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5 early signs of throat cancer

Here are the 5 early signs of throat cancer, which include sore throat, difficulty swallowing, changes in the voice, unexplained weight loss, and neck mass.

1. Sore throat
   • Sore throat is a common symptom seen in various conditions caused by infection or inflammation of the throat.
   • Sore throat due to throat cancer lasts longer than usual, does not subside with treatment, and is often associated with chronic cough.
2. Difficulty swallowing
   • Difficulty swallowing is referred to as dysphagia.
   • A person may feel that the food is stuck in the throat. This sensation may worsen gradually and impacts the diet when people tend to reduce eating solid food due to discomfort.
   • Dysphagia to solid foods may worsen with time to the extent that the person even finds it hard to swallow liquids.
3. Changes in the voice
   • Some hoarseness in the voice could be present, and eventually, people may lose the ability to speak clearly.
   • Though there are various noncancerous reasons for hoarseness, persistent and worsening hoarseness may be present in throat cancer.
4. Unexplained weight loss
   • If a person is losing weight without making any adjustments to their diet or activity, especially if they are dropping 10 pounds or more without making conscious efforts, this might be an indication of cancer.
5. Neck mass
   • A lump or a mass in the neck region could be observed. There may be various reasons for a neck mass that are noncancerous, including throat, dental, nose, and ear infections, and goiter (enlarged thyroid gland).
   • Though most of the signs are seen with infections or other noncancerous reasons, it is always recommended to consult a doctor for thorough examination and determination of the cause followed by appropriate treatment. 
   • Other symptoms include:
     • Trouble opening the mouth
     • Inability to move the tongue
     • Pain in the ear, jaw, and neck
     • Excess cough associated with or without hemoptysis (coughing up of blood)
     • Whitish patches on the tongue and inner lining of the mouth
     • Breathing issues

What is throat cancer?

Throat cancer is the uncontrolled growth of cells that can begin in the different parts of the throat and results in the accumulation of nonfunctional cancerous cells, which may form lumps.

The throat is divided into these two main parts:

1. Pharynx (throat): A tube-like structure that starts behind the nose and ends at the top of the windpipe and esophagus, and is subdivided into three parts.
   • Nasopharynx
   • Oropharynx
   • Hypopharynx or laryngopharynx
2. Larynx: Contains vocal cords and enables people to speak, as well as protects the airways and allows people to breathe. It has a flap-like covering called the epiglottis, which prevents the food from entering the lungs, and contains three main parts.
   • Glottis
   • Supraglottis
   • Subglottis

What are different types of throat cancers?

The throat is lined by thin flat cells called squamous epithelial cells. Most throat cancers arise from these cells and are referred to as squamous cell carcinomas.

Rarely lymphomas and cancer of the minor salivary glands may develop in the throat.

Even though most cancers develop from the same types of cells, particular terms are used to distinguish the location of cancer in the neck.

Cancer in different parts of the pharynx

• Nasopharyngeal cancer (NPC)
  • The nasopharynx is the upper section of the throat behind the nose and toward the base of the skull. The air travels from the nose to the throat through the nasopharynx.
  • Both noncancerous (benign) and cancerous (malignant) tumors develop in the nasopharynx. Different types of nasopharyngeal carcinoma include:
    • Nonkeratinizing undifferentiated carcinoma, which is the most common type of NPC in the United States
    • Nonkeratinizing differentiated carcinoma
    • Keratinizing squamous cell carcinoma
    • Lymphomas
    • Adenocarcinoma and adenoid cystic carcinoma, which start in the minor salivary glands in the nasopharynx
• Oropharyngeal cancer
  • The oropharynx is the middle section of the throat behind the mouth that includes the base of the tongue, tonsils, and soft palate. Most throat cancers are seen in the oropharynx.
  • The most common risk factors of oropharyngeal cancer are:
    • Smoking
    • Human papillomavirus (HPV) infection
    • Oropharyngeal cancer caused by HPV infection has a better prognosis rather than tumors caused by other factors.
• Hypopharyngeal cancer
  • Hypopharynx is the bottom section of the throat where it ends at the top of the trachea and esophagus.
  • Hypopharyngeal cancer may develop in one or more areas of the hypopharynx and are caused by:
    • Smoking
    • Chewing tobacco
    • Excess alcohol intake
    • Consumption of non-nutritious diet (such as vitamin deficiencies)
    • Plummer–Vinson syndrome (web-like growth of membranes in the throat, making it difficult to swallow, commonly associated with iron deficiency anemia)
  • Apart from squamous cell carcinoma, other types of cancers may be developed in the hypopharynx, they include:
    • Minor salivary gland cancer
    • Sarcomas (particularly chondrosarcoma)

Cancer in different parts of the larynx

• Glottic cancer
  • Glottis is the middle part of the larynx that contains vocal cords.
  • An individual with glottic cancer may find it difficult to perform important activities that include:
    • Breathing
    • Swallowing
    • Producing speech
• Supraglottic and subglottic cancers
  • Supraglottis is the upper region of the larynx above the vocal cords. Subglottis is the lower part of the larynx below vocal cords and above the trachea.
  • Cancerous development in these regions is referred to as supraglottic or subglottic carcinoma.
  • Although supraglottic and subglottic carcinoma is caused by a combination of hereditary and environmental factors, the exact cause is not known.
  • The most significant risk factors of developing supraglottic or subglottic carcinoma include:
    • Tobacco use
    • Alcohol use
    • Other types of laryngeal carcinomas include:
    • Lymphoma
    • Neuroendocrine tumors
    • Plasmacytomas

How to diagnose throat cancer

Early detection of cancer generally leads to more successful treatment choices. Some early malignancies may have detectable signs and symptoms; however, this is not always the case.

• Physical examination
  • An examination of the body to identify general indicators of health, including illness symptoms, such as enlarged lymph nodes in the neck or anything else that appears strange. 
  • To check for abnormal regions, the medical doctor or dentist does a thorough examination of the mouth and neck, including a look under the tongue and down the throat using a tiny, long-handled mirror.
  • A history of the patient's health habits, as well as previous diseases and treatments, will be collected.
• Laryngoscopy examination
  • A laryngoscope is a special device with a light and lens that is inserted into the throat to examine the larynx.
  • It collects some samples from the throat for a histopathology examination.
• Biopsy
  • This is a process where a fine needle is injected into the area to extract tissue. The collected samples are studied by a pathologist under a microscope to rule out malignancy.
• Human papillomavirus (HPV) test
  • If the cells are found to be cancerous, they undergo tests to detect the presence of the infection-causing virus HPV 16.
  • HPV infection is one of the leading causes of oropharyngeal cancer and cancer caused by HPV has a good prognosis when appropriate treatment is administered.

Radiological imaging

• Computed tomography (CT) scan
  • This test takes a sequence of detailed photographs from various perspectives of places within the body, such as the head, neck, chest, and lymph nodes.
  • A computer coupled to an X-ray machine creates the images.
  • A dye could be injected into a vein or ingested before the test to make the organs or tissues show up more clearly.
• Positron emission tomography (PET) scan
  • A radioactive sugar will be injected before the scan.
  • The PET scanner moves around the body, capturing images of where glucose is utilized in the body.
  • The cancer cells take up the glucose actively than normal cells. So, the area that appears bright in the image indicates the presence of cancer.
• PET-CT scan
  • A PET-CT scan can be used to identify cancer, plan treatment, or determine how well treatment is working.
  • This is a process that combines images from positron emission tomography (PET) with CT. 
  • The PET and CT scans are performed on the same equipment at the same time.
  • The combined scans provide more comprehensive images of locations inside the body than either scan alone.
• Magnetic resonance imaging (MRI)
  • An MRI uses both magnetic and radio waves to generate a sequence of detailed images of different locations within the body.

