Throat Cancer Latest Facts: Types, Causes, Symptoms and Treatment

Throat cancer is a malignant tumor that grows in the laryngeal area where the voice system i.e the vocal cord is located. In most cases, laryngeal cancer affects smokers. Therefore, smoking as well as alcohol abuse are considered the most important risk factors for laryngeal cancer. This malignant tumor most often occurs in men usually developing between 50 and 70 years of age with a peak incidence between 64 and 66 years of age.

oropharynx

oropharynx

The term “throat cancer” is used to describe malignant tumors of not just the larynx but is also used to describe the malignancies of the throat (oropharynx, nasopharynx, and larynx) and the initial parts of the esophagus.

Etiology

There are certain factors that can contribute to the development of laryngeal cancer:

  • Smoking is considered the single most important risk factor for laryngeal cancer. Cigarette smoke contains substances that can interact with cells on the larynx mucosa causing damage to the cell membrane and the genetic apparatus resulting in mutations that result in tumor formation. Additionally, smoking can also suppress the mechanisms that protect the body by transiently making the ciliary epithelium dysfunctional. 
  • If people live in industrialized areas with high air pollution, they are more likely to be diagnosed with malignant diseases such as laryngeal cancer.
  • Consumption of alcoholic beverages: When alcohol enters the upper larynx, the mucous membrane can get irritated and altered. Because regeneration of irritated tissue is intensified, a tumor may develop during the process of increased cell turnover. 
  • Occupational hazards are another important risk associated with throat cancers such as in a person who comes into contact with harmful chemicals or their vapors, works in companies where temperatures are very high and the air is dusty.
  • Corrosive chemicals, either acid or alkali can also have a particularly negative effect on the larynx.
  • Laryngitis in its chronic form can provoke cancer of the throat
  • Frequent consumption of spicy, hot food
  • Pre-cancerous diseases such as Barrett’s esophagus 

Among those with laryngeal cancer, 94-97% are smokers. Tobacco smoke contains many toxic and irritating substances, soot particles, and radioactive substances. By irritating and burning the mucous membrane, they cause and maintain chronic inflammation, which contributes to the formation of neoplasms. Smokers get laryngeal cancer 20-30 times more often than non-smokers. The overall risk of cancer-related deaths directly from smoking is 30.6% (45% for men and 21.5% for women).

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Smoking cigarettes with a filter does not save you from laryngeal cancer, as the filter only retains a small proportion of the harmful substances that contribute to inflammation of the larynx mucosa.

Risk Factors:

  • The most common laryngeal cancer (oropharyngeal cancer, laryngeal tumor) is found in people who smoke. The longer you have smoked, the higher the risk of getting laryngeal cancer.
  • Alcohol abuse.
  • Lack of B and A vitamins may also contribute to laryngeal cancer.
  • The risk group includes people with a weak immune system – people with congenital diseases, people infected with HIV.
  • Contact with harmful chemicals such as wood dust, paints, varnishes, etc.
  • HPV infections may later develop into malignant tumors in the larynx.
  • Laryngeal cancer (oropharyngeal cancer) is more commonly diagnosed in African Americans.

Symptoms of throat cancer

Certain symptoms and signs can indicate the presence of throat cancer, these clinical features can be divided into general and specific types.

General symptoms include:

  • High temperature up to 100.4°F (38°C), especially during the morning hours.
  • Unmotivated weight loss, weakness, reduced appetite.
  • A drop in levels of hemoglobin and erythrocyte levels (anemia), which are often found incidentally during medical examinations.

Specific symptoms:

  • Persistent sore throat, which is not relieved by conventional means.
  • Difficulty breathing.
  • Dry cough, perspiration, and a feeling of dryness in the throat.
  • Bad breath, which is not related to dental problems.
  • The appearance of red and white spots, pustules, and abscesses on the mucous membrane of the mouth.
  • Disturbed taste sensations.
  • Hoarseness
  • Numbness, asymmetry in the lower parts of the face.
  • Increased neck size due to lymph nodes and soft tissue swelling.

Localization of laryngeal tumors and their clinical picture

It should be noted that clinical manifestations depend largely on the localization of the tumor.

Vestibular laryngeal cancer: The progression of vestibular cancers is aggressive, they quickly spread to the surrounding organs and are characterized by an increased tendency to metastasize early on into the lymph nodes of the neck.

This is due to the well developed lymphatic system in the vestibular area and its numerous connections to lymphatic vessels in the throat.

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Unfortunately, this is also the most frequent location of laryngeal cancer. At the beginning of the disease, the patient usually feels discomfort during swallowing, which is later replaced by a feeling of a foreign body as the tumor grows. As the disease progresses, pain occurs during swallowing which gradually increases in intensity. In the final stages, the pain goes to the ears, causes great suffering to the patient, and becomes a reason for limited food intake, which leads to a sharp drop in body weight.

Middle laryngeal cancer: Cancer in the middle department has the most favorable prognosis. Limited lymphatic vessels in this area are the reason behind the rare metastasis of tumors of the middle larynx. Even with a small tumor size early on during the disease course, patients often go to see a doctor. This is due to a disturbance in the tight closure of the vocal folds due to a mechanical obstacle i.e. the tumor. Subsequently, hoarseness is a manifestation of the restricted mobility of the fold or its complete immobility due to the growth of the tumor into the vocal muscle.

This symptom is characterized by a gradual worsening process, from mild hoarseness to complete loss of voice. In later periods, it is also characterized by difficulty in breathing. This is due to the growth of the tumor into the larynx, the narrowing of the larynx, and the immobility of one or both halves of the larynx. With further growth, the tumor can spread to adjacent laryngeal regions with corresponding clinical manifestations and can also grow forward into the soft tissues of the neck.

