Throat Cancer (Larynx and Pharynx)
What Is It?
Throat cancer occurs when cells in the organs used for breathing, speaking, and swallowing begin to divide rapidly and abnormally. Most throat cancer begins on the vocal cords. Later, it spreads to the voice box (larynx); to the back of the throat, including part of the tongue and the tonsils (this whole area is called the pharynx); or below the voice box to the subglottis and trachea (windpipe). An early symptom of throat cancer is unexplained hoarseness or a raspy voice.
Smokers are at high risk of throat cancer. Other people at high risk include those who drink a lot of alcohol, especially if they also smoke.
The newest risk factor is infection with certain strains of human papillomavirus (HPV). Most often people acquire HPV in the mouth and throat through oral sex.
Throat cancer is associated with other cancers. Some throat cancer patients are diagnosed with cancer of the mouth, esophagus, or lung at the same time. Some people with throat cancer develop these cancers later on. Bladder cancer can occur in patients with throat cancer, because smoking increases the risk of this type of cancer, too.
Throat cancer is more common among men than women, probably because more men smoke. This cancer is less common among people younger than 55. Many throat cancers can be treated successfully. However, treatment may affect the person's ability to speak.
When throat cancer affects your vocal cords, the first symptom is a change in your voice. You may sound hoarse or raspy. Other symptoms of throat cancer include
painful or difficult swallowing
a sore throat that doesn't go away
a sense of a "lump in the throat" or a constant need to swallow
swelling or pain in the neck
enlarged glands (lymph nodes) in the neck
a chronic cough
unexplained weight loss
coughing up blood.
If your doctor suspects you have throat cancer, he or she will examine your throat. This can be done with a long-handled mirror or with a lighted tube called a laryngoscope. He or she might give you a local anesthetic to ease discomfort.
If your doctor finds any abnormalities, he or she will do a biopsy. This involves removing bits of tissue for examination under a microscope. Throat cancer can only be confirmed through a biopsy.
Your doctor might send you for a test called a computed tomography (CT) scan. This special type of x-ray creates images of the body from different angles, producing a cross-sectional view. A CT scan can help to locate a tumor, judge whether a tumor can be removed surgically, and determine the cancer's stage of development.
Doctors describe cancer using numerical stages. For example, a Stage 0 or Stage I tumor has not grown very far into tissues. A Stage III or IV tumor may be growing through and beyond nearby tissues.
PET scanning is the newest way to evaluate the extent of a cancer. The test helps to determine whether the cancer has spread to lymph nodes in the neck or other parts of the body. Doctors may also use it to plan your treatment, or as part of your long-term follow-up care.
Without treatment, throat cancer will continue to grow.
Because throat cancer is usually caused by a person's behavior, it can be prevented. If you smoke, get help to quit. Don't use smokeless tobacco products. Eat a healthy, balanced diet. Use alcohol only in moderation. Most experts recommend that women have no more than one drink a day and that men have no more than two drinks a day.
Using condoms during oral sex may help reduce HPV transmission. Researchers are studying the effectiveness of the approved HPV vaccines in protecting against HPV related mouth and throat cancer.
The type of treatment you'll receive depends largely on the cancer's stage (how far it has spread). The preferred treatments for the early stages of throat cancer are radiation therapy and surgery. In more advanced cases, chemotherapy may be given in combination with surgery and/or radiation. When throat cancer already has spread widely throughout the body, chemotherapy may be given alone. Under these circumstances, surgery or radiation is unlikely to help, and it's unlikely the cancer can be cured.
Here's what doctors often recommend, based on cancer stage:
Stage 0 throat cancers have not become invasive. They usually can be treated by removing the affected tissue.
Stage I or II throat cancers require surgery, radiation therapy or both. Radiation therapy can be highly successful with these cancers, but throat cancers rarely are found this early.
Stage III or IV throat cancers likely will require a combination of surgery, radiation therapy and chemotherapy.
Most cancers at later stages require the removal of part or all of the larynx or pharynx. Surgical removal of part or all of the larynx is called laryngectomy. Surgical removal of part or all of the pharynx is called pharyngectomy.
One of the most exciting new developments in the treatment of pharyngeal cancer is the use of robotic surgery. Complex operations that took hours and were quite debilitating can now be performed with greater efficiency using robotic assisted techniques.
A laryngectomy is the most common surgery for throat cancer. Even if only part of the larynx is removed, the patient will lose some of his or her ability to speak. He or she will need to learn special techniques or have reconstructive procedures to regain the use of his or her voice.
If cancer cells have spread beyond the larynx or pharynx and into the lymph nodes, a surgery called neck dissection is required. In this surgery, lymph nodes thought to contain cancer cells are removed. This can help contain the cancer before it spreads throughout the body. After surgery, radiation therapy may be done to destroy remaining cancer cells.
After treatment for throat cancer, some people will learn new ways to speak with voice aids, breathing techniques, and surgical restructuring. Because the pharynx is a passage to the digestive tract, patients undergoing pharyngectomy might need surgery to reconstruct the pharynx to allow food to pass through.
Seek advice and treatment from experts who treat throat cancer regularly. Experience counts.
When To Call a Professional
See a doctor if any symptoms of throat cancer, such as hoarseness, continue for more than two weeks. You may be referred to a specialist, called an ear, nose, and throat doctor (otolaryngologist), who deals mainly with disorders of the larynx and pharynx.
As with all cancers, the outlook is much better if throat cancer is found before it spreads. Although patients with earlier stages of throat cancer can be cured with surgery or radiation therapy, many have to learn new ways to speak. Also, throat cancer patients are at risk of developing other cancers in the mouth, throat, or esophagus. That's why follow-up examinations are crucial.
American Cancer Society (ACS)
1599 Clifton Road, NE
Atlanta, GA 30329-4251
Cancer Research Institute
One Exchange Plaza
55 Broadway, Suite 1802
New York, NY 10006
National Cancer Institute (NCI)
NCI Public Inquiries Office
6116 Executive Blvd.
Bethesda, MD 20892-8322
American Academy of Otolaryngology (Head and Neck Surgery)
1650 Diagonal Road
Alexandria, VA 22314-2857