Throat cancer (pharyngeal cancer)

Classification

Pharyngeal cancer, also known colloquially as throat cancer, is a malignant tumor that is located in the head and neck area. Throat cancer starts in a large number of cases from the mucous membrane that lines the throat.

The pharynx begins behind the mouth and nasal cavity and extends to the beginning of the esophagus and windpipe. It can be divided into three sections:

• Nasopharynx (Nasopharynx or epipharynx)
• Pharynx (Oropharynx or mesopharynx)
• lower final part (Hypopharynx)

Depending on the location of the throat cancer, this is called differently. A malignant tumor in the nasopharynx is called nasopharyngeal cancer. Correspondingly, cancer of the oropharynx is called oropharyngeal cancer and cancer of the lower parts of the pharynx is called hypopharyngeal cancer.

Read more on the topic: Diseases throat

Symptoms of throat cancer

Unfortunately, throat cancer only leads to symptoms or visible changes in the late stages. Here a swelling of the cervical lymph nodes can be felt and seen. These are already caused by metastases (settlements) of the actual tumor. Symptoms that are triggered by the tumor itself can only be observed at an extremely advanced stage and can present themselves in different ways, depending on the location of the throat cancer.

Nasopharyngeal carcinoma can be responsible for restricted nasal breathing or even lead to recurrent nosebleeds. Since impaired nasal breathing also leads to ventilation problems in the inner ear, other symptoms of nasopharyngeal carcinoma are ear pain and hearing loss.

Throat cancer in the oropharynx causes a sore throat that can sometimes extend into the ear. Hypopharyngeal carcinomas also cause sore throats. This is accompanied by difficulty swallowing and a feeling of lump in the throat. The difficulty swallowing can lead to restricted food intake and associated weight loss.

You can find detailed information on this at: What are the symptoms of throat cancer?

These can be signs of throat cancer

The tricky thing about throat cancer is that in its early stages there are often no symptoms. When the first symptoms appear, the disease is often well advanced. If the tumor is more in the upper part of the throat, the first symptoms are often recurrent otitis media. This is because this area of ​​the throat is where the Eustachian tubes end, which are important for ventilating the middle ear.
The disruption of ventilation also leads to hearing loss. Pressure equalization is prevented by a tumor blocking the mouth of the tubes. Bleeding from the nose can also be a sign of an upper throat tumor.
If the tumor is in the middle and lower part of the throat, it often affects language. The language sounds as if the patient has a lump in his throat. A tumor in this area can also cause difficulty swallowing, as the path from the mouth to the esophagus is narrowed by the tumor. This change can feel like you have a foreign body in your lower throat that you cannot remove by coughing or choking.
Another symptom of a lower throat tumor can be ear pain. The reason for this atypical radiation to a relatively distant organ is that the same nerve that supplies the lower throat also supplies the middle ear, which means that the pain can be transmitted to the ear. In throat cancer of any location, there is often painless swelling of the lymph nodes on the neck.

Therapy of throat cancer

If throat cancer is discovered at an early stage, when it is still small and circumscribed, cure with the help of surgical removal is possible. However, the problem is that the diagnosis is often too late.

The goal of therapy is then to restore or maintain the quality of life so that the patient can, for example, breathe or eat again without restriction. The therapy also depends on the location of the throat cancer, because nasopharyngeal carcinoma differs in treatment from that of oro or hypopharynx carcinoma.

If an oro or hypopharyngeal carcinoma is discovered at a stage where healing is still possible, surgical removal or radiation therapy is carried out. A combination of surgical removal and radiation therapy can also be performed. If the tumor has already grown into neighboring structures, such as the thyroid or esophagus, parts of these must also be removed. In many cases, however, a complete removal of the tumor is problematic.

Furthermore, a neck lymph node removal, known in medical jargon as neck dissection, is performed. This can also be of advantage if the throat cancer in the cervical lymph nodes is not yet visible, as the colonization does not always have to be directly visible.

In the case of advanced oro or hypopharyngeal carcinomas, radiation therapy is combined with chemotherapy. Since nasopharyngeal carcinoma is difficult to access during surgery, radiation therapy is used here. Not only the region of the throat cancer itself is irradiated, but also the cervical lymph nodes, since lymph node metastases can often be observed in nasopharyngeal carcinoma.
Neck dissection, i.e. the surgical removal of these lymph nodes, can also be considered.

It is usually used for nasopharyngeal cancer, if there are metastases after radiation or if there is a relapse. If the lymph node metastases are already present, radiation therapy is often combined with chemotherapy. Such a combination is called chemoradiotherapy.

Prognosis in throat cancer

A timely diagnosis and therapy is, as with all cancer diseases, also with throat cancer of great importance. If the tumor is still small, has not yet spread and has not yet grown into neighboring structures, the prognosis is good. The further the tumor has progressed, the worse the prognosis.

What positively influences life expectancy?

The most important factor that has a positive effect on life expectancy is early detection of the cancer, as treatment in the early stages is often associated with a longer life expectancy. In addition, throat cancer associated with a human papilloma virus (HPV) responds better to chemotherapy and is therefore prognostically more favorable. Risk factors are smoking and alcohol abuse, it is important to avoid these risk factors in order to reduce the risk of throat cancer.

What is the life expectancy with throat cancer?