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How is the staging of throat cancer done?

Based on the American Joint Committee on Cancer (AJCC) system, throat cancer is classified into five stages depending on the biopsy and radiological images.

The staging helps determine the prognosis as well as the treatment modality, such as:

• Surgery
• Radiation therapy
• Chemotherapy

Throat cancer is classified into these five stages:

1. Stage 0: This is the initial stage of developing cancer, where the lining of the throat is found to have aberrant cells, which have the potential to develop into cancer cells. This is also referred to as carcinoma in situ.
2. Stage I: This is referred to as a very early stage of cancer. The formed cancerous tumor is not more than 2 cm in diameter, and there is no spread of cancerous cells to the lymph node.
3. Stage II: The tumor size increases beyond 2 cm but not more than 4 cm. The cancer cells have not spread to the lymph nodes.
4. Stage III: The size of the cancerous lump may become larger than 4 cm, or there may be a spread of cancer cells to lymph nodes on the same side of the neck. However, the lymph node size is less than 3 cm.
5. Stage IV: The more advanced throat cancer comes under stage IV. The size of the tumor is not considered if there is a presence of spread of cancer to distant locations.
   • Spread to the neck, trachea, thyroid, esophagus, jaw, and mouth
   • One lymph node larger than 3 cm on the same side of the tumor
   • Multiple lymph nodes of various sizes on the same side of the tumor
   • One lymph node of any side on the opposite side of the tumor
   • Spread to distant parts of the body, beyond the throat, such as the lung, liver, or bone

What are the treatment options for throat cancer?

The treatment modality is based on several factors, such as:

• Location of the cancer
• Stage of the cancer
• Involvement of human papillomavirus
• Overall health status

Surgery

Surgery for throat cancer depends on the location and stage of cancer.

• Removal of cancerous tissue from small throat cancers that have no lymph node involvement.
• Laryngectomy: Removal of the complete or part of the larynx.
• Pharyngectomy: Removal of a small part of the throat.
• Neck dissection: Removal of all affected lymph nodes in the neck.

Various advanced surgical techniques and sophisticated technology are used to eliminate cancer from the body, they include:

• Minimally invasive or endoscopic surgery: The tumor is removed through the mouth with the use of an endoscope. This is a minimally invasive technique where no disturbance to the vocal cords is done, and so, the speech is unaltered. The swallowing ability is improved.
• Transoral laser microsurgery (TLM): Surgeons use a flexible fiber to remove tumors that were very small and inaccessible earlier. There will be minimal injuries to the surrounding tissues.
• Transoral robotic surgery (TORS): The cancer tissue is removed by a robot-assisted surgery with the help of a three-dimensional visualization on the computer. This helps reach small spaces without extensive incisions to reach the tumor.
• Supracricoid partial laryngectomy: This is an advanced technique used to remove supraglottic and vocal cord tumors without the need for removal of the vocal cords. Here, the tumor is removed while retaining part of the vocal cords for speech.

Radiation therapy

The cancer cells are destroyed with the use of high-energy beams, such as X-rays and protons.

There are two types of radiation therapy:

1. External beam radiation: A machine that emits these rays are placed close to the body.
2. Brachytherapy: Small radioactive seeds and wires are placed inside the body near the tumor.

Chemotherapy

Special drugs are injected into the body that has the potency to kill the cancer cells. Both chemotherapy and radiation therapy may be administered simultaneously to treat throat cancer.

Target drug therapy

Targeted drugs are special drugs that stop the growth of cancer cells by targeting defects in the cells. Targeted drugs may be administered as pills or infused into the body and are used alone or in combination with chemotherapy and radiation therapy.

Immunotherapy

The cancer cells produce a special protein that protects them from the immune system. Immunotherapy interferes with that process and increases the fighting capacity of the immune system against cancer cells in the body.