Throat Cancer

Throat cancer refers to the multiplication of cancer cells or abnormal cells in the throat, which results in several complications including speech and eating difficulties. It usually starts as a small growth and may increase in size over a period of time. The growth can accelerate suddenly or may take several months. Throat cancer can affect the larynx (voice box), pharynx or other parts of the throat.

Throat cancer is a broad term, which includes cancers of different areas in the throat. The throat extends from behind the nose up to the epiglottis, where the food and windpipe begin. Although throat cancers have similar kinds of cells, they can be differentiated based on where the cancer is located in the throat.

• Nasopharyngeal cancer
  This type of throat cancer is seen in the nasopharynx, which is the upper portion of the throat behind the nose.
• Oropharyngeal cancer
  This type of throat cancer begins in the upper part of the throat right behind the mouth. Here, cancer typically involves the back of the tongue or the tonsils.
• Hypopharyngeal cancer
  Hypopharyngeal cancer originates in the lower portion of the throat, which is right above the food pipe and windpipe. It is seen behind the larynx.

Within the voice box, cancer may be present in different regions:

• Glottic cancer
  Glottic cancer is the one that develops in the vocal cords.
• Supraglottic cancer
  Supraglottic cancer begins in the upper part of the larynx and includes the cancer of the epiglottis (a thin flap of cartilage, which functions as a protective covering of the windpipe and prevents food from getting aspirated into it).
• Subglottic cancer
  Subglottic cancer originates in the lower part of the larynx.

As cancer progresses, the stage of cancer also advances. Each type of throat cancer may have its own staging system. These stages are:

• Stage 0
  The cancer cells are yet to grow to form full-fledged cancer and are still just a few cells in the lining of the throat.
• Stage I 
  This is a very early stage where the cancer is under 2 cm in size and has not reached any lymph nodes.
• Stage II
  Tumour size may vary between 2-4 centimetres. It has not yet affected the surrounding lymph nodes.
• Stage III 
  In stage III, throat cancer may have spread to the lymph nodes on the same side of the neck but these lymph nodes are under 3 cm in size. The size of the tumour is greater than 4 cm in diameter.
• Stage IV 
  In stage IV, cancer spreads to lymph nodes along with the different regions of the throat, head, neck or chest. In severe stage IV, cancer may have spread to distant organs as well. The size of the tumour is larger than 4 cms. 

The symptoms of throat cancer depend on the location of cancer and the stage at which it is. Some of the early symptoms of throat cancer include:

• Changes in the voice (hoarseness or inability to speak clearly).
• Prolonged coughing.
• A sore throat.
• Pain in the throat.
• Difficulty in swallowing.
• Lump in the throat.
• Sudden weight loss.
• Swelling in the eyes, jaw and throat.
• Blood in the sputum.
• Pain in the ear.
• Ringing in the ears.
• A sensation of something stuck in the throat.
  
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Most of these symptoms may be confused with the symptoms of common throat infections. However, throat cancer causes prolonged symptoms, which may be more pronounced only when cancer has progressed.

Causes

The cause of any type of cancer is primarily the uncontrolled growth of cells in a particular region. Similarly, in throat cancer, the cells divide unchecked and uncontrollably in different areas. The cells start dividing due to genetic mutations, damage and other changes in their DNA. These mutations result in cells growing at a much faster rate and living beyond their normal lifespan. The accumulation of such cells leads to the formation of a lump or a tumour in the throat.

The cause of these mutations is not specifically known.

Risk Factors

While the exact causes of throat cancer may not be well known, there are certain risk factors, which have been implicated in increasing the risk of developing throat cancer:

• Consumption of excessive alcohol.
• Use of tobacco (smoking and chewing tobacco).
• Unhealthy diet.
• A family history of cancer.
• Presence of goitre.
• Infection by HPV (Human Papilloma Virus), which is sexually transmitted.

Other risk factors include:

• Gender
  Men are more likely to develop throat cancer than women. 
• Age
  Most people get diagnosed with throat cancer after the age of 65. 
• Environmental factors
  Constant exposure to chemicals, such as asbestos, nickel and sulfuric acid fumes can increase the risk of developing throat cancer.  

Not all types of throat cancers can be prevented. However, there are preventive measures that can be taken in order to reduce the risk.

