Throat Cancer: Types, Symptoms, Causes, Diagnosis, Treatment & Prevention

Throat cancer definition 

Throat cancer refers to cancer that begins in the pharynx or larynx but and refers to cancer that starts in the esophagus (food pipe). Most of the throat cancers are squamous cell carcinoma (cancer that begin in thin, flat cells). There are two main types of throat cancer; one is pharyngeal cancer and the other is laryngeal cancer; these two types have several subtypes. Symptoms commonly include persistent sore throat, hoarseness, trouble swallowing, and lumps in the neck. 

There is no exact known cause of throat cancer but there are several factors increases the risk such as excessive smoking, alcohol consumption, infection with human papillomavirus (HPV), Epstein Barr virus (EBV), poor diet, and family history of cancer which increases the risk of developing throat cancer. Surgical oncologists and radiation oncologists can treat throat cancer.

Throat cancer meaning

The term “throat cancer” consists of two words 

The term “throat” is derived from the Middle English word “throte" which means the front region of the neck or the jugular region of the body. 

The term “cancer” is taken from the Greek word “karkinos” which, like the Modern English word, has three meanings: a crab, a tumor, and the zodiac constellation which is represented by a crab. It is also derived from the Old English word “cancer " meaning a spreading sore or malignant tumor.

Throat cancer statistics

Throat cancer statistics in India

As per estimates of GLOBOCAN 2020, there will be about 21 lakhs of new cancer cases by 2040, an increase of 57.5 percent from the year 2020 in India. Head and neck cancer (HNC) contributes about 30 percent of all cancer cases. The age-standardized incidence rate of head and neck cancers was 25.9 and 8.0 per 100,000 population, respectively, for males and females.

Types of throat cancer

The throat primarily has two main parts: the pharynx and the larynx. Cancer of the throat can begin in either in the pharynx or larynx. The type of throat cancer depends on the type of cell in which it is originates:

Pharyngeal cancer

Pharynx is a thin muscular tube that extends from the back of the nose and mouth to the trachea. The cancer that begins or originates in the pharynx is called pharyngeal cancer. The pharynx has three main sections: 

• Nasopharynx: It is the upper part of the pharynx where the throat connects to the mouth and nose. Cancer which originates in the nasopharynx is termed as nasopharyngeal cancer.
  
• Oropharynx: It is the middle part of the pharynx which includes tonsils where the throat meets the oral cavity. Cancer, which originates in the oropharynx is termed oropharyngeal cancer.
  
• Hypopharynx: It is the bottom or end part of the pharynx where the throat meets the windpipe. Cancer originating in the hypopharynx is called hypopharyngeal cancer. 

Throat cancer can begin in any part of the pharynx, but the most common area of throat cancer development is the oropharynx. Hypopharyngeal and nasopharyngeal cancer are rare forms of throat cancer. 

Laryngeal cancer

It is the part of the throat between the base of the tongue and the windpipe. It is termed as a voice box as it has vocal cords in it. The cancer that begins in the larynx is termed laryngeal cancer. It has three main sections:

• Supraglottis: It is the upper portion of the larynx which is above the vocal cords including the epiglottis.
  
• Glottis: It is the middle portion of the larynx where the vocal cords are located. 
• Subglottis: It is the lower portion of the larynx situated between the vocal cords and the windpipe.
  

Causes of throat cancer

There is no exact known cause of throat cancer but there are a few factors which can increase the likelihood of developing throat cancer, and these factors depend on the type of throat cancer.

Throat cancer symptoms

Symptoms of throat cancer may differ based on the location of the cancer. Asymmetrical tonsils, persistent sore throat, difficulty in swallowing, and a lump in the neck are some of the initial symptoms of throat cancer. The following are some of the signs and symptoms of throat cancer: 

Sore throat

The pain or discomfort in the throat is the most common symptom of throat cancer and this pain doesn’t go away. 

Voice changes

Throat cancer may affect the voice of the patient, the voice might sound different and may be quieter, husky, or sound as if the patient has cold all the time. The patient may slur some words or may have trouble pronouncing certain sounds.

