range from 0 to 4:
- Stage 0: The tumor has not invaded tissue beyond your throat.
- Stage 1: The tumor is less than 7 cm and limited to your throat.
- Stage 2: The tumor is slightly larger than 7 cm, but still limited to your throat.
- Stage 3: The tumor has grown and spread to nearby tissues and organs.
- Stage 4: The tumor has spread to your lymph nodes or distant organs.
Your doctor can use a variety of tests to stage your throat cancer. Imaging tests of the chest, neck, and head can provide a better picture of the disease’s progression. These tests may include the following:
Magnetic resonance imaging (MRI): This imaging test uses radio waves and strong magnets to create detailed pictures of the inside of your neck. An MRI looks for tumors and can determine whether cancer has spread to other parts of the body. You’ll lie in a narrow tube as the machine creates images. The length of the test varies, but typically doesn’t take longer than one hour.
Positron emission tomography (PET scan): A PET scan involves injecting a type of radioactive sugar into your blood. The scan creates images of areas of radioactivity in your body. This type of imaging test can be used in cases of advanced cancer.
Computed tomography (CT scan): This imaging test uses X-rays to create a cross-sectional picture of your body. A CT scan also produces images of soft tissue and organs in the body. This scan helps your doctor determine the size of a tumor. It also helps them determine whether the tumor has spread to different areas, such as the lymph nodes and the lungs.
Barium swallow: Your doctor may suggest a barium swallow if you’re having difficulties swallowing. You’ll drink a thick liquid to coat your throat and esophagus. This test creates X-ray images of your throat and esophagus.
Chest X-ray: If your doctor suspects that the cancer has spread to your lungs, you’ll need a chest X-ray to check for abnormalities.
Treatment options for throat cancer
Throughout treatment you’ll work closely with a variety of specialists. These specialists include:
- an oncologist who performs surgical procedures like the removal of tumors
- a radiation oncologist who treats your cancer using radiation therapy
- a pathologist who examines tissue samples from your biopsy
If you have a biopsy or surgery, you’ll also have an anesthesiologist who administers anesthesia and monitors your condition during the procedure.
Treatment options for throat cancer include surgery, radiation therapy, and chemotherapy. The treatment method recommended by your doctor will depend on the extent of your disease, among other factors.
If the tumor in your throat is small, your doctor may surgically remove the tumor. This surgery is done in the hospital while you’re under sedation. Your doctor may recommend one of the following surgical procedures:
- Laryngectomy: This procedure removes all or a portion of your voice box, depending on severity of the cancer. Some people can speak normally after surgery, but some people must learn how to speak without a voice box.
- Pharyngectomy: This procedure removes a part of your throat.
- Neck dissection: If throat cancer spreads within the neck, your doctor may remove some of your lymph nodes.
Following the removal of the tumor, your doctor may recommend radiation therapy. Radiation therapy uses high-energy rays to destroy malignant cancer cells. It targets any cancerous cells left behind by the tumor. Types of radiation therapy include:
- Intensity-modulated radiotherapy and 3D-conformal radiation therapy: In both types of treatment, radiation beams are tailored to the shape of the tumor. This is the most common way radiation is given for laryngeal and hypopharyngeal cancer.
- Brachytherapy: Radioactive seeds are placed directly inside the tumor or close to the tumor. Although this type of radiation could be used for laryngeal and hypopharyngeal cancer, it’s rare.
- Proton therapy: This therapy uses beams of protons to deliver radiation to the tumor. Currently, this is not a standard treatment option for most types of throat cancer.
In the case of large tumors and tumors that have spread to the lymph nodes and other organs or tissue, your doctor may recommend chemotherapy as well as radiation. Chemotherapy is a drug that kills and slows the growth of malignant cells.
Target drug therapy is a type of chemotherapy. These drugs stop the spread and growth of cancer cells by interfering with specific molecules that are responsible for tumor growth. One type of targeted therapy used to treat throat cancer is Cetuximab (Erbitux). Other types of targeted therapy are being researched in clinical trials. Your doctor may recommend this therapy along with standard chemotherapy and radiation.
Some people with throat cancer require therapy after treatment to relearn how to speak. This can be improved by working with a speech therapist and a physical therapist.
In addition, some people with throat cancer experience complications. These may include:
- difficulty swallowing
- disfigurement of the neck or face
- inability to speak
- difficulty breathing
- skin hardening around the neck
You can discuss reconstructive surgery with your doctor if you have face or neck disfigurement after surgery. Occupational therapists can help with swallowing difficulty.
Long-term outlook for throat cancer
If diagnosed early, throat cancer has a high cure rate.
Throat cancer may not be curable once malignant cells spread to parts of the body beyond the neck and head. However, those diagnosed can continue treatment to prolong their life and slow the progression of the disease.
Preventing throat cancer
There’s no definitive way to prevent throat cancer, but you can take steps to reduce your risk:
- Stop smoking. Use over-the-counter products to quit smoking such as nicotine replacement products or talk to your doctor about prescription medications to help you quit.
- Reduce alcohol intake. Males should consume no more than two alcoholic drinks per day, and women should consume no more than one drink per day.
- Maintain a healthy lifestyle. Eat plenty of fruits, vegetables, and lean meats. Reduce fat and sodium intake and take steps to lose excess weight. Engage in physical activity at least 150 minutes a week.
- Reduce your risk of HPV. This virus has been linked to throat cancer. To protect yourself, limit your number of sexual partners and practice safe sex. Talk to your doctor about the benefits of the HPV vaccine.
Throat cancer: Q&A
Is throat cancer hereditary?
Most throat cancers are generally related to smoking and not hereditary, unless the family members are predisposed to smoking. Outside of the larynx, a number of inherited genes predispose family members to cancer development. Some people inherit DNA mutations from their parents that greatly increase their risk for developing certain cancers. Inherited mutations of oncogenes or tumor suppressor genes rarely cause throat cancer, but some people seem to inherit a reduced ability to break down certain types of cancer-causing chemicals. These people are more sensitive to the cancer-causing effects of tobacco smoke, alcohol, and certain industrial chemicals.Helen Chen, MPHAnswers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.