• Stop smoking
  Use of tobacco has been strongly linked to throat cancer and oral cancer as well. Smoking and chewing tobacco are highly injurious to health and can result in serious health problems. For habitual smokers, the risk is immense and hence, quitting smoking or tobacco use of any other kind is imperative. Although the process of quitting may not be easy, there are several rehabilitation centres, which offer assistance to help rid oneself of this habit.
• Reduce alcohol consumption
  Reducing the intake of alcohol can prevent cancer and reduce its risk significantly. Alcohol results in dehydration of the throat lining and excessive consumption may result in its constant irritation and abnormalities in the cells. Hence, it is recommended to consume alcohol in moderation.
• Follow a healthy diet
  To reduce the risk of any type of cancer, doctors recommend following a healthy diet. Consumption of fruits and vegetables and a diet rich in antioxidants can help in lowering the risk of cancer. The American Cancer Society recommends eating more plant foods such as fruits, vegetables, whole grain bread and cereals instead of refined grains and processed foods.
• Prevent infection by HPV
  The risk of having an HPV infection is significantly higher in people who have multiple sexual partners. People who smoke are more susceptible to the infection, as smoking weakens the immune system. There are vaccines, which can help in reducing the risk of infection with certain types of HPV. 

Throat cancer is diagnosed with the help of multiple tests:

• Physical examination
  A physical examination of the throat can help the doctor to find any swelling, lumps or tender areas in the throat. The doctor may also use a device with a camera fitted on one end to examine the larynx. This procedure is called laryngoscopy.
• Video stroboscopy
  In this procedure, a flexible tube is inserted through one of the nostrils. This tube has a camera fitted on one end that goes down the throat and gives a clear view of the vocal cord region on the monitor.
• Biopsy
  A biopsy may be done to examine the cells of the throat in order to identify cancerous cells. A sample of the tissue is collected and examined under a microscope.
• Scanning/imaging tests
  Scanning tests include ultrasound, computed tomography (CT) scan, magnetic resonance imaging (MRI) scan or positron emission tomography (PET) scan and X-rays. These tests help the doctor in determining how big the tumour is and the extent to which it has spread. 

The course of treatment of throat cancer depends upon the location, type and size of cancer. Treatment options include:

• Radiation therapy
  Radiation therapy for cancer uses controlled doses of rays like gamma rays to target and destroy cancer cells in specific regions.
• Chemotherapy
  Chemotherapy involves the use of certain drugs, which help in eliminating cancer cells. Chemotherapy is often used in combination with radiotherapy for cancer treatment.
• Surgery
  By surgical intervention, the tumour can be removed. In order to get rid of a tumour, other tissues or parts like the thyroid may have to be removed. This depends upon the size of a developing tumour. Neighbouring lymph glands may also have to be removed in order to prevent further spread of cancer.
• Multimodality treatments
  This involves the use of radiotherapy or chemotherapy after surgery. It is usually administered for large tumours.
• Rehabilitation therapy
  Rehabilitation therapy goes hand in hand with the medical treatment of cancer. It includes assistance in terms of diet, speech and mental health. Counsellors, social workers and psychologists can help a person in recovering from the mental stress of undergoing intensive cancer treatment. 

Side effects of the treatment procedures include:

• Nausea and vomiting
  Nausea and vomiting occur due to chemotherapy drugs and radiation therapy.
• Speech difficulties
  Throat surgery can have an effect on speech. There may be side effects like voice changes, which may or may not improve with time.
• Scarring
  In case tissue of other parts of the throat is removed, it may result in scarring or some degree of deformity. 

Lifestyle management

In some cases, cancer may have advanced and a definite cure may not be possible. In such cases, palliative care is used in order to manage the pain and symptoms. Some aspects of palliative care include:

• Pain management
  This is planned by keeping in mind the requirements of the person and the intensity of the treatment. Pain relief medications may be used to minimise the pain.
• Support from family members 
  This plays a crucial role, as the support provided by family members and friends can help the person greatly in getting through the treatment.
• Counselling 
  Counselling from a professional psychologist who specialises in dealing with people with cancer can be very helpful in providing mental support. Psychological and spiritual counselling can help in providing comfort.

The course of treatment followed can produce side effects, which require care and management:

• To deal with the tiredness, which comes with cancer treatment, one may engage in mild exercise such as short outdoor walks and doing other activities, which do not cause exertion.
• Cancer treatment may also have some impact on memory. People with cancer can write down the tasks or things that they have to do and keep a checklist or reminders as well. Help can be taken from friends and family members for doing tasks like shopping or driving.
• The treatment of throat cancer is followed by regular checkups. Visits to the doctor may be scheduled every few months in order to track the progress and manage any other ongoing symptoms. 

Prognosis

Early detection of cancer can help greatly in preventing it from spreading and improving the success rate of the treatment. There is a higher risk of throat cancer recurrence in people who smoke or consume alcohol even after the treatment. Careful and vigilant management of the symptoms can limit the complications. 

Complications

Complications associated with throat cancer include:

• Difficulty in eating.
• Loss of voice.
• Permanent scarring.
• Metastasis (the spread of cancer to the other body parts).
• Disfigurement due to surgery.
• Difficulty in breathing due to airway obstruction.