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Throat Cancer: Symptoms, Diagnosis and Treatment

  • A cancer found in the pharynx or larynx, linked to tobacco and/or alcohol use, and certain viruses
  • In addition to a persistent sore throat, symptoms can include difficulty swallowing, voice changes
  • Common treatments include surgery or radiation, chemotherapy or targeted therapy if advanced
  • Involves head & neck cancers program, otolaryngology

Overview

The throat is important in eating, breathing and speaking. To accomplish these different tasks, the throat is divided into two main parts. The pharynx is the avenue through which food travels to the stomach and air is sent to the lungs. The larynx (sometimes called a voice box) allows us to speak and also protects the airway from food when we eat.

Throat cancer, a type of head and neck cancer, can be found in the pharynx or larynx. It most often affects squamous cells, or thin, flat cells that line the surface of these organs. The majority of people diagnosed with throat cancer are tobacco users and/or alcohol consumers. In recent years, an increasing number of cases of throat cancer are being diagnosed in people with certain viral infections, including human papillomavirus (HPV), a common sexually transmitted disease, and the Epstein-Barr virus, which causes “mono.”

Pharyngeal cancer is more common than laryngeal cancer. Combined, these diagnoses are given to some 31,000 people in the United States each year. Throat cancer affects more men than women, most likely due to the fact that more men use alcohol and/or tobacco. While people over the age of 55 are at highest risk for developing throat cancer, it’s growing more common in younger people due to the increased prevalence of HPV.  

The most common treatments for throat cancers include surgery, radiation therapy and chemotherapy. Targeted therapy may be used to treat advanced forms of throat cancer.

“There are a wide variety of ways to treat throat cancer, depending on the location and stage,” says Yale Medicine’s Heather Osborn, MD, a cancer surgeon who specializes in head and neck cancer. “Working with a multidisciplinary team of experts, like the ones at Yale Medicine, ensures that all treatment options are considered to make sure that you have the best possible treatment plan for you.” 

What is throat cancer?

In general, cancer occurs in the body at the cellular level, caused by a disruption in cellular activity when normal cell reproduce uncontrollably or don’t die as they should. Throat cancer mostly originates in squamous cells, which are thin, flat cells that line the pharynx and larynx.

Throat cancer can affect either the pharynx or larynx and there are a variety of different types, based on where the cancer is found. Squamous cell cancer of the throat can spread to other areas of the body including the lungs, bone and liver.

The pharynx is a 5-inch hollow tube that starts behind your nose and mouth, and ends at the top of the trachea (also known as the “wind pipe”). Cancer in any part of the pharynx is known as pharyngeal cancer. There are three parts to the pharynx that can further classify the type of pharyngeal cancer a person has. Going from top to bottom, these are the nasopharynx (part of the pharynx behind your nose, where nasopharyngeal cancers occur), the oropharynx (part of the pharynx behind your mouth, where oropharyngeal cancers can be found), and the hypopharynx (the bottom part of the pharynx, where people can have hypopharyngeal cancers).

The larynx contains your vocal cords, which are used to speak, and also helps to support the processes of breathing and swallowing. Cancer in any part of the larynx is known as laryngeal cancer. Like the pharynx, the larynx has three parts. From upper to lower, these are the supraglottis (where supraglottic carcinoma can occur), glottis (where glottic carcinoma can occur), and subglottis (where subglottic carcinoma occurs).

Who is at risk for throat cancer?

Tobacco use (in any form) and excessive alcohol consumption are the two greatest risk factors for developing throat cancer. Infection with the human papillomavirus (HPV) is increasingly linked to throat cancer as well, especially in younger people. Poor diet and oral hygiene, vitamin deficiency and Epstein-Barr virus are also risk factors. 

What are the symptoms of throat cancer?

Symptoms for throat cancer can vary, depending on where the cancer is found. Generally, though, they include a sore throat that doesn’t go away, pain or difficulty swallowing, persistent ear pain, a lump in the neck or throat, hoarseness or other changes in the voice, nosebleeds, headaches, coughing up blood, unexplained weight loss, sores in the throat, constant bad breath and a stiff jaw.

How is throat cancer diagnosed?

Diagnosis of throat cancer typically begins with a physical exam conducted by your doctor to check for any signs of abnormality, such as a sore or lump in your mouth or swollen lymph nodes in your neck. Your doctor might also conduct an endoscopy, a procedure using a small camera and light. The endoscope is inserted through your nose and travels down the throat, allowing the doctor to take a closer look.   

If an abnormality is spotted, your doctor will recommend a biopsy to confirm the presence of cancer. If throat cancer is diagnosed, you will likely need imaging tests  (usually CT and PET scans) to determine whether the throat cancer has spread to other areas of the body. 

How is throat cancer treated?

Treatment for throat cancer depends on the type of cancer you have, and whether it has spread to other parts of your body, such as your mouth or lymph nodes. Common treatments include radiation to kill the cancer cells, or surgery to remove the affected area. Removal of part or all of the larynx or pharynx can affect a person’s ability to speak. A person recovering from throat cancer surgery may need to learn how to speak in new ways, either using breathing techniques or voice aids.

If the throat cancer has spread to other areas of the body, more extensive treatment might be required. Your doctor might also recommend the following additional treatments to give your body the best chance at eliminating the cancer completely:

  • Radiation therapy: This uses high-energy rays to kill cancer cells and prevent new cancer cells from growing. It is highly recommended that people who are being treated with radiation for throat cancer quit smoking before receiving treatment in order to maximize the effectiveness of radiation therapy.
  • Chemotherapy: This uses anticancer drugs to kill cancer cells in the body. Chemotherapy is often recommended for advanced stage (3 and 4) throat cancer, and is usually prescribed in combination with radiation. Sometimes, chemotherapy is given prior to surgery in order to shrink the tumor in the throat.
  • Targeted therapy: This uses drugs to kill cancer cells without harming normal cells. It may be recommended for advanced stage throat cancers. Currently, targeted therapy is used primarily to treat laryngeal, oropharyngeal, and hypopharyngeal cancers.

Why is Yale Cancer Center unique in its care of head and neck cancers?

Yale Cancer Center uses advanced technologies in the management of throat cancers, including robotic surgery and targeted therapies. “We work in multidisciplinary teams, including surgeons, medical oncologists, radiation oncologists, speech and swallow therapists, oncology navigators, physical therapists and integrative medicine professionals, to ensure that you have all the information, expertise and support you need, every step of the way,” says Dr. Osborn.