On the surface, cancer seems uncomplicated. It occurs when mutated cells grow out of control to form a tumor. But, like a jigsaw puzzle, that’s just the picture on the box. Inside, are thousands of pieces, nuances that make every cancer unique. Understanding each piece and how they fit together may help doctors and patients make better treatment decisions and grasp potential long-term implications of the disease.
Consider throat cancer, for example. It occurs when abnormal cells in the throat grow to form a tumor. But the disease is much more complex than that. Throat cancer is a general term for several types of cancer that form in the five-inch tube inside the neck, from behind the nose to the top of the windpipe and esophagus.
Knowing where in the throat, also called the pharynx, the cancer originated and what type of cancer it is helps doctors develop personalized treatment options tailored to the patient’s needs and specific diagnosis. It may also help patients understand how their disease and its treatment may affect basic functions, such as talking, swallowing or hearing.
The concern over such long-term effects of the disease often makes people afraid to talk to their doctor if they experience throat cancer symptoms, says Beomjune B. Kim, DMD, MD, Director of Head and Neck Surgery and Microvascular Reconstruction at Cancer Treatment Centers of America® (CTCA), Atlanta. “They’re afraid of disfigurement, and they’re worried about losing their speech or the ability to swallow,” he says.
A better understanding of the nuances of throat cancer and knowing the differences between various types of the disease, may help patients better prepare for the side effects and make educated decisions about their care.
Types of throat cancers
Laryngeal cancer and pharyngeal cancer are the two most common types of throat cancers. The American Cancer Society (ACS) estimates that laryngeal cancer will account for approximately 12,620 new diagnoses and 3,770 deaths in the United States in 2021.
Laryngeal cancer occurs when cancer cells form in the tissues of the larynx, commonly called the “voice box.” The larynx helps you swallow and makes the sound of your voice unique.
The larynx is divided into three parts, and cancer may form in any of them:
- Supraglottis is the area above the vocal cords.
- Glottis is the middle section, where the vocal cords are located.
- Subglottis is the area below the vocal cords that connects the larynx to the windpipe.
Cancer of the vocal cords is also called glottic cancer.
Pharyngeal cancer is categorized by these three types:
Nasopharyngeal cancer forms in the upper part of the throat, behind the nose. When you draw a breath, air comes in through the nose, throat and nasopharynx on its way to the lungs.
Oropharyngeal cancer forms in the middle part of the throat, beyond the mouth. The oropharynx supports the respiratory and digestive systems.
Hypopharyngeal cancer forms in the bottom part of the throat, just above the larynx. The hypopharynx provides an opening for food to enter the esophagus (the tube that connects the throat to the stomach).
Throat cancers are among a broad range of head-and-neck-cancer. And like nesting dolls, the various types of head and neck cancers have multiple layers, all concentrated in the small area around the head, mouth and throat.
Most throat cancers, like 90 percent of all head and neck cancers, are squamous cell carcinoma, which forms in the thin, flat cells that line much of the throat.
Oropharyngeal cancers are often categorized as oral cavity cancers, which include cancer of the lips, inside the cheeks, gums, most of the tongue and the hard palate, the bony roof of the mouth. Approximately 54,010 new cases of oral cavity and oropharyngeal cancer are expected to be diagnosed in the United States in 2021.
Early signs
Certain symptoms may help the oncologist better diagnose where the cancer originated. Hearing loss or ear pain, for instance, is more associated with nasopharynx cancer, while sores, ulcers and white patches are typical signs of oropharyngeal cancer.
In most cases, patients with early-stage throat cancer don’t experience symptoms. “Usually, there are no symptoms of throat cancer at the beginning,” says Dr. Kim. “What you’d notice is an abnormal red or white lesion in the throat.”
Other signs of throat cancer may include:
- Bleeding
- Numbness
- Difficulty swallowing
- Hoarseness
“If your voice becomes hoarse or raspy or it changes, you should seek medical care,” says Dr. Kim. If people who wear dentures suddenly realize they don’t fit, that may be a sign of throat cancer, he adds.
Who’s at risk?
Most people who are diagnosed with laryngeal cancer are 55 or older, according to the ACS. African-American men are more likely to be diagnosed with laryngeal cancer than white men and are more likely to die as a result. Men are much more likely to develop laryngeal cancer than women.
Some promising news: Both the rate of new cases of laryngeal cancer and the rate of deaths from the disease are down by about 3 percent a year in the United States, which the ACS attributes to fewer people smoking.
The human papillomavirus (HPV), the most common sexually transmitted infection in the United States, causes 70 percent of oropharyngeal cancers, according to the U.S. Centers for Disease Control and Prevention. Other risk factors of throat cancer include:
- Smoking
- Drinking alcohol
- Getting too much sun
- Inhaling toxic fumes
Treatment options for throat cancer
Because of their location and the potential to affect speaking, breathing and swallowing, throat cancers require precise treatment approaches. Treatment options for throat cancer may include:
- Surgery, including minimally invasive robotic surgery and reconstructive surgery
- Radiation therapy, including external beam radiation therapy and brachytherapy
- Chemotherapy, which may be used in combination with other treatments
- Immunotherapy
- Targeted therapy
Treatment options may depend on a variety of factors, including the type, stage and progression of the disease. For example, while surgery and radiation therapy may be first-line treatments for many oral cancers, radiation therapy may be preferred in the throat especially in advanced stages. Surgery may also involve removing lymph nodes if the cancer has spread or is thought to have spread to them. Immunotherapy may be an option if the cancer has metastasized.
Throat cancer patients may also benefit from multiple supportive care services. Patients who need to learn to speak again may be referred to a speech therapist, for example. Those with swallowing and breathing difficulties may require physical therapy.
The key to better outcomes and fewer side effects, Dr. Kim says, is early detection. “The earlier patients see their doctor,” he says, “the better chance they have for a positive prognosis and a better quality of life.”
