Throat (pharynx) cancer
This section contains information on the following:
1. Presentation
2. Diagnosis
3. Risk factors
4. Treatment
5. Surgery
6. Non-surgical treatment
7. Outcome
8. Prevention
1. How does cancer of the throat present?
Cancer of the throat can present in a variety of ways, such as a painful ulcer (sore) or lump inside the throat, or difficulty in swallowing. While usually these symptoms are caused by a simple viral or bacterial throat infection and should not be cause for alarm, persistence beyond 2 weeks calls for urgent specialist attention. Rarely, it can cause change in voice or a lump in the neck.
2. How do I find out if I have cancer?
In the first instance, a thorough clinical examination, including an out-patient fiberoptic endoscopy under local anesthesia, needs to be performed. If suspicion is high, a thorough endoscopic examination is performed under general anesthesia and any suspicious lesion is biopsied. A contrast CT is also done to stage the disease.
3. Why does it occur?
Tobacco exposure in the form of smoking, chewing etc and heavy alcohol intake are known risk factors. There is some evidence to suggest that nutritional deficiencies may also play a role. Recent research shows that a type of virus (Human Papilloma Virus) is often the cause, especially for tumors of the tonsil and tongue base (back portion of tongue). In some patients, there are no obvious risk factors.
4. How is it treated?
A variety of treatment options are available for throat cancer, depending on tumor site, stage and patient preference. For early stage tumors, surgery or radiotherapy may be sufficient. Surgery can be performed entirely endoscopically using the microscope and CO2 laser to achieve complete tumor removal (see ). For advanced stage tumors, combined treatment is essential. This involves either open surgical removal of the tumor, along with lymph nodes in the neck, followed by radiotherapy (with or without additional chemotherapy), or primary chemoradiation treatment (organ preservation) followed by planned or salvage (for recurrence) surgery. These tricky and complex decisions need to be taken as a team that comprises the surgeon, radiotherapist, medical oncologist, pathologist, radiologist, speech therapist, dietician and counsellor, and of course most importantly, you.
5. How do I choose between surgery and non-surgical treatment?
The decision can be easy or complex, depending on tumorsite and stage and your expectations. Smaller tumors can be treated with surgeryor radiation with equally good results. Radiation avoids the need to undergosurgery, but can causeburning throat pain, dry mouth,and rarely long-termswallowing difficulty. If the tumor comes backafter radiation, (salvage)surgery can be performed, but this is associated with higher complications, suchas wound infection. On the other hand, primary surgery for smaller tumorstypicallycauses a scar in the neck. However with the advent of CO2 laser, thesetumors can be removed entirely endoscopically withexcellent speech andswallowing outcomes (see ). For bigger tumors that have not fixed or destroyedthe voice box, organ preservation treatment with chemoradiation can beattempted. Sometimes, even though the throat structures have beenpreserved,chemoradiation maycause severe scarring and result in inability toswallow normal diet.
These complex issues mean that no singletreatmentwould suit all patients. You must carefully discuss the pros and consof all available treatment options with your specialist before choosing thetreatment modality.
6. What are my chances of cure?
Stage of the tumor is currently accepted as the most important factor that determines cure. Early stage tumors in general have an excellent outcome. Advanced stage tumors that are fully treated with combined strategies also have good potential for cure. In addition, lots of other data that are available in the biopsy report also help predict the outcome.
7. How can I prevent throat cancer?
Quitting smoking and moderating alcohol intake are the two most important preventive steps. Maintaining a healthy lifestyle with good intake of fruits and vegetables and regular exercise is recommended. Attending screening camps, especially if you use tobacco, would also help pick up very early/suspicious lesions.