The question of life expectancy in throat cancer is difficult to give a general answer, as it depends heavily on the stage at which the cancer is discovered and treated. Unfortunately, throat cancer often lacks specific early symptoms, so that it is discovered very late. If the cancer has already spread, i.e. metastasized, life expectancy is drastically reduced. In addition, the survival rate depends on the area in which the cancer originated.
The worst prognosis is for a carcinoma in the lower pharynx (hypopharyngeal carcinoma), as this is where breathing is most likely to be hindered by an ingrowing tumor.

What has a negative impact on life expectancy?

Detecting cancer very late has a negative impact on life expectancy. Treatment is difficult because late-stage cancer may have metastasized to other organs such as the lungs. The location of the tumor in the lower pharynx is also negative for life expectancy. This localization is associated with the highest mortality. Smoking and the consumption of alcohol should be stopped immediately.

Classification of throat cancer

Most pharyngeal cancer is classified according to its location. The pharynx consists of 3 floors, the upper pharynx (epipharynx) or nasopharynx (nasopharynx), carcinomas located on this floor are called the corresponding nasopharynx or epipharynx carcinomas.

The middle level (mesopharynx) is connected to the oral cavity and is therefore also called the oropharynx (from the Latin oris = mouth). Carcinomas in the middle of the throat are called oropharyngeal or mesopharyngeal carcinomas.

The lower throat (hypopharynx) is connected to the larynx, the larynx is also called the larynx. Accordingly, this part of the throat is also called the laryngopharynx and carcinomas in this area are hypopharyngeal or laryngopharyngeal carcinomas. Furthermore, the carcinomas can be classified according to their cell type; different cell types that are degenerate can have different causes.

Another important classification that is also used for other types of tumors is the TNM classification, in which the tumor is classified according to tumor size and spread.

Precursors of throat cancer

In the throat area, changes in the mucous membrane can often be detected before the actual throat cancer occurs, which then lead to a malignant tumor. These preliminary stages are known as precancerous diseases.

A precancerous condition in the throat is leukoplakia, a whitish, non-painful discoloration of the mucous membrane that typically cannot be stripped off. An excessive proliferation of mucous membrane cells can also represent a precancerous condition. Precancerous lesions should be diagnosed, treated, or at least monitored urgently as they can lead to a malignant tumor.

Risk factors

Throat cancer is primarily promoted by external environmental influences. For example, alcohol and tobacco consumption clearly favor the development of oro or hypopharyngeal carcinoma. The combination of the two is extremely harmful.

Alcohol causes damage to the mucous membrane of the throat, which is then particularly vulnerable to the carcinogenic substances introduced by smoking. In the meantime, however, another risk factor for the development of throat cancer has been identified.

An infection with human papillomaviruses (HPV), which are actually known to cause cancer in the genital area, can also promote cancer in the throat area. Adequate oral hygiene is critical to avoiding such an infection.

Risk factors for throat cancer of the nasopharynx are infection with the Epstein-Barr virus (EBV), which is usually called Pfeiffer's glandular fever (infectious mononucleosis) triggers. EBV-induced carcinoma of the nasopharynx is common in Asia and East Africa.

Another risk factor for nasopharyngeal cancer is, for example, frequent use of the chemical formaldehyde. As with many cancers, the genetic component also plays a role, i.e. if you develop throat cancer in close family members, you yourself have an increased risk of developing throat cancer.

Cancer of the palate is also one of the carcinomas of the mouth and throat. In the following article, you will find out how to recognize palatal cancer and how it is treated if you are present: Palate Cancer - Things to Watch Out For

Common ages for throat cancer

It is difficult to pinpoint an exact range for the typical age for throat cancer. The range is very wide and the age peak is between the 4th and 7th decades of life. Since throat cancer is mainly triggered by exogenous pollutants, i.e. pollutants that are supplied from the outside, it plays a major role whether there is nicotine or alcohol abuse. There are also forms of throat cancer that can occur earlier. However, these forms are usually triggered by an infection with HPV (Human Papilloma Virus).

What is the role of HPV?

The main known human papillomavirus is that infection with the virus can cause cervical cancer. In the meantime, the infection can be prevented by vaccinating girls before their first sexual intercourse. In addition to cervical cancer, the virus can also cause other genital tumors, such as vaginal carcinomas or penile carcinomas, but anal carcinomas are also possible. The virus is mainly transmitted through sexual contact. After infection, the viruses survive in the mucous membrane of the genital organs. Oral sex can also infect the oral cavity and cause various types of cancer. In addition to throat cancer, tongue cancer and floor cancer can also develop.

Find out more about the topic here: Vaccination against cervical cancer

diagnosis

The correct doctor for diagnosing throat cancer is an ear, nose and throat doctor. Often the throat cancer is detected by a simple mirror examination, during which a suitable instrument is inserted into the oral cavity.

With the help of a simple ultrasound examination (sonography), the cervical lymph nodes can be shown and possible colonization of throat cancer can be shown. In addition, a so-called panendoscopy is performed under general anesthesia in order to remove tissue samples (Biopsies) for the exact pathological examination.
Endoscopy means something like “looking inside” and is generally used to examine and visualize body cavities.

Finally, computed tomography (CT) or magnetic resonance imaging (MRI) should also be performed.
This is where the extent of the tumor can best be assessed and a possible breakthrough of the throat cancer into nearby structures can also be determined. Since viruses can also promote throat cancer, a blood test can be helpful and support the suspicion if the blood is found.

prevention

Limiting alcohol and tobacco consumption are particularly helpful against the development of throat cancer. Of course, it is even better to do without it completely. Good oral hygiene and a healthy diet also have a positