Throat Cancer

Definition

Throat cancer is the presence of cancer cells or tumor(s) in the throat. The throat is made of a number of structures and the term throat cancer represents all of these cancers including cancer of the:

• Epiglottis—flap in the throat that blocks the airways when you swallow food or drink
• Tonsils
• Soft palate—rear section of the roof of the mouth
• Pharynx—tube part of your throat

Throat Cancer

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Causes

Cancer occurs when cells in the body divide without control or order. Eventually these uncontrolled cells form a growth or tumor. The term cancer refers to malignant growths. These growths can invade nearby tissues including the lymph nodes. Cancer that has invaded the lymph nodes can then spread to other parts of the body.

It is not clear exactly what causes these problems in the cells, but is probably a combination of genetics and environment.

Risk Factors

Throat cancer is more common in men, and in people aged 40 years and older. Other factors that may increase your chances of throat cancer:

• Smoking or use of any tobacco products
• Excessive alcohol consumption
• Family history
• Vitamin A deficiency
• Diet low in fruits and vegetables
• Suppressed immune system
• Infections caused by certain viruses such as:
  • Epstein-Barr virus
  • Human papillomavirus (HPV)
• Radiation exposure
• Excess consumption of cured meats or fish
• Marijuana use
• Occupational exposure to certain materials such as in:
  • Nickel refining
  • Woodworking
  • Working with textile fibers

Symptoms

Throat cancer may cause:

• Sore throat
• Feeling that something is caught in the throat
• Difficulty chewing or swallowing
• Difficulty moving the jaw or tongue
• Voice changes or hoarseness
• Change in voice quality
• Pain in the head, throat, or neck
• Lump in the neck
• Unexplained weight loss
• Coughing blood

Diagnosis

You will be asked about your symptoms and medical history. A physical exam will be done. The doctor may feel for any lumps in your neck. You may be referred to an otolaryngologist, a doctor who specializes in head and neck surgery.

Your bodily fluids and tissues may be tested. This can be done with:

• Fine needle aspiration
• Incisional biopsy

Images may be taken to evaluate your throat and surrounding structures. This can be done with:

• Laryngoscopy
• Panendoscopy
• MRI scan
• PET scan
• CT scan

The physical exam, combined with all of your test results, will help to determine the type and stage of cancer you have. Staging is used to guide your treatment plan. Like other cancers, throat cancer is staged from 1 to 4. Stage 1 is a very localized cancer, while stage 4 indicates a spread to other parts of the body.

Treatment

Cancer treatment varies depending on the stage and type of cancer. A combination of therapies may be more effective. For example, surgery may be used in conjunction with chemo- or radiation therapy.

Treatment options for throat cancer include:

Surgery

Surgery removes the cancerous tumor and nearby tissue, and possibly nearby lymph nodes. In very rare cases, surgery to remove large tumors of the throat may also require removal of tissue for swallowing. As a result, food may enter the windpipe and reach the lungs, which might cause aspiration pneumonia. In this case, a tracheotomy may need to be done. The windpipe will be attached to the skin through a hole in the neck, which is used for breathing.

Radiation Therapy

This is the use of radiation to kill cancer cells and shrink tumors. Radiation may be:

• External radiation therapy—radiation directed at the tumor from a source outside the body
• Internal radiation therapy—radioactive materials placed into the throat in or near the cancer cells

Chemotherapy

This is the use of drugs to kill cancer cells. Chemotherapy may be given in many forms including pill, injection, and/or via a catheter. The drugs enter the bloodstream and travel through the body killing mostly cancer cells, but also some healthy cells.

Prevention

To help reduce your chance of throat cancer:

• Do not smoke or use tobacco products. If you do smoke or use tobacco products, talk to your doctor about how to quit.
• Drink alcohol only in moderation. Moderate alcohol intake is a maximum of 2 drinks per day for men and a maximum of 1 drink per day for women.
• Eat a healthful diet, one that is low in saturated fat and rich in whole grains, fruits, and vegetables.
• See your doctor and dentist regularly for checkups and cancer screening.

References

• Clump DA, Bauman JE, Ferris RL. Cancer of the oropharynx. Surg Oncol Clin N Am. 2015 Jul;24(3):509-520.
• Genden EM, Sambur IM, et al. Human papillomavirus and oropharyngeal squamous cell carcinoma: what the clinician should know. Eur Arch Otorhinolaryngol. 2013 Feb;270(2):4052018 Nov 29-16
• Head and neck cancer. EBSCO DynaMed website. Available at: https://www.dynamed.com/condition/head-and-neck-cancer/.
• Mehanna H, Evans M, et al. Oropharyngeal cancer: United Kingdom National Multidisciplinary Guidelines. J Laryngol Otol. 2016 May;130(S2):S90-S96.
• Oropharyngeal cancer. EBSCO DynaMed website. Available at: https://www.dynamed.com/condition/oropharyngeal-cancer.
• Oropharyngeal Cancer Treatment (Adult)–Health Professional Version National Cancer Institute website. Available at: https://www.cancer.gov/types/head-and-neck/hp/adult/oropharyngeal-treatment-pdq1.
• Pfister DG, Spencer S, et al. Head and Neck Cancers. Version 1.2018. In: National Comprehensive Cancer Network (NCCN) Clinical Practice Guidelines in Oncology (NCCN Guidelines). NCCN 2018 Feb from NCCN website.