Throat cancer

What is throat cancer?#

The throat (also called the pharynx) is a hollow tube that starts behind the nose and leads to the food pipe (esophagus) and the windpipe (trachea). Throat cancer usually refers to cancer that starts in the pharynx or the larynx (voice box), but the term may also be used for cancers that begin in the esophagus or thyroid.

Throat cancer is a type of head and neck cancer. Cancers that begin in the tissue or lymph nodes of the head and neck region – including the mouth, tongue, salivary glands, sinuses, nose and ear – are grouped together as head and neck cancers.

Parts of the throat#

Pharyngeal cancer (cancer of the pharynx) can affect three parts of the throat:

• Nasopharynx (nasopharyngeal cancer) – the upper part, behind the nose and around the soft palate.
• Oropharynx (oropharyngeal cancer) – the middle part, including the soft palate, the base of the tongue and the tonsils.
• Hypopharynx (hypopharyngeal cancer) – the lower part, around the voice box (larynx).

Cancer that starts in the larynx is called laryngeal cancer. The larynx is a short passage connecting the lower part of the throat (hypopharynx) with the windpipe (trachea). The thyroid gland sits in front of the trachea, below the voice box. Parts of the larynx include:

• Epiglottis – the small flap of tissue that covers the larynx when you swallow, to stop food going into the trachea and lungs.
• Glottis – contains the vocal cords, which vibrate as air passes through them to produce the sound of your voice.
• Subglottis – the area below the vocal cords.

How throat cancer develops and spreads#

The membranes of the throat are lined with flat, firm cells called squamous cells, and throat cancers can begin in these surface cells. Without treatment, a squamous cell carcinoma can spread into deeper tissue – including muscle and bone – or to the lymph glands in the neck.

Some thyroid cancers can quickly invade nearby structures such as the trachea. If not treated, the enlarging tumour can press on the trachea and cause breathing problems. Throat cancer can also spread to other parts of the body, such as the lungs, so it is important to diagnose and treat it early. Throat cancer can often be treated successfully when found at an early stage, so see your doctor promptly if you notice any changes to your throat or neck.

Symptoms#

In the early stages, symptoms of throat cancer may not be noticeable. Some symptoms can also be caused by other, less serious illnesses, so having them does not necessarily mean you have cancer. The only way to be sure is to see your doctor and have the necessary tests.

Symptoms of throat cancer may include:

• a lump or swelling in the neck or throat
• a persistent sore throat or cough
• throat pain or difficulty or pain when swallowing
• voice changes or hoarseness that do not go away
• unexplained weight loss
• bad breath
• spitting or coughing up blood
• ear pain or frequent ear infections
• a blocked nose or ear, or hearing loss
• a feeling that your air supply is blocked, or difficulty breathing
• numbness of the face or headache
• dull pain around the breastbone

Risk factors#

Risk factors for throat cancer include:

• smoking or chewing tobacco
• heavy alcohol consumption
• human papillomavirus (HPV)
• Epstein-Barr virus (EBV), the virus that causes glandular fever
• a family history of cancer (a genetic predisposition)
• a poor diet
• being overweight or obese
• chronic goitre (enlargement of the thyroid gland)
• radiation exposure

Tobacco, alcohol and throat cancer#

Smoking and drinking alcohol are major risk factors for throat cancer. If you both smoke and drink, your risk is significantly higher, because alcohol may make it easier for other carcinogens, including tobacco, to enter and damage cells. While smoking and drinking are major risk factors, younger people who do not smoke or drink are increasingly being diagnosed with throat cancer.

HPV and throat cancer#

Human papillomavirus (HPV) – the same virus that causes cervical cancer – causes about 70 per cent of oropharyngeal cancers. HPV is spread mainly through vaginal, anal and oral sex, and it usually clears from the body on its own. In some people, HPV spread through oral sex can cause a persistent oral infection that damages cells and leads to oropharyngeal cancer. Symptoms can take months to develop. The best protection from HPV is vaccination, ideally given before a person becomes sexually active.

