Throat cancer primarily affects the organs that help breathe, swallow and speak. About 50% of these cancers happen in the throat. Throat, also called the pharynx, is the tube that starts behind the nose and ends in the neck. The remaining ones occur in the voice box (larynx). Throat cancer can also affect the piece of cartilage (epiglottis) that acts as a lid for your windpipe. Tonsil cancer, another form of throat cancer, affects the tonsils, which are located on the back of the throat. Throat cancer tends to grow quickly therefore it is recommended to get treatment early. This provides the best chance of beating the disease and maintaining a good quality of life.
Most throat cancer types grow in the flat thin cells that line the throat and voice box. They are identified by their location which are Nasopharynx, Oropharynx and Hypopharynx. Throat cancer can grow in three parts of the voice box as well, namely the Glottis, Supraglottis and Subglottis.
Throat Cancer in India and many other developing countries is on a rise and the risk of throat cancer can be reduced by not smoking, chewing tobacco and limiting alcohol consumption.
The occurrence of a few symptoms may not explain the problem. However, symptoms that are persistent or increase or gradually become severe tend to reveal the presence of throat cancer. Some of the common symptoms include:
- Hoarseness: a rough quality of the voice
- Throat discomfort, sensation of a foreign body in the throat, a feeling of lump in the throat
- Sore throat or throat pain, aggravated by swallowing
- Coughing purulent bloody sputum with smelly odour, even coughing up blood
- Bad breath
- Difficulty in swallowing
- Weight loss for unknown reasons
- A lump in the back of the mouth, throat or neck
The reasons for the mutation that leads to throat cancer are not completely clear. However, factors that can increase the risk of throat cancer include:
- Tobacco use, including smoking and chewing tobacco
- Excessive alcohol use, which translates to more than two drinks a day for men and more than one drink a day for women
- A virus called Human Papillomavirus (HPV)
- A diet lacking in fruits and vegetables
Other risk factors are:
- Men are five times more likely to get throat cancer than women
- Most people get diagnosed with throat cancer after the age of 65
- African-American men are at the biggest risk of getting throat cancer
- Exposure to chemicals such as asbestos, nickel and sulphuric acid fumes increase the chances of getting throat cancer.
In order to determine if a person is suffering from throat cancer or not, the dentist advices one of the following methods for diagnosis:
- Endoscopy: This test is performed to determine the extent of the tumour. During the procedure, the upper portion of the gastrointestinal tract and respiratory tract are visualised with endoscopes – long, thin and flexible tubes equipped with a tiny video camera and light on the end. Other areas which can be examined include the oesophagus, trachea and bronchi of the lungs. In many cases, endoscopy is a more precise examination than X-ray studies.
- Imaging Tests: Another method that is generally used by the doctors are imaging tests, such as a Computed Tomography (CT) scan, Positron Emission Tomography (PET) scan or Magnetic Resonance Imaging (MRI), which provide additional information regarding the stage of the tumour and whether the cancer has spread to surrounding lymph nodes in the neck or elsewhere in the body.
- A Biopsy: It is done to collect tissue samples that get examined under a microscope. It is the only way to know for sure if the tumour is cancerous or not. A biopsy procedure can be done with a surgery or a fine needle or through the endoscope.
Multi-disciplinary approach is known to have improved the quality of cancer care and ensures that the patient has access to the best current thinking on cancer management. Surgery or radiation therapy by themselves or a combination of these therapies may be part of the treatment plan. The treatment plan is based on the staging, location and other health factors of the patient. The stages of throat cancer are:
Stage 1 and 2: The cancer is this stage is smaller and remains in one location
Stage 3: The cancer may have spread to the lymph nodes and/or other parts of the throat
Stage 4: Here the cancer may have spread to lymph nodes and different parts of the throat, head, neck, or chest. The most serious stage 4 throat cancer is when it has metastasised to distant parts of the body like the lungs or liver.
Medical Oncology for Throat Cancer:
Chemotherapy is a process where medical drugs are used to kill cancer cells. Systemic chemotherapy is delivered through the bloodstream to reach cancer cells throughout the body. For advanced stage tumours, chemotherapy is often given in combination with radiation therapy, typically in the setting of a therapeutic clinical trial.
Surgical Oncology for Throat Cancer:
Surgery can be performed by an incision with a scalpel, by an endoscope, through laser or robotic surgery. Very early stage throat cancer is usually taken out by endoscopic or laser surgery. However, if the tumour is advanced and has spread to surrounding areas, surgery will be more extensive and may involve the removal of parts of the throat, mouth, jaw or voice box. In these cases, the ability to speak, chew, swallow and breathe may be affected.
Reconstructive surgery in throat cancer treatment can help in restoring the appearance of the organ and rehabilitate the ability to speak and swallow. In more advanced cases, the patient may need to use tubes for feeding and breathing and an artificial voice aid for speaking. In addition, one may have to work with a dietician who will help in developing a nutrition plan that includes healthy foods that are easy to swallow and chew. With the advancements in the technology, robotic surgery in treatment of throat cancers is now used to deliver best possible outcome in a minimally invasive way.
Radiation Oncology for Throat Cancer:
Sometimes radiation is the only treatment needed for early stage throat cancer. Radiation Therapy uses high-energy particles or waves (like x-rays, gamma rays, electron beams) to destroy or damage cancer cells. Radiation therapies could be used with chemotherapy and surgery, in the treatment of stage 3 and 4 throat cancer. Radiation therapies are painless, do not require surgery and are aimed at destroying cancer cells in a specific area. It can either come from a high energy x-ray machine or from a small source of radioactive material placed close to or on the tumour.