Trouble swallowing

Pain or burning sensation may be felt in throat cancer patients when chewing and swallowing food. The patient may feel like the food has stuck in the throat. 

A lump in throat

Due to enlarged lymph node a lump in throat may develop. Swelling or inflammation in one or more lymph nodes in the neck region is the most common symptom of throat cancer, as well as other cancers of the head and neck.

Weight loss

In different types of cancer, weight loss is the most common symptom. Throat cancer makes it difficult for the patient to eat and swallow, which can gradually lead to weight loss.

Other symptoms of throat cancer:

• Trouble in opening the mouth
• Trouble in moving the tongue
• White patches on the tongue or the lining of the mouth 
• Nose bleeds 
• Headaches
• Throat pain

Throat cancer risk factors

There is no known cause of throat cancer but there are a few factors that can increase the risk of developing throat cancer. A risk factor is anything which can increase the likelihood of developing a disease or a condition. The following are some of the risk factors for throat cancer: 

Smoking or chewing tobacco

Tobacco chewing and smoking are the major risk factors of throat cancer. The chemicals found in the tobacco are carcinogenic, it increases the risk of throat cancer. When inhaled the chemicals present in cigarette gets introduced into throat and voice box. 

Heavy alcohol consumption

With excessive alcohol consumption the risk of throat cancer increases. Alcohol converts to acetaldehyde in the body which can bind to DNA and damages. The damaged DNA can grow uncontrollably and causes cancer. 

Human papillomavirus (HPV)

These are a group of over 150 related viruses. They are termed as papillomaviruses as some of them result in a type of growth called a papilloma, also known as a wart. Human papillomavirus infection is a rare risk factor for cancers of throat.

Epstein-Barr virus (EBV)

This is a common human virus; it can increases the risk of development of throat cancer particularly nasopharyngeal cancer. It doesn’t normally cause any symptoms But, in rare cases, it can cause genetic changes in cells which make them more likely to become cancerous. 

Family history of cancer

In individuals whose family member such as parent, siblings, or child having a history of throat cancer are at an increased risk of developing throat cancer. 

Poor diet

A diet which is rich in red meat, processed food and deep-fried food increases the risk of developing throat cancer. Diet which includes plenty of fruits, green vegetables, and omega 3 fatty acid decrease the risk of cancer development. 

Chronic goitre (enlargement of the thyroid gland)

An enlarged thyroid gland can increase the risk of throat cancer. Usually, a simple goiter is not cancerous but a goiter, particularly one with nodules, increases the risk of developing cancerous cells within the thyroid gland. 

Being overweight or obese

Obesity or overweight is associated with numerous cancers, and they are common and modifiable risk factor. Excess fat in the body affects certain processes such as imbalance of hormones, all this can increase the risk of cancer by affecting how and when cells divide and die.

Throat cancer complications

Complication refers to an unfavorable result or event associated with a disease condition. There is always a risk of complications following a disease condition. The following are some of the complications of throat cancer:

Airway obstruction

Cancer by growing directly into the airway passages of the throat (into the larynx and pharynx) blocks the flow of air. This blockage of air flow can lead to symptoms of difficulty in breathing and coughing. 

Difficulty in swallowing

The tumor present in the throat narrows the space and prevents the smooth movement of food down the esophagus. This narrowing caused by the tumor results in blockage, leading to pain and difficulty swallowing. 

Disfigurement of neck or face

In throat cancer patients undergo surgery or chemotherapy, a number of changes in appearance or disfigurement can happen. This can happen because an oncologist removes the tumor first, then uses bone, skin and muscle grafts to restore function and appearance.

Hardening of the skin of the neck

When the cancer spreads to the lymph nodes it causes a lump to develop which hardens the skin on the neck. 

Loss of voice and speaking ability

Throat cancer damages the larynx or the nerves that controls the larynx. This damage to the larynx results in a loss of voice or speaking ability. While treating throat cancer patients, chemotherapy can also damage the larynx. 

Spread of cancer to other body areas (metastasis)

Generally, throat cancer originates in the throat. As cancer malignancy progresses, tumors grow larger and cancerous cells can spread to areas outside the throat and neck. This metastasis of throat cancer is termed as metastatic throat cancer or stage 4 throat cancer.