Diagnosis#

Diagnosis depends on the nature of your symptoms. Your doctor or dentist may do some general tests and refer you to a specialist. Tests may include:

• a review of your medical history
• a physical examination of the mouth, throat and neck
• blood tests
• a biopsy – a sample of cells or tissue examined in a laboratory
• laryngoscopy – done under general anaesthetic, a tube with a light and small camera (laryngoscope) is passed into the mouth and throat for a close-up view
• endoscopy of the larynx – a thin tube with a light (endoscope) is passed through the nose to look for physical changes
• nasendoscopy – done under local anaesthetic, a thin flexible tube with a light and camera (nasendoscope) examines the nose and throat
• videostroboscopy – after a topical anaesthetic numbs the nasal passages, a small flexible tube with a camera and strobe light is passed through the nose to view the larynx and record vocal cord movements
• thyroid scan – a special x-ray of the thyroid after an injection of radioactive material
• imaging such as x-ray, ultrasound, CT scan, MRI or PET scan

Test results can take a few days to come back, and it is natural to feel anxious while waiting. It can help to talk to a close friend or relative about how you are feeling, and you can also speak with a cancer nurse.

Treatment#

Treatment depends on the size, type and location of the cancer and whether it has spread. It can include:

• Surgery – the tumour is removed. This may involve partial or total removal of the thyroid, tissue or muscle, or removal of the entire larynx (laryngectomy) or tongue (glossectomy), depending on the location and size of the tumour. Nearby lymph glands may also be removed if the cancer has spread.
• Radiation therapy – small, precise doses of radiation target and destroy cancer cells.
• Chemotherapy – cancer-killing drugs, often used in combination with radiotherapy. Because the whole body is treated, chemotherapy can help control cancers that have spread (metastases).
• Multi-modal treatment – surgery on larger tumours may be followed by radiation therapy, and chemo-radiotherapy may also be used.

All treatments have side effects, which vary with the type of treatment. Many side effects are temporary, but some may be permanent. Your doctor will explain the possible side effects before treatment begins. Ongoing care after treatment may include long-term monitoring, speech therapy and dietary advice.

When throat cancer can’t be cured#

If throat cancer has spread and cannot be cured by surgery, your doctor may still recommend treatment to control the cancer and relieve symptoms. This may include chemotherapy, radiotherapy, surgery, immunotherapy or symptom-relieving medications, alone or in combination. Treatment may help you feel better and may allow you to live longer.

You may hear this called palliative care. It is not just for people nearing the end of life – it is designed to manage symptoms rather than cure, and you can receive it at the same time as cancer treatment. The goal is to improve your quality of life and that of your family, friends and carers.

Reducing your risk#

You can reduce your risk of throat cancer by:

• quitting smoking and avoiding tobacco
• reducing your alcohol intake
• eating a healthy diet, including plenty of non-starchy vegetables and fruit (thought to help lower the risk of cancers of the oropharynx and larynx)
• maintaining a healthy body weight
• practising safer sex, including using condoms
• getting vaccinated against HPV

The HPV vaccine can significantly reduce the chances of developing HPV-related illnesses, including cervical and oropharyngeal cancers. People who missed the vaccine when younger may be able to get a catch-up dose – ask your doctor, pharmacy or local immunisation provider. Following this advice does not guarantee you will never get throat cancer, but it can reduce your risk and has other health benefits too. It also helps to attend your doctor and dentist for regular check-ups and to report any changes to your throat or neck.

Key points#

• Throat cancer is a head and neck cancer; the number of people affected is increasing.
• The main types are pharyngeal cancer (of the pharynx) and laryngeal cancer (of the larynx or voice box).
• If not treated, an enlarging tumour can press on the trachea and cause breathing problems.
• Throat cancer can spread to other parts of the body, such as the lungs, so it is important to diagnose and treat it early.
• In early stages, symptoms may not be noticeable, and some can resemble other illnesses, so see your doctor for tests.

Where to get help#