Throat cancer

Symptoms Of Throat Cancer 

The signs of throat cancer may differ based on the particular site and stage of the disease.

Common symptoms may include:

• Persistent sore throat 

• Hoarseness or change in voice

• Difficulty in swallowing

• Persistent cough

• Ear pain

• Nasal congestion

• Lumps in the neck and throat

• Unexplained weight loss

Additional symptoms of throat cancer, often seen in advanced stages, may include: 

• Coughing up phlegm tinged with blood

• Persistent sensation of throat obstruction

• Throat pain

• Breathing difficulties or shortness of breath

• Swollen lymph glands

• Gastrointestinal issues, including excessive reflux (GERD), diarrhea, or constipation

 
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Types of Throat Cancer

Throat cancer can be categorized based on the part of the throat affected, i.e pharynx (that includes the nasopharynx, oropharynx, and hypopharynx) or the larynx:

1. Nasopharyngeal: This type of cancer occurs in the nasopharynx, the upper part of the throat behind the nose. 

2. Oropharyngeal cancer: This cancer affects the oropharynx, which includes the base of the tongue, tonsils, soft palate, and the walls of the pharynx. 

3. Hypopharyngeal cancer: This rare type of cancer originates in the hypopharynx, the lower part of the throat that surrounds the larynx and esophagus (the muscular tube connecting the throat to the stomach).

4. Laryngeal cancer: Laryngeal cancer develops in the larynx, commonly known as the voice box. 

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Causes Of Throat Cancer

The cause of throat cancer is generally attributed to genetic mutations in the cells of the throat, which lead to uncontrolled cell growth and the formation of tumors. 

Here's an overview of the processes involved in cancer:

• DNA, the hereditary material, controls the behaviour, growth, division, and death of cells.

• Certain genes regulate the timing of cell growth, division, and death, such as:

• Oncogenes promote cell growth, division, and survival.

• Tumor suppressor genes control cell division and initiate cell death when necessary.

Throat cancer can result from DNA mutations that activate oncogenes or deactivate tumor suppressor genes, leading to uncontrolled cell growth and abnormal mass formation in the throat.

Cancer has a dual connection with our genes

Firstly, there are inherited gene mutations that are transmitted through families. Secondly, acquired gene mutations develop over an individual's lifetime. 

Risk Factors For Throat Cancer

The exact causes of throat cancer are not always clear, but certain risk factors can increase the likelihood of developing this type of cancer. The primary risk factors and causes associated with throat cancer include:

1. Tobacco use

Smoking and chewing tobacco increase throat cancer risk, with higher danger from prolonged and heavy use.

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2. Alcohol consumption

Heavy and prolonged alcohol consumption is a known independent risk factor for throat cancer.

Note: The risk is further amplified when combined with smoking, reaching up to 177 times compared to non-smokers and non-drinkers.

3. Viral infections

• Human Papillomavirus (HPV) infection: Infection with certain strains of HPV, particularly HPV-16 and HPV-18, has been linked to an increased risk of oropharyngeal cancer, which affects the tonsils, base of the tongue, and soft palate.
  
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• Epstein-Barr Virus (EBV): EBV is a known contributor to the development of nasopharyngeal cancer.

4. Age and gender

The risk of throat cancer increases with age, and men are more likely to develop throat cancer.

5. Gastroesophageal Reflux Disease (GERD)

Chronic acid reflux, which can damage the lining of the esophagus, may increase the risk of developing cancer of the lower throat or esophagus.

6. Poor oral hygiene

It can increase the risk of throat cancer by allowing harmful bacteria to thrive. 

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7. Occupational exposure

Certain occupational exposures to carcinogens, such as asbestos, nickel, and other industrial substances, can heighten the risk of throat cancer. 

8. Genetic factors

While rare, there may be a genetic predisposition to throat cancer in some cases.

9. Obesity

Excess weight increases throat cancer risk, making healthy weight management essential for prevention.

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Diagnosis Of Throat Cancer

The diagnosis of throat cancer involves a comprehensive approach, including:

1. Medical history and physical examination

• The doctor will begin by taking a detailed medical history, including information about symptoms, risk factors, and any relevant family history.

• A thorough physical examination of the throat, neck, and surrounding areas will be conducted to identify any abnormalities, such as lumps or changes in tissue.

2. Imaging studies

Imaging tests help determine the extent of the cancer and whether it has spread to other areas. Common imaging studies include:

• CT scan (Computed tomography): Provides detailed cross-sectional images of the throat and surrounding structures.