Sublaryngeal cancer: This variant of sublaryngeal cancer is relatively rare. Tumors in this area also have a number of features: they tend to have an endophytic growth form, are resistant to ionizing radiation, and metastasize mainly into prelaryngeal and pre-tracheal lymph nodes.

Such tumors account for about 2% of all laryngeal tumors. By spreading to or penetrating the vocal fold, they lead to hoarseness. Quite rarely, a tumor narrows down the laryngeal lumen, causing breathing difficulties on inhalation.

One of the growth directions of the tumor of this localization is to spread to the first rings of the trachea. A large proportion of patients come with lesions of two or three laryngeal regions. In such cases, there is a combination clinical presentation of the lesions on different parts of the larynx.

Stages Of Cancer

Certain stages of laryngeal cancer are distinguished:

  1. The first stage- symptoms of laryngeal and throat cancer at an early stage – an ulcer or some kind of mass localized to a specific region. 
  2. The second stage – The tumor spreads to surrounding nearby structures but there is no metastasis in the lymph nodes area
  3. The third stage- The tumor can invaginate into the deeper layers of the larynx which leads to a disturbance in the mobility of the larynx. Metastases occur in the lymph nodes. At this stage, it is already much more difficult to cure the disease.
  4. The fourth stage: the tumor spreads to 2 or more sections, and it also grows deep spreading to the organs that are nearby with metastases to the lymph nodes.

Diagnosis of laryngeal cancer

The following procedures are used for diagnosis:

  1. Indirect laryngoscopy, external examination, and palpation. Fibrolaryngoscopy. This method is one of the main methods used to diagnose throat cancer. With this procedure, it is possible to examine all laryngeal sections in high resolution and without “blind spots”.
  2. The instrument is inserted into the larynx easily and safely and it is possible to take a biopsy for a cytological examination. On top of that, it is possible to visualize the underlying larynx and take high-quality photographs.
  3. Morphological examination (histological, cytological) of material obtained from biopsies, punctures, and scrapes. Computer tomography (CT) of the larynx. Used to assess the condition of the cartilage larynx, which cannot be seen with laryngoscopy. This method also provides additional information on the vestibular larynx and laryngeal larynx.
  4. Magnetic resonance imaging (MRI). This method assesses the condition of vocal folds, laryngeal ventricle lumen, buccal folds, and pear-shaped sinuses. Radiography of the lungs. Used in case of suspicion of remote metastases.
  5. Ultrasound examination of the liver and neck lymph nodes. Used in the case of suspected remote and regional metastases. In case of enlarged regional lymph nodes – puncture for cytological confirmation. All these methods make it possible to make an unequivocal diagnosis and prescribe appropriate treatment.

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Throat cancer treatment

Treatment of laryngeal cancer is extremely complex and depends primarily on the location of the tumor in the larynx and its size. It can be long-term and consists of the following individual methods or a combination of them.

  • Surgical treatment
  • Radiation therapy
  • Chemotherapy.

A special feature of the treatment is that doctors strive not only to cure the disease, but also to preserve the respiratory, vocal, and protective functions of the larynx.

Treatment usually starts with conservative treatment (radiation or chemotherapy). In the initial stages of the disease, a conservative cure is achieved in 85-90% of cases. The laryngeal function is not impaired, and patients continue to live normal lives.

Surgical intervention is performed in cases where conservative treatment is not effective enough. If the tumor is small, only part of the larynx is removed, while its vocal and respiratory functions are preserved. But if the patient seeks help late, the entire larynx is removed. In such cases, the patient starts voice training after the wound has healed. After 2-3 months of such exercises, the patient can already communicate with others.

After treatment, all patients need regular close monitoring by a specialist for five years or more. This is necessary to prevent and treat possible complications, relapses, or metastases of the tumor in a timely manner. During and after treatment, the patient should receive a full, high-calorie, and vitamin-rich diet. Sour, salty, and spicy foods and condiments should not be eaten, as this increases dryness in the throat and promotes swelling. Sick people should not smoke, consume any alcohol, sunbathe, or perform any thermal procedures around the neck.

It is strictly forbidden to use various stimulants (aloe tincture, propolis, mumiyo, etc.), as they contain large amounts of biologically active substances that can accelerate tumor growth.

Treatment for stage 4 throat cancer

In the early stages of development, throat cancer has virtually no characteristic symptoms. The patient does not go to a health center immediately, so the diagnosis is often delayed.

The diagnosis of stage 4 throat cancer shows that cancer cells are spreading throughout the body. In this case, the disease is manifested by pronounced symptoms. Curative treatment is rarely achieved at this stage of the disease, but it is possible to extend the life of the patient or at least improve the quality of life by palliative care.

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Throat cancer in the final stage is not merely a primary tumor, but also metastases to various organs, so there is no surgical intervention in this such a case. Radiation therapy, which reduces the size of the tumor and slows down the progression of the disease, has proved to be a good practice. Radiation therapy for throat cancer has been somewhat successfully combined with chemotherapy in many cases.

The patient’s life expectancy and well-being largely depend on the form of the tumor, its location, the age of the patient, and the quality of medical care.

My Opinion

Throat Cancer is often diagnosed late due to the vague nature of its clinical presentation. Relative to other forms of cancer, throat cancer has a particularly poor prognosis with a poor quality of life during the final stages. It is therefore vital to know all the risk factors that can increase your likelihood of acquiring this fatal condition, and actively protect yourself from acquiring this preventable yet fatal condition. 

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References

https://www.nidcr.nih.gov/health-info/oral-cancer/more-info

https://www.cancercenter.com/cancer-types/throat-cancer/about

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