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, diarrhea, or constipation

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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:

1. DNA, the hereditary material, controls the behavior, growth, division, and death of cells.
2. 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.

Note: Cancer has a dual connection with our genes. Firstly, there are inherited gene mutations that are transmitted through families. Secondly, there are acquired gene mutations that develop over an individual's lifetime.

Explore genetic testing for comprehensive cancer risk assessment and personalized treatment strategies.

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:

• Tobacco use: Smoking tobacco (cigarettes, cigars, pipes) and chewing smokeless tobacco (tobacco, snuff). The risk is influenced by the duration and intensity of tobacco use.
• Alcohol consumption: Heavy and prolonged alcohol consumption is a known independent risk factor for throat cancer. The risk is further amplified when combined with smoking, reaching up to 177 times compared to non-smokers and non-drinkers.
• 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.
  • Epstein-Barr Virus (EBV): EBV is a known contributor to the development of nasopharyngeal cancer.
• Age and gender: The risk of throat cancer increases with age, and men are more likely to develop throat cancer.
• Poor dietary choices: A diet low in fruits and vegetables may elevate the risk of throat cancer. Inadequate intake of essential vitamins and minerals may compromise the body's ability to repair cell damage.
• 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.
• Poor oral hygiene: Chronic irritation of the throat due to poor oral hygiene or the use of irritating substances may contribute to the development of throat cancer.
• Occupational exposure: Certain occupational exposures to carcinogens, such as asbestos, nickel, and other industrial substances, can heighten the risk of throat cancer.
• Genetic factors: While rare, there may be a genetic predisposition to throat cancer in some cases.
• Obesity: Being overweight is a specific risk factor for throat cancer, as excess body weight is associated with an elevated susceptibility to developing this particular form of cancer. Maintaining a healthy weight is essential in reducing the risk of throat cancer.

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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: Involves swallowing a contrast material containing barium to visualize the upper gastrointestinal tract during X-rays, revealing 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, which typically indicates advanced cancer.
   • Bone scan: Involves injecting a low-dose radioactive tracer into the veins to detect cancer-related bone injuries. This imaging technique is recommended when there are indications that the cancer may have 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. Types include:

   • Panendoscopy, or upper endoscopy: Involves a thorough examination of the upper digestive system, including the larynx, esophagus, stomach, and small intestine for cancer using endoscopes.
   • Laryngoscopy: Done to visually examine the larynx (voice box) using a flexible or rigid scope, allowing for the detection and evaluation of abnormalities and tumors.
   • Pharyngoscopy: Done to check for abnormalities of the throat using a flexible or rigid scope.
   • Videostroboscopy: A fiber optic video technique similar to indirect laryngoscopy, aiding in identifying tumor location, size, and impact on laryngeal function, enabling early detection of potential changes before they become visible.
5. Additional tests
   • Blood Tests: Certain blood tests, such as complete blood count, thyroid stimulating hormone (TSH), and international normalized ratio (INR), can detect infections or monitor the effects of treatment. They provide valuable information about a patient's overall health and may contribute to the overall assessment of their condition.
   • Genetic testing (Genome testing): This test assesses tumor cells for genetic mutations associated with the specific cancer type, providing 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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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:

• Stay clear from all forms of tobacco:
  • Avoid all forms of tobacco, including cigarettes, cigars, and chewing tobacco.
  • Avoid exposure to secondhand smoke.
• Drink alcohol in moderation: Excessive and prolonged alcohol consumption is a known risk factor for throat cancer. Abstain from alcohol or limit it to one drink per day for women and up to two drinks per day for men. Note: A drink means a 5-ounce glass of wine, a 12-ounce beer, or a 1.5-ounce shot of spirits.
• Be mindful of what you eat: A well-balanced diet of foods rich in antioxidants and essential nutrients may contribute to a lower risk of cancer. What to eat:
  • Fresh fruits and vegetables for their antioxidants and nutrients.
  • Include tomatoes for their lycopene content.
  • 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.
• 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. You can also choose to take probiotic supplements.
• Maintain a healthy weight: Obesity increases the risk of throat cancer. Maintaining a healthy weight through a balanced diet and regular exercise can help reduce this risk.
• Get regular dental checkups: Regular dental examinations can help detect and address oral health issues early, reducing the risk of throat cancer.
• Practice safe sex: Practicing safe sex and limiting the number of sexual partners can reduce the risk of HPV transmission. While condom use is recommended, it does not provide complete protection against HPV.
• 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.

Are you at high risk of developing throat cancer? Specific drugs like tamoxifen, raloxifene, and finasteride have been shown to reduce the risk of developing cancer or prevent its recurrence.

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 a 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: This 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. Checkpoint inhibitors, a type of immunotherapy, may be used to block proteins that prevent immune cells from attacking cancer cells. Drugs used are:
   • Pembrolizumab
   • Nivolumab
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.

Note: Rehabilitation and supportive therapies are vital in treatment, mitigating side effects, and improving the patient's quality of life.

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.

Complementary and alternative therapies can be considered alongside conventional medical treatments for throat cancer after consultation with your medical team. Some complementary therapies may include:

• Acupuncture: Involves the insertion of needles through the skin at specific points on the body. Acupuncture has proven to be a successful alternative therapy for patients with cancer, easing symptoms such as nausea and vomiting, which are common side effects of cancer treatments.
• Aromatherapy: Utilizes essential oils to alleviate pain, nausea, stress, and sleep difficulties during cancer treatment, promoting relaxation and comfort.
• Hypnosis: Conducted by a therapist, this method utilizes relaxation exercises to encourage positive thoughts and reduce nausea and anxiety in cancer patients.
• Relaxation exercises: Techniques such as breathing exercises, meditation, and mindfulness improve pain perception, reduce stress, and enhance overall mental well-being. Invest 10-15 minutes daily in meditation to safeguard against diseases or enhance disease management.
• 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.
• Exercise: Regular exercise enhances mood by releasing endorphins and supports overall immune function during cancer treatment. Brisk walking has been found to reduce the risk of further complications in individuals fighting cancer.
• Music therapy: Music can be therapeutic and help promote healing, improving one's quality of life.
• Tai chi: A mind-body system that improves health and well-being through movement, meditation, and breathing. It has been shown to help some individuals improve their strength and balance, alleviating cancer symptoms.

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:

1. Follow your doctor’s instructions on medications
   • Use prescribed numbing agents
   • Take pain medicine as directed
   • Follow antibiotic prescriptions for infections
2. 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
3. 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
4. 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
5. 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
6. Work on restoring your sense of smell after laryngectomy
   • Loss of smell post-laryngectomy is common due to altered airflow
   • Olfactory rehabilitation techniques, such as polite yawning, can be learned to potentially recover your sense of smell
7. 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

Physical, emotional, and social effects of cancer: Coping and Remissions

1. Coping with Physical Side Effects
   • Throat cancer and its treatments can lead to various physical challenges, including changes in sexual health
   • Discuss these effects with your health care team to manage and alleviate discomfort
   • Tracking side effects can aid discussions with the healthcare team, especially regarding potential long-term or late effects after treatment concludes
2. Coping with the Costs of Cancer Care
   • Cancer care expenses can be substantial, causing stress
   • Unplanned costs may hinder treatment adherence
   • Discussing financial concerns with the health care team is encouraged for comprehensive support and well-being
3. Coping 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
   • It is crucial to manage emotions with the support of your family or friends. You can find help with support groups as well