• MRI (Magnetic resonance Imaging): Produces detailed images that can help evaluate the extent of tumor involvement.
  
  

• PET-CT scan (Positron Emission Tomography with Computed Tomography): Helps identify areas with increased metabolic activity, indicating possible cancer spread.
  
  

• Barium swallow: It involves swallowing a contrast material containing barium to visualize the upper gastrointestinal tract during X-rays. It can reveal abnormalities in various throat regions, often identifying small, early-stage tumors.

• X-ray: Conducting an X-ray of the chest helps assess potential lung metastasis. Lung involvement typically indicates advanced cancer.
  
  

• Bone scan:  A low-dose radioactive material is injected to detect cancer-related bone damage. This scan helps check if cancer has spread to the bones.

3. Biopsy

Tissue samples obtained during endoscopy or other procedures are sent to a pathologist for examination. There are three main types:

• Endoscopic biopsy: A lighted instrument called an endoscope is used to visualize and sample abnormal areas in the throat.
  
  
• Incisional biopsy: Small tissue pieces are cut from abnormal areas, often requiring surgery in an operating room with general anesthesia.
  
  
• Fine needle aspiration (FNA cytology): A thin needle is used to extract cells from tumors or lumps.
  

4. Endoscopy

This involves the use of a flexible tube with a light and camera (endoscope) to examine the inside of the throat.

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5. Additional tests

• Blood Tests: Certain Blood tests such as complete blood count, thyroid stimulating hormone (TSH), international normalized ratio (INR) etc. can detect certain infections, or monitor the effects of treatment. 

• Genetic testing (Genome testing): This test assesses tumor cells for genetic mutations associated with the specific cancer type. It provides insights for personalized treatment strategies.

• HPV testing for throat cancer: Particularly relevant in HPV-positive cases, this test facilitates the development of customized treatment plans with reduced intensity and minimized side effects.

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Prevention Of Throat Cancer

Preventing throat cancer involves adopting a proactive approach through lifestyle choices and protective measures. Here are key strategies to help reduce the risk of developing throat cancer:

1. Stay clear from all forms of tobacco

• Avoid all forms of tobacco, including cigarettes, cigars, and chewing tobacco.
• Avoid exposure to secondhand smoke.

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2. Drink alcohol in moderation

Reduce your risk of abstaining from alcohol or limit it to one drink per day for women and up to two drinks per day for men. 

3. Be mindful of what you eat

What to eat

• Fresh fruits and vegetables for their antioxidants and nutrients.

• Consume citrus fruits like oranges, grapefruits, and lemons.

• Incorporate fish oil, and flaxseeds for their omega-3 fatty acids.

What to avoid/limit

• Processed and red meat intake.

• Packaged, processed and junk food options.

• Sugary items like cakes, muffins, soda and packaged beverages.

• Unhealthy fats, such as saturated and trans fats.

4. Add probiotics to your diet

Probiotics, live microorganisms offering health benefits, are known to exhibit a protective effect against cancer cell activity. Kimchi, kombucha, yogurt, cheese and kefir, are examples of rich sources of probiotics.

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5. Maintain a healthy weight

Achieve healthy weight through a healthy diet and regular exercise to reduce this risk.

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6. Get regular dental checkups

Regular dental examinations can help detect and address oral health issues early, reducing the risk of throat cancer.

7. Practice safe sex 

Practising safe sex and limiting the number of sexual partners can reduce the risk of HPV transmission. 

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8. Get vaccinated against HPV

Consider getting the HPV vaccine as it helps protect against certain high-risk strains of HPV that are linked to throat and other cancers.

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Doctor To Visit

Cancer is a group of related diseases, necessitating comprehensive care. The healthcare professionals are responsible for diagnosing and planning treatment for throat cancer patients are:

• Dentists
• Otolaryngologists (ENT specialist)
• Oncologists
• Radiation oncologists
• Medical oncologists
• Dieticians
• Speech therapists

A dentist may assist in the detection of throat cancer by identifying oral symptoms, examining abnormalities in the mouth and throat, and referring patients for further evaluation and treatment.

An otolaryngologist is a medical professional specializing in conditions affecting the ears, nose, and throat.

An oncologist specializes in diagnosing and treating cancer cases. A radiation oncologist employs radiation therapy to treat cancer, while a medical oncologist utilizes chemotherapy and other medications in the cancer treatment process.

A dietician can help manage nutritional challenges during treatment, ensuring patients receive adequate nutrients to maintain strength and aid in recovery.

A speech therapist assists throat cancer patients in preserving or regaining speech and swallowing abilities.

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Treatment Of Throat Cancer

The treatment of throat cancer depends on various factors, including the type and stage of the cancer, as well as the patient's overall health. Here is an overview of the common treatment modalities:

1. Surgery

If the tumor is of significant size, surgery might be advised for its removal. The specific surgical approach will be determined by the cancer's location. Various surgical approaches include:

• Laser surgery: Early-stage tumors may be treated with laser surgery, a minimally invasive procedure that uses a laser beam to remove or vaporize cancerous tissue. 
  
  
• Cordectomy: Part or all of the vocal cords are removed, suitable for small or surface-level glottic cancers. Speech changes may occur, ranging from hoarseness with partial removal to the loss of speech if both vocal cords are removed.
  
  
• Minimally invasive or endoscopic surgery: It involves the removal of entire tumors through the mouth, eliminating the need for external incisions and minimizing impacts on speech and swallowing functions.
  
  
• Vocal cord stripping: When cancer or pre-cancer is limited to the surface of the vocal cords, this surgical procedure removes the cancer and superficial layers of tissue. After this operation, most individuals can regain normal speech.
  
  
• Partial laryngectomy: In cases where the cancer is confined to a specific part of the larynx, a portion of the larynx may be removed while preserving vocal function.
  
  
• Total laryngectomy: In advanced cases, the entire larynx may need to be removed, necessitating lifestyle adjustments and potentially impacting speech and breathing. Reconstructive surgery may be performed to restore some functions.
  
  

2. Chemotherapy

Following throat cancer surgery, chemotherapy may be employed to eradicate any remaining tumor cells. It involves the administration of drugs that circulate throughout the body, targeting and eliminating cancer cells. 

Often, it is combined with radiation therapy in a treatment approach known as chemoradiation, aiming to enhance overall effectiveness.

Drugs used for chemotherapy include:

• Carboplatin 
• Paclitaxel 
• Oxaliplatin 
• Capecitabine
• Docetaxel 
• Cisplatin
• 5-fluorouracil (5-FU)
  
  

3. Radiation therapy

• External beam radiation: High-energy beams are directed at the cancer from outside the body to destroy cancer cells. This can be the primary treatment or used post-surgery to eliminate residual cancer cells.
  
  
• Internal beam radiation (Brachytherapy): Radioactive sources are placed directly into or near the tumor, delivering targeted radiation. It is often used in combination with external beam radiation.
  
  

4. Targeted therapy

• In this therapy, targeted drugs may be used in combination with radiation therapy or chemotherapy for certain cases of laryngeal and hypopharyngeal cancers. 

• It targets specific molecules involved in cancer growth. 

• Cetuximab is the most commonly used drug.
  
  

5. Immunotherapy

• Immunotherapy enhances the body's immune system, enabling it to identify and eliminate cancer cells. 

  Drugs used are:

  • Pembrolizumab

  • Nivolumab

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6. Proton therapy

• It involves using proton beams to precisely target tumors, minimizing damage to surrounding healthy tissue. 

• It offers a more targeted and potentially less damaging radiation treatment option compared to traditional radiation therapies.

Complications Of Throat Cancer

Throat cancer, like any form of cancer, can lead to various complications, depending on factors such as the stage of cancer, its location, and the chosen treatment. Some common complications associated with throat cancer include:

• Voice changes: This can range from hoarseness to a complete loss of voice depending on the location of the cancer, particularly if the larynx (voice box) is affected.

• Difficulty swallowing or speaking: Throat cancer, depending on its stage and location, can impair the normal function of the throat and vocal cords.

• Malnutrition: Difficulty swallowing and changes in taste can contribute to malnutrition.

• Infections: Weakened immune defenses from cancer treatments can make patients more susceptible to infections, including respiratory and oral infections.

• Airway obstruction: It may occur due to the tumor's growth, leading to breathing difficulties and potentially necessitating interventions like a tracheostomy to maintain an open airway.

• Oral mucositis: It is inflammation and ulceration of the mucous membranes lining the oral cavity. It is a common side effect of radiation therapy and chemotherapy.

• Tissue fibrosis: It is the scarring of healthy tissues in the throat that can result from radiation therapy leading to reduced flexibility, impaired function, and complicating swallowing and speaking.

• Reduced salivation: This is reduced saliva production, often due to radiation therapy, which can lead to dry mouth increasing the risk of dental issues.

• Disfigurement: Surgical procedures, radiation, and the progression of the disease itself can result in changes to facial appearance, causing emotional distress and impacting a patient's self-esteem.

Alternative Therapies For Throat Cancer

Complementary and alternative therapies can be considered alongside conventional medical treatments for throat cancer after consultation with your medical team. It is important to note that these should not replace the conventional treatment. Some common therapies include:

1. Acupuncture

• It involves the insertion of needles through the skin at specific points on the body. 

• Acupuncture has proven to be a successful alternative therapy form for patients who have cancer that can ease symptoms such as nausea and vomiting, which are common side effects of cancer treatments.

2. Aromatherapy

It utilizes essential oils to alleviate pain, nausea, stress, and sleep difficulties during cancer treatment, promoting relaxation and comfort.

3. Hypnosis

It is conducted by a therapist, and utilizes relaxation exercises to encourage positive thoughts and reduce nausea and  anxiety in cancer patients.

4. Relaxation exercises

Techniques like breathing exercises, meditation, and mindfulness improve pain perception, reduce stress, and enhance overall mental well-being.

5. Yoga 

• Yoga enhances physical well-being, fostering flexibility, strength, and balance. 

• It provides emotional support through mindfulness and meditation, helping manage stress and anxiety. 

• Additionally, it may alleviate symptoms like fatigue and nausea, contributing to holistic healing.

6. Exercise

Regular exercise enhances mood by releasing endorphins (feel-good hormones) and supports overall immune function during cancer treatment. 

7. Music therapy

Music can be therapeutic and help in promoting healing and improving one's quality of life.

8. Tai chi

• It is a mind-body system that improves health and well-being through movement, meditation, and breathing. 

• It has been shown to help some people improve their strength and balance, alleviating cancer symptoms.

Living With Throat Cancer

Living with throat cancer presents challenges, but with proper support, medical care, and lifestyle adjustments, individuals can lead fulfilling lives. Here are practical tips for coping:

Follow your doctor’s instructions on medications

• Use prescribed numbing agents

• Take pain medicine as directed

• Follow antibiotic prescriptions for infections
  
  

Follow post-surgery diet guidelines

• Opt for small, nutrient-dense meals post-esophageal cancer surgery.

• Gradually increase portion sizes.

• Chew thoroughly, eat slowly, and limit liquid intake during meals.

• Embrace a high-calorie, protein-rich diet for optimal nutrition.
  
  

Take care of your mouth and throat

• Rinse with salt water 

• Avoid alcohol-based mouthwashes

• Stay hydrated with water and sugarless options

• Use a straw for tender areas

• Keep lips moist and maintain oral hygiene

• Inform your dentist about cancer treatment.
  
  

Focus on nutrition 

• Maintain good nutrition during cancer treatment to prevent infection, fight infection, and aid in healing.

• Avoid raw or undercooked meats, raw seafood, and unpasteurized products

• Choose pasteurized dairy and thoroughly washed, cooked, or peeled fruits and vegetables

• Practice safe food handling and hygiene to prevent bacterial contamination

• Stay hydrated with liquids that meet safety standards, such as pasteurized juices and boiled or filtered water

• If unable to eat enough, inquire about nutrition supplements and liquid meal replacements from your doctor.

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Get speech and swallowing therapy (Rehabilitation therapy)

• Work with therapists to improve speech and swallowing.

• Follow recommended exercises and strategies to enhance communication and manage swallowing abilities, neck stiffness, and pain.
  
  

Work on restoring your sense of smell after laryngectomy

• Loss of smell post-laryngectomy is common due to altered airflow

• Olfactory (sense of smell) rehabilitation techniques, polite yawning, can be learned to potentially recover your sense of smell
  
  

Go for regular follow-ups and screening

• Stay proactive in managing your health and promptly address any new symptoms or concerns.

• Attend regular follow-up appointments to monitor your health and detect any potential recurrence or long-term effects of treatment.
  
  

Regular tests are generally performed:

• Every 1 to 3 months during the first year

• Every 2 to 6 months during the second year

• Every 4 to 8 months during the 3rd to 5th years

• Every year after the 5th year
  
  

Manage the Cost of Cancer Care

• Cancer care expenses can be substantial, causing stress.

• Unplanned costs may hinder sticking to the treatment

• Discussing financial concerns with the health care team is encouraged for comprehensive support and well-being.

Cope with emotional and social effects

• A cancer diagnosis brings emotional stress, such as sadness and anxiety. 

• Coping strategies, including professional support and effective communication with loved ones, can help navigate these emotional challenges.

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