Throat Cancer: Comprehensive Health Information

This information is provided by SSCHRC to help you understand throat cancer and its management. It is written in a patient-friendly and medically accurate style.

1. General Information

Throat cancer is a collective term for various cancers that develop in the head and neck region, with most originating in the lining of the throat. This lining is composed of thin, flat cells called squamous cells, which is why the majority of throat cancers are known as squamous cell carcinomas.

These cancers are situated in either the larynx (voice box) or the pharynx (the tube running from the back of the nasal cavity down to the oesophagus and trachea). The exact location is a crucial factor in determining the patient's treatment and overall prognosis.

The larynx contains the vocal cords, enabling speech, and also functions as a valve for breathing and directing swallowed materials away from the lungs. The pharynx is involved in both breathing and swallowing and has three main sections:

Types of Throat Cancer

Oropharyngeal Cancer

Forms in the oropharynx and is the most common type of throat cancer in certain regions, with cases rising primarily due to the Human Papillomavirus (HPV) infection.

Nasopharyngeal Cancer

Develops in the nasopharynx. It is rare in the West but more common in Asia.

Hypopharyngeal Cancer

A rare form of cancer in the hypopharynx, often treated similarly to laryngeal cancer.

Laryngeal Cancer

Affects the larynx or voice box.

Pharynx Sections

  • Nasopharynx: The upper section, located behind the nasal cavity.
  • Oropharynx: The middle section, connecting the pharynx and the mouth.
  • Hypopharynx: The lower section, situated next to the larynx, sometimes referred to as the laryngopharynx.

Throat Cancer Risk Factors

Anything that increases the likelihood of developing throat cancer is considered a risk factor, including:

Viral Infections

  • • HPV Infection: Human papillomavirus is the primary cause of oropharyngeal cancer in some countries.
  • • Sexual History: Since HPV is often spread through sexual contact, a person's sexual history can influence their risk.
  • • Epstein-Barr Virus (EBV) Infection: This virus, known to cause glandular fever (mononucleosis), is a risk factor specifically for nasopharyngeal cancer.

Lifestyle Factors

  • • Tobacco Use: Using tobacco products increases the risk of throat cancer.
  • • Alcohol Consumption: Heavy drinkers have an elevated risk.

Demographic Factors

  • • Gender: Men are significantly more likely to be diagnosed with throat cancer than women.
  • • Age: Historically, most cases occur in patients over 60, but HPV-related cancers are increasingly seen in patients in their 50s and younger.

2. Symptoms

Throat cancer symptoms vary among individuals, largely depending on where the cancer first develops.

How Throat Cancer Feels: In its early stages, throat cancer is usually painless and presents no symptoms. When patients do feel the cancer, they often describe it as a pinpoint pain in one specific spot in the throat. They may also report a dull earache, typically on the same side as the cancer, and painful swallowing.

Early Signs of Oropharyngeal Cancer (Most Common Type)

As most throat cancers occur in the back of the tongue and the tonsils, early signs may include:

  • • A sore throat that does not go away
  • • A persistent, dull earache on one side
  • • Tonsil asymmetry (one tonsil is larger or shaped differently than the other)
  • • Difficulty and/or pain when swallowing
  • • Mucus that is tinged with blood

Signs of Advanced Oropharyngeal Cancer

Symptoms that may indicate more advanced disease are:

  • • A painless lump in the neck that can be seen or felt from the outside
  • • A cough that persists
  • • Difficulty moving the tongue or opening the mouth
  • • Spitting up blood
  • • Hoarseness or other voice changes

Note on Similar Conditions: Nearly all throat cancer symptoms can also be caused by much less serious conditions such as allergies, bronchitis, laryngitis, or strep throat. If a symptom resolves on its own or with standard treatment like antibiotics, it is almost certainly one of these minor conditions. However, if a symptom persists for more than two weeks or fails to improve despite appropriate treatment, it is important to see a specialist, such as an ear, nose, and throat (ENT) doctor, for a thorough examination.

3. Diagnosis

Early and accurate diagnosis is critical for increasing the chance of cure while preserving quality of life, especially the patient's ability to speak and swallow.

If throat cancer is suspected based on symptoms, your doctor will perform an examination and ask about your health history, lifestyle factors like smoking and drinking habits, and family medical history.

The diagnostic tests used depend on the suspected type of cancer and whether it is believed to have spread. Tests are also used to monitor the disease and its response to treatment.

Fiberoptic Laryngoscopy

Often the first test. A small, flexible camera is passed through the nose to examine the nasopharynx, oropharynx, and larynx, helping the doctor determine if a biopsy is required.

Biopsy

This is the only definitive way to diagnose throat cancer. Doctors retrieve suspected cancer tissue for examination under a microscope. Common methods include:

  • Fine-Needle-Aspiration Biopsy (FNA): Used for lumps in the neck. A thin needle is inserted to withdraw cells, often guided by an ultrasound.
  • Conventional Incisional Biopsy: The doctor surgically removes a portion of the suspicious tissue.
  • Excisional Biopsy: A type of biopsy that removes most or all of the suspected cancerous tissue, frequently performed alongside a tonsillectomy in the operating theatre.
  • Endoscopic Biopsy: An endoscope (a long, thin tube with a light and lens) is inserted through the mouth, nose, or an incision to view organs and tissue and remove tissue samples. This is primarily used for nasal cavity or nasopharyngeal cancers.

Imaging Exams

These tests help locate the cancer, determine if it has spread, and monitor its progression and response to therapy. They may include:

  • • CT or CAT (Computed Axial Tomography) scans
  • • PET (Positron Emission Tomography) scans
  • • MRI (Magnetic Resonance Imaging) scans
  • • Ultrasound
  • • Chest and dental X-rays

Swallowing Tests

Used to assess the throat's function and assist in planning treatment. Types include:

  • Barium Swallow: The patient drinks liquid barium, which enhances visibility on X-rays, to evaluate the passage from the throat to the stomach for changes in structure and muscle movement.
  • Modified Barium Swallow: Ingestion of liquid, pudding, and solid food containing barium, with swallowing observed in real-time using a specialised X-ray exam called a fluoroscopy.
  • Fiberoptic Endoscopic Examination of Swallowing (FEES): A small, flexible endoscope is inserted through the nose to allow a doctor or speech pathologist to examine the swallowing process.

Throat Cancer Staging

Staging is the process of defining the primary tumour and determining if it has spread (metastasised) to the lymph nodes or bloodstream. It provides a standard language for clinicians to discuss treatment options, assess their likely effectiveness, and determine the overall prognosis after treatment is completed.

4. Treatment

At SSCHRC, we are dedicated to customising your throat cancer treatment to maximise the chance of a cure while maintaining your quality of life.

Given the throat's critical role in speaking, breathing, and swallowing, treatment plans are personalised to each patient, with a focus on preserving these functions while eliminating the cancer.

Your care will be provided by a multidisciplinary team of experts, including a medical oncologist, radiation oncologist, head and neck surgeon, and plastic surgeon. Depending on the cancer type and how far it has spread, you may receive one or more of the following therapies.

Surgery

Surgery is a common treatment for most throat cancers, including oropharyngeal, hypopharyngeal, and laryngeal cancer, though it is rarely used for nasopharyngeal cancer. The specific procedure depends on the location of the cancer.

For oropharyngeal cancer, which is the most common type, surgery is often used in the early stages. Recent advancements have led to less invasive surgical techniques and approaches, resulting in much shorter recovery times. Surgeries for oropharyngeal cancer include:

  • Transoral Robotic Surgery (TORS): This is the most common surgery for oropharyngeal cancer. It is a minimally invasive procedure that uses robotic tools and advanced three-dimensional imaging to completely remove the tumour without the need for large incisions in the mouth and jaw area.
  • Transoral Laser Microsurgery: This procedure uses a flexible, hollow-core fibre that transmits CO2 laser energy to remove tumours in tight, previously inaccessible locations, minimising damage to nearby tissue.

Chemotherapy

Chemotherapy drugs are used to kill cancer cells, control their growth, or relieve disease-related symptoms. Treatment may involve a single drug or a combination of two or more, depending on the type and growth rate of the cancer. Chemotherapy may be used to shrink a throat tumour before surgery, or to eliminate any residual cancer cells after surgery and/or radiation. A combination of chemotherapy and radiation therapy may be used as the primary treatment for patients with larger tumours or those who are unable to tolerate surgery.

Immunotherapy

Cancer can be a complex disease capable of evading the body's immune system. Immunotherapy works by enhancing the immune system's ability to recognise and destroy cancer cells. At present, only immune checkpoint inhibitors are approved to treat throat cancers. These drugs prevent the immune system from 'turning off' before the cancer is fully eliminated.

Targeted Therapy

Targeted therapy drugs are designed to stop or slow the growth or spread of cancer at a cellular level. Cancer cells rely on specific molecules (often proteins) to survive and multiply. Targeted therapies interfere with, or target, these molecules or the cancer-causing genes that produce them.

Radiation Therapy

Radiation therapy uses focused, powerful beams of energy, typically photons, to destroy cancer cells. Types of radiation therapy used for throat cancer include:

  • Intensity Modulated Radiation Therapy (IMRT): This technique focuses multiple radiation beams of varying intensities directly onto the tumour to deliver the highest possible dose. A variant is Volumetric Modulated Arc Therapy (VMAT), which uses a rotating machine to deliver radiation from multiple angles.
  • MR LINAC Radiotherapy: This approach uses a specialised device to adjust treatment daily, which can reduce side effects and effectively treat tumours that change over time.
  • Stereotactic Body Radiation Therapy (SBRT): Also known as stereotactic ablative radiotherapy, SBRT precisely targets tumours with very high doses of radiation using several beams of various intensities aimed from different angles.

Clinical Trials

As a premier cancer centre, SSCHRC is actively involved in developing and participating in clinical trials for new throat cancer therapies. These trials can sometimes offer the best treatment option for patients and are vital for advancing cancer care for the future.

Specialized Care for Throat Cancer Patients

Both throat cancer and its treatments can affect a person's ability to eat, drink, and speak, as well as their appearance. SSCHRC offers a range of specialised therapies and services to help patients manage and overcome these challenges:

Speech Therapy

Our speech pathologists and audiologists offer advanced techniques to help patients restore speech function after treatment.

Swallowing Therapy

Experts in our Speech Pathology and Audiology Section are dedicated to evaluating and treating patients who experience difficulty with eating, drinking, and swallowing after treatment. The swallowing service at SSCHRC is a leader in the field.

Reconstructive Surgery

Treatment can impact a patient's appearance. SSCHRC is home to renowned reconstructive surgeons who perform procedures to help restore appearance.

Dental Care

The disease and its treatments can sometimes damage the teeth and jaw. Our dentists specialise in designing implants and performing procedures to help restore function and appearance for throat cancer patients.

Survivorship

SSCHRC operates a dedicated survivorship clinic for head and neck cancer patients. Regular follow-up and screenings are essential due to the high risk of the cancer returning to the throat or head and neck area. Patients are advised to see their doctors every three to six months for the first two years post-treatment, as most recurrences happen within this period. Patients are also strongly urged to refrain from smoking or drinking alcohol during and after treatment, as these habits can reduce treatment effectiveness, worsen side effects, and significantly increase the risk of cancer recurrence.