Cancer is a class of diseases in which abnormal cells multiply and divide uncontrollably in the body. These cells form malignant growths called tumors. When people talk about throat cancer, they often mean cancer of the:

  • gullet
  • windpipe
  • thyroid gland

Doctors do not usually use the term throat cancer. Instead, they refer to cancers of the head and neck.

In this article, we will look at cancer that affects the voice box (larynx), the vocal cords, and other parts of the throat, such as the tonsils and pharynx.

The National Cancer Institute (NCI) refers to these as:

  • pharyngeal cancer, often grouped with oral cavity cancer as oropharyngeal cancer
  • laryngeal cancer

Throat cancer is relatively uncommon compared with other cancers.

According to the NCI, oropharyngeal cancer accounts for around 2.8 percent of all cancer cases and 1.8 percent of all deaths from cancer. In the general population, the chance of having a diagnosis of one of these cancers is around 1.2 percent.

Laryngeal cancer accounts for around 0.7 percent of new cancer cases and 0.6 percent of cancer deaths. Around 0.3 percent of people can expect to develop this type of cancer at some time.

The treatment plan and outlook for cancer will depend on the type. A biopsy will show what type of cancer cell is present.

The most common type of throat cancer is squamous cell carcinoma, which affects the flat cells lining the throat.

Two main categories of throat cancer are:

Pharyngeal cancer

This cancer develops in the pharynx, the hollow tube that runs from behind your nose to the top of your windpipe. Pharyngeal cancers that develop in the neck and throat include:

  • nasopharynx cancer (upper part of the throat)
  • oropharynx cancer (middle part of the throat)
  • hypopharynx cancer (bottom part of the throat)

Laryngeal cancer

This cancer forms in the larynx, which is your voice box. Cancer can develop in the:

  • supraglottis (part of the larynx above the vocal cords)
  • glottis (part of the larynx around the vocal cords)
  • subglottis (part of the larynx below the vocal cords
  • hypolarynx (below the larynx)
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Illustration by Diego Sabogal

Signs and symptoms common to cancers that occur in the throat include:

Make a doctor’s appointment if any of these symptoms develop and do not go away.

The risk factors for throat cancer will depend on the type, but here are some factors that may increase the risk of developing oropharyngeal and laryngeal cancer:

People who smoke and drink a lot are around 30 times more likely to develop oropharyngeal cancer than those who don’t, and they’re much more likely to develop laryngeal cancer, according to the American Cancer Society (ACS).

Oral HPV is a sexually transmitted virus that affects around 10 percent of men and 3.6 percent of women, according to the Centers for Disease Control and Prevention (CDC). The CDC adds that HPV may account for around 70 percent of cases of oropharyngeal cancer in the United States.

Males are more likely to develop oropharyngeal or laryngeal cancers than females. While the overall rate is higher among white people, it is significantly higher for Black males compared with all females and with males from other races, according to statistics published by the NCI.

A 2014 study notes that the difference in survival rates for laryngeal cancer between Black and white American males increased rather than decreasing between 1975 and 2002. The study authors suggest that socioeconomic factors, a later stage at diagnosis, and less access to appropriate treatment could be the reasons.

It is not always possible to prevent throat cancer, but you can take steps to reduce your risk:

  • avoid or quit smoking and tobacco use
  • monitor your alcohol intake
  • consume a nutrient-rich diet that includes fresh fruits and vegetables and limits the intake of added fats, sugars, and highly processed foods
  • engage in regular physical activity
  • ask your doctor about getting the HPV vaccine to help reduce the risk of contracting an oral HPV infection

According to the NCI, alcohol use and smoking combine to form the biggest risk factor for developing these cancers.

This makes limiting alcohol consumption and avoiding smoking two main ways of helping prevent head and neck cancers.

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 cancer in some part of the throat.

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 the larynx. They may use special mirrors to see these areas or insert an endoscope into your throat for a clearer view.

A panendoscopy allows the doctor to see the larynx, esophagus, mouth, nasal cavity, and possibly the lungs at one time. If cancer is present in one location, it can also occur in other areas prone to the same risk factors, such as smoking.

If these tests show changes that could indicate cancer, your doctor may order a tissue sample to be taken (called a biopsy) for testing.

They will also order imaging tests, such as an X-ray, CT scan, MRI scan, or ultrasound to help get a correct diagnosis. Blood tests cannot show if cancer is present in the mouth or throat, but they can help assess your overall health.

If your doctor needs more detail about your gullet, you may need to have an X-ray after drinking a chalky liquid called a barium swallow. The barium swallow helps show any problems with the gullet on an X-ray.

A bone scan can show if cancer has spread to the bones.

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 most basic way of staging cancers in the throat involves a number system, ranging from 0 to 4:

  • Stage 0: The tumor is only on the top layer of cells of the affected part of the throat.
  • Stage 1: The tumor is limited to the part of the throat where it started.
  • Stage 2: The tumor has grown into a nearby area.
  • Stage 3: The tumor has grown into other structures in the throat or spread to one lymph node.
  • Stage 4: The tumor has spread to the lymph nodes or distant organs.

To work out the stage, your doctor will consider the tumor size (T), lymph node involvement (N), and if any cells have spread to other parts of the body, known as metastasis (M). Together, these are known as the TNM system. The diagnosis will depend on how these factors combine.

Cancer staging is a complex process. If you receive a diagnosis, your doctor will consider the stage, grade, and individual factors to prepare an individual treatment plan.

Learn more about what cancer stages mean.

A number of specialists will be involved in your diagnosis and treatment, such as:

  • 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
  • an anesthesiologist, who administers anesthesia and monitors your condition during a biopsy or surgery

Treatment options for throat cancer include:

  • surgery
  • radiation therapy
  • chemotherapy

The treatment method your doctor recommends will depend on the cancer stage and other factors.

Surgery

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:

  • Endoscopic surgery. The surgeon uses an endoscope (a long thin tube with a light and camera at the end) through which they can pass surgical instruments or lasers to treat early stage cancers.
  • Cordectomy. This procedure removes all or part of your vocal cords.
  • Laryngectomy. This procedure removes all or a portion of your voice box, depending on the severity of the cancer. Some people can speak after surgery, but others will 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.

Radiation therapy

Following the removal of the tumor, your doctor may recommend radiation therapy. Radiation therapy uses high-energy rays to destroy cancer cells. It targets any cancerous cells the tumor has left behind. 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 of giving radiation 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 rarely is.

Chemotherapy

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.

Targeted therapy

Targeted therapies are drugs that stop the spread and growth of cancer cells by interfering with specific molecules responsible for tumor growth. One type of targeted therapy used to treat throat cancer is cetuximab (Erbitux).

Experts are researching other types of targeted therapy. Your doctor may recommend this therapy along with standard chemotherapy and radiation, possibly as part of a clinical trial.

Immunotherapy

This treatment involves drugs that enable your own immune system to fight cancer. The drugs are called checkpoint inhibitors.

Usually, the immune system uses cells called “checkpoints” to turn on an immune response when the body needs it. Cancers, however, sometimes use these checkpoints to stop the immune system from attacking them. Some drugs stop these checkpoints from working. When this happens, the immune system can attack the cancer cells.

If you have laryngeal cancer, two checkpoint inhibitors that may help shrink a tumor are pembrolizumab (Keytruda) and nivolumab (Opdivo). If these drugs are suitable for you, a doctor may prescribe them alone or alongside chemotherapy. You will receive them intravenously, usually every 3, 4, or 6 weeks.

Some people with throat cancer require therapy after treatment to relearn how to speak. A speech therapist and a physical therapist can help with this.

In addition, some people with throat cancer experience complications. These may include:

  • difficulty swallowing
  • changes in the appearance of the neck or face
  • difficulty speaking
  • difficulty breathing
  • skin hardening around the neck

Occupational therapists can help with swallowing difficulty. If you need reconstructive surgery to help with this or other issues, your doctor can advise you.

The outlook for cancers in the throat depends on various factors, including where it started, the type, and individual factors, such as if the person is a smoker who continues to smoke.

The overall 5-year survival rate for people with oropharyngeal cancer is 66.9 percent, according to the NCI.

Per the ACS, if you have an early diagnosis, before cancer has spread, the survival rate is 62 percent. This means you have a 62-percent chance of living another 5 years compared with a person who does not have a diagnosis.

For laryngeal cancer, the NCI states the 5-year survival rate is 60.7 percent, but rates vary according to where cancer starts.

For example, if you have cancer in the glottis, the area that includes the vocal cords, and it has not spread beyond the original site, your chance of living at least another 5 years is around 83 percent, according to the ACS.

These figures are based on statistics for people who received a diagnosis between 2011 and 2017 and do not predict the outcome for individuals with these cancers.

Various types of cancer can affect the throat, including oropharyngeal and laryngeal cancer. Smoking and high alcohol consumption increase the risk, but not everyone who develops these cancers will have these risk factors.

If you have symptoms such as a hoarse voice or sore throat that does not go away, you should seek medical advice. Getting an early diagnosis can help improve the outcome of these and other types of cancer.