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Top questions about throat cancer

What you should know about throat cancer

Over the past 30 years, the morbidity and mortality rates for throat cancer have declined, due in large part to public health efforts discouraging tobacco use. Recently, though, and for the first time ever, the rate of head and neck cancers linked to human papillomavirus (HPV) infection in men has surpassed the incidence of HPV-related cervical cancer in women. Experts now are working to spread awareness of HPV as a major risk factor for head and neck cancer, and throat cancer in particular.

Because of throat cancer’s location, the disease and its treatment often cause physical side effects. Surgery, for example, may affect a patient’s ability to chew, swallow and speak, as well as his or her appearance.

Many throat cancer patients also have a high risk of developing a secondary cancer, typically in the larynx (voice box), esophagus or lungs. After treatment ends, some patients may also develop another cancer in the lungs, mouth, throat or other nearby area. That’s why experts recommend that throat cancer patients receive follow-up exams for the rest of their lives, and avoid tobacco and alcohol, which increase the risk for secondary cancers.

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What is throat cancer?

Throat cancer forms in the throat (pharynx), larynx or tonsils. Typically, throat cancers are referred to as squamous cell carcinomas because they begin in the flat, squamous cells that line the moist surface of the throat.

What are the symptoms of throat cancer?

Common signs and symptoms of throat cancer include:

  • A neck mass
  • A cough that won’t go away
  • A sore throat that won’t go away
  • Difficulty swallowing
  • Changes in voice, including hoarseness
  • Ear pain
  • Weight loss

What are the main types of throat cancer?

Throat cancers are categorized according to where they develop:

Nasopharyngeal cancer occurs in the throat, just behind the nose.

Oropharyngeal cancer forms in the throat, just behind the mouth, and sometimes in the tonsils.

Hypopharyngeal cancer develops in the lower part of the throat, just above the esophagus and windpipe.

Glottic cancer occurs in the vocal cords.

Supraglottic cancer forms in the upper part of the voice box and includes cancers that affect the epiglottis, which blocks food from entering the windpipe.

Subglottic cancer develops in the lower part of the voice box, below the vocal cords.

What are the biggest risk factors for throat cancer?

Risk factors for throat cancer include:

  • Tobacco use
  • Alcohol use
  • HPV infection
  • A diet lacking in fruits and vegetables
  • Gastroesophageal reflux disease (GERD)
  • Genetic syndromes, including Fanconi anemia and Dyskeratosis congenita
  • Workplace exposures, including long exposures to wood dust, paint fumes, asbestos and certain chemicals
  • Gender, with men more than twice as likely as women to develop the disease
  • Age, with more than half of throat cancer patients diagnosed at the age of 65 years or older

Learn more about the HPV vaccine

What type of doctor should I see if I think I have throat cancer?

If you are experiencing symptoms of throat cancer, it is important to see a doctor for an accurate diagnosis. A timely diagnostic evaluation is essential to catching the disease early, when it is easier to treat. An oncologist trained and experienced in treating throat cancer may diagnose your cancer and advise you on a treatment or combination of treatments tailored to your needs and your specific cancer. Consider specifically seeking out an otolaryngologist, a doctor who treats diseases of the ear, nose and throat, especially one with experience in treating cancer, to diagnose the disease and advise you on what to do next.

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Questions about throat cancer treatment

Treatments for throat cancer typically depend on several factors, including the location of the tumor, the stage of the cancer, and the patient’s age, health, individual needs and treatment goals. Treatment also is determined by where the cancer originated and whether it has spread.

How is throat cancer treated?

In most cases, surgery is the first-line treatment for throat cancer when it is caught early. Surgical options may include removing all or part of the larynx (voice box), part of the throat or cancerous lymph nodes in the neck. For throat cancer that has advanced or is recurrent, surgery is often combined with other forms of treatment, such as radiation therapy and chemotherapy.

Minimally invasive surgical options may be available for some patients, such as flexible robotic surgery, which allows surgeons to access hard-to-reach areas of the mouth and throat with a flexible scope. Benefits of flexible robotic surgery may include a shorter hospital stay, quicker recovery and reduced post-surgical pain.

What are the potential side effects of throat cancer treatment?

Depending on the therapy, treatment for throat cancer may cause side effects, including changes in voice and difficulty swallowing. Voice changes are often caused by surgery to remove the vocal cords. Radiation therapy also may cause hoarseness. Trouble swallowing, called dysphagia, may range from chronic dry mouth to an inability to swallow anything, including saliva. Other common side effects include impaired speech, difficulty chewing, swelling, facial disfigurement, loss of appetite and changes in taste.

How can treatment-related side effects be managed?

Many side effects of throat cancer treatment may be managed with supportive care therapies, such as nutrition therapy, and oncology rehabilitation techniques like speech and occupational therapies. If a feeding tube is required to help sustain your nutrition, your doctor will determine whether you will need it on a short-term or long-term basis. In some cases, the tube may be removed as soon as normal eating is possible.

Pain management physicians, dietitians, speech therapists, physical therapists and naturopathic clinicians may offer a range of techniques to help prevent and reduce side effects of throat cancer treatments. They may be involved from the beginning of treatment, during treatment, or after treatment is complete.

How long do side effects last?

The length of time patients experience side effects varies. Voice loss may be permanent for some throat cancer patients, but options may be available in certain circumstances. For example, with a tracheoesophageal puncture, or TEP, a doctor places a small, one-way valve between the trachea and the esophagus to help the patient speak. The TEP may be an option for patients who undergo a laryngectomy, or the removal of all or part of the vocal cords.

Questions to ask your doctor

Early diagnosis is critical to seeing that you have as many treatment options as possible for throat cancer. Still, many patients experience delayed diagnoses, mostly because of a lack of available screening tools and because symptoms, such as a lingering sore throat, mimic less serious conditions. That’s why, if you have a neck mass that won’t go away or have other reasons to suspect throat cancer, experts suggest you seek a specialist who can perform a biopsy. If you are diagnosed with throat cancer, knowing which questions to ask your doctor will help get you started on a course of treatment tailored to you.

Do I have throat cancer?

A diagnostic evaluation is often the first step in confirming the disease. A neck mass is often misdiagnosed as an infection, with doctors prescribing an antibiotic, which may lead to a delay in diagnosis. Throat cancer patients who are diagnosed in the early stages have more treatment options available to them.

Also, although throat cancer typically affects patients over the age of 65, younger people who experience throat cancer symptoms for longer than two weeks or whose symptoms don’t respond to an antibiotic should see a doctor for a thorough diagnosis. The disease is on the rise among men and women younger than 50, largely because of an increase in human papillomavirus (HPV)-linked cancers.

What is the stage of my cancer?

Knowing the stage of your throat cancer is important in developing a treatment plan tailored to your individual needs. Early-stage cancer, for example, may only require surgery to remove the tumor. But more advanced cancers may require more aggressive treatments, including a combination of therapies, such as surgery with radiation therapy and chemotherapy.

Is flexible robotic surgery a treatment option for me?

If you have throat cancer, particularly tonsil or base-of-tongue cancer, flexible robotic surgery may be an option. Flexible robotic surgery is minimally invasive, and may leave less scarring and damage to important structures in the throat, such as the nerves and large blood vessels, than traditional surgery. These benefits may help patients recover from their surgery quicker and experience less pain, so they are better able to resume eating and other daily activities on their own faster.

Does my treatment plan follow nationally recognized treatment guidelines for throat cancer?

Treatments for throat cancer fall under the guidelines of the National Comprehensive Cancer Network (NCCN). Doctors who aren’t up to date on the NCCN treatment guidelines for throat cancer may not be aware of all of the options available to you and your specific cancer. For instance, some doctors may recommend radiation therapy for patients who could benefit from newer surgical approaches. Ask your doctor whether your treatment plan follows NCCN guidelines.

How important are follow-up appointments after treatment is complete?

Because of the risk for a secondary cancer—during treatment or after treatment ends—throat cancer patients should have follow-up exams for the rest of their lives. An exam may detect cancer in a nearby area, such as the larynx (voice box), esophagus or lungs. After treatment, some patients may also develop cancer in the lungs, mouth, throat or other part of the body. Throat cancer recurrence most often develops in the first two to three years after treatment ends.

Patients also should avoid tobacco and alcohol, which increase the risk for secondary cancers. Smoking and drinking during throat cancer treatment also reduces the effects of certain therapies.

Next topic: What are the facts about throat cancer?

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