Complications following surgery of cancer of the larynx and hypopharynx

There is always a risk of complications following a surgical procedure. The following are some of the common surgical complications of throat cancer: 

• Wound infection: Infections are the common complication following surgery of throat cancer. This procedure can increase the risk of wound infection because of bacterial contamination.

• Wound necrosis: During the treatment of throat cancer wound necrosis may occur due to radiation or due to bacterial infections. Radiations damage the blood supply to normal tissue resulting in necrosis (death) of the tissue. Similarly, bacteria cause infection in the surrounding tissue which has reduced healing power. 

• Salivary fistula: It is one of the most common and undesirable complications as it can be difficult to address and may delay postoperative radiation. Throat cancer patients who have undergone radiotherapy are at a higher risk of developing salivary fistula. 

• Hemorrhage: In patients with recurrent or metastatic head and neck squamous cell carcinoma there is always a risk of hemorrhage associated with surgery. 

• Carotid artery catastrophe: It is a condition which occurs when the carotid artery gets ruptured, injured or gets blocked due to fatty deposits in arteries, it can lead to stroke.
  

Throat cancer diagnosis

Early diagnosis and evaluation of throat cancer are important as they increase the chance of being cured, help in maintaining the quality of life of the patient, including the ability to speak and swallow. Based on the type of cancer suspected, the oncologist may choose specific diagnostic tests. The following are the steps involved in the diagnosis of throat cancer: 

Initial evaluation 

• Medical history 
• Physical examination 



Diagnostic tests

• Blood tests 
• Complete blood count (CBC)
• Blood Chemistry Studies 
• Biopsy 
• Endoscopy 
• Nasal endoscopy 
• Pan endoscopy
• Imaging studies
• Ultrasound 
• X rays
• CT scan 
• MRI
• PET scan
  

Throat cancer treatment

Treatment of throat cancer depends on the type of cancer, where it is located, how far it has spread, how abnormal the cells look under a microscope and also depends on the general health of the patient. Throat cancer involves the following:

• Surgery 
• Endoscopic surgery
• Laryngectomy 
• Total or partial pharyngectomy
• Lymph node removal (when cancer has spread to the lymph nodes) 
• Thyroidectomy (if cancer has spread to the thyroid gland)
• Radiotherapy 
• Chemotherapy
• Targeted drug therapy 
• Immunotherapy
  

Throat cancer prevention

There is no proven or guaranteed way to prevent throat cancer but by managing the risk factors of throat cancer, associated with throat cancer can be decreased. The following are some of the measures for preventing throat cancer: 

By quitting smoking and vaping

Smoking is one of the major risk factors for throat cancer. Chemicals present in tobacco are carcinogenic, they have a high potential to cause cancer when inhaled. It can increase the risk of throat cancer by exposing the larynx to these carcinogenic agents. Therefore, it is important to quit smoking. 

Limiting alcohol intake

Alcohol, which is one of the major risk factors of throat cancer, acts as an irritant in the mouth and throat. The cells damaged by excessive alcohol consumption try to repair themselves leading to DNA changes which can be a step toward cancer. It can also raise the levels of estrogen and other hormones. Reducing alcohol intake reduces the major risk of throat cancer development. 

Vaccination against HPV

Human papilloma virus (HPV) is one of the most common viruses and there are many different types of human papilloma virus which can affect different parts of body. Practicing safe sex, regular cervical screening tests can protect from HPV Infection. It is important to get vaccinated against human papilloma virus to reduce the risk of throat cancer. 

Diet

Excess body weight, deficiency of vitamins, and poor nutrition are linked to throat cancer. Following healthy eating habits and with a proper balanced diet the risk of throat cancer can be reduced to a larger extent.

Difference between Throat cancer and Tonsilitis

Throat cancer vs Tonsilitis

Throat cancer is a cancer that originates in the pharynx or larynx whereas tonsilitis is inflammation of the tonsils due to infection. Though throat cancer and tonsilitis cause similar symptoms such as swelling in the neck, sore throat, and difficulty in swallowing they have different causes and treatments. The following are some of the key parameters that differentiate between throat cancer and tonsilitis: