Everything You Need To Know About Throat Cancer

Throat Cancer refers to the rapid, uncontrolled growth of harmful cells in the throat (pharynx), voice box (larynx) or tonsils. These abnormal cells form malignant growths called tumours. Throat cancer usually begins in the flat cells that line the inside of the throat.

Types Of Throat Cancer

There are many different types of throat cancer. The primary types of cancer are:

• Squamous Cell Carcinoma: This type of throat cancer affects the flat, thin cells lining the throat and the voice box.
• Adenocarcinoma: This type of throat cancer affects the epithelial cells and is quite rare.

Apart from these primary types, throat cancer can be categorised based on the location where it occurs.

• Pharyngeal Cancer: This develops in the neck and throat. This includes sub-categories such as:
• Nasophaynx Cancer: This occurs in the upper part of the throat behind the nose.
• Oropharynx Cancer: This develops in the middle of the throat behind the mouth.
• Hypopharynx Cancer: This originates in the bottom part of the throat in the narrow area behind the voice box.
• Laryngeal Cancer: This affects the larynx, also known as the voice box. In the larynx, cancer can grow in three locations: glottis, supraglottis (the area above the glottis) and subglottis (the area between the vocal cords and the windpipe)

Signs and Symptoms Of Throat Cancer

The symptoms of throat cancer are non-specific and vary from person to person. Every person will of course not exhibit the same signs and symptoms, but the common potential signs of throat cancer include the following:

• Difficulty in swallowing, also known as dysphagia
• Changes in the voice, for example, cracking, hoarseness or unable to speak clearly
• Chronic sore throat
• Persistent cough, with or without blood
• Headache
• Mass or lump in the neck (swollen lymph nodes)
• Bleeding in the mouth or through the nose
• Swollen eyes, jaw, throat or neck
• Ear pain
• Persistent production of phlegm
• Unexplained weight loss
• Wheezing and breathing problems

What Are The Causes And Risk Factors Of Throat Cancer?

There is no specific cause of throat cancer, although there are some factors that increase the risk of throat cancer. Men are usually more likely to develop throat cancer compared to women.

The common risk factors are:

• Smoking and consumption of other tobacco products
• Gastroesophageal Reflux Disease (GERD), a condition in which acid from the stomach leaks into the food pipe.
• Excessive alcohol consumption
• Chewing betel nuts
• Poor nutrition
• Insufficient Vitamin A consumption
• Poor dental hygiene
• Exposure to asbestos
• Exposure to HPV
• Genetic conditions

How is Throat Cancer Diagnosed?

The doctor begins the diagnosis by asking in detail about the symptoms and getting a complete and accurate medical history. If a person has symptoms such as persistent cough, hoarseness, sore throat etc. which are unexplained, throat cancer is a primary suspect. In this case, the doctor performs a test known as laryngoscopy, in which a tube with a light at one end is inserted into the throat to provide a closer view of the throat. If this reveals any abnormalities, the doctor may perform one or more of the following tests:

• Biopsy: The doctor extracts a small sample of the tissue through an incision for further analysis. This is done after the patient is under the influence of general anaesthesia. A variation of the conventional biopsy is known as Fine Needle Aspiration (FNA) in which the doctor inserts a thin needle directly into a tumour to extract the sample cells.
• Imaging Tests: Imaging tests such as Magnetic Resonance Imaging (MRI), Computerised Tomography (CT) and Positron Emission Tomography (PET) scans can help doctors determine the extent of cancer assess the extent and severity of cancer and help them devise the best way to treat it.

This process, of assessing the severity of the cancer, is called the staging of cancer.

Stages of Throat Cancer

Depending on the severity of the cancer, throat cancer ranges across 4 stages:

• Stage 0: The tumour is present only on the top layer of the affected cells in the throat and hasn’t spread to the tissue beyond the throat.
• Stage 1: The tumour is small in size and is restricted to the part of the throat from where it originated.
• Stage 2: The tumour is slightly larger, but is usually still limited to a particular area of the throat.
• Stage 3: The tumour has grown and spread to other structures in the throat or has spread to one lymph node.
• Stage 4: Cancer has spread to the neck glands and/or the distant organs.

 What is the Treatment for Throat?

The treatment for throat cancer depends on several factors including its location, the severity of the stage of cancer and the general health of the affected person. The usual treatment measures are:

• Radiation Therapy: It uses high-energy beams from X-rays or protons to deliver high-intensity, targeted radiation to the cancer cells, thereby killing them. This is an effective treatment for early-stage cancers. For more advanced stages, this may be used along with chemotherapy or surgery for better treatment. The types of radiation therapy are:
• Brachytherapy: Radioactive seeds are placed directly inside the tumour or very close to it.
• 3-D Conformal Radiation Therapy: The radiation beams are shaped according to the shape and dimensions of the tumour. This is the most common method of radiation for laryngeal and hypopharyngeal cancer.

Surgery: The tumour and affected tissue are surgically removed. There are many types of surgical procedures depending on the location and stage of the cancer. The surgery may be done using a scalpel through incisions or may be less invasive. Some of the surgical options are:

• Endoscopic Surgery: In this method, a long thin tube with a light and a camera at one end, known as an endoscope, is inserted into the throat or the voice box, and special surgical tools or laser is passed through this tube to cut out or vaporise the cancers. This method is used to treat early-stage cancers.
• Laryngectomy: In this procedure, either the entire voice box or a part of it that is affected by cancer, is removed. In case the entire voice box is removed, the windpipe is then attached to a hole in the throat (stoma), to allow the person to breathe. This process is known as tracheotomy.
• Cordectomy: This procedure removes all or part of the vocal cords.
• Pharyngectomy: This surgery is done to remove part of the throat.
• Neck dissection: This is done if the throat cancer has spread deep within the neck. In this method, some or all of the lymph nodes are removed to see if they contain cancer cells.

Chemotherapy: This is usually performed in case of large tumours or if cancer has spread to the lymph nodes and other organs or tissues. This uses drugs to kill cancer cells. Chemotherapy is often used along with radiation therapy, but doing so increases the side effects of both treatments.
Targeted Therapy: This consists of drugs that can starve the cancer cells by interfering with the specific substances that are responsible for the growth and spread of the tumour. One particular type of targeted therapy is Cetuximab (Erbitux).

Post-Treatment Recovery

If detected in the early stages, there is a high probability of treatment curing throat cancer. However, there may be some after-effects of treatment, including:

• Tiredness
• Pain
• Memory problems
• Nerve changes resulting in numbness, tingling and weakness in different parts of the body.

The person should get sufficient rest and follow healthy lifestyle habits like exercising regularly and eating good, nutritious food. It is recommended to quit smoking and drinking as these can negate the effects of treatment, and also increase the risk of getting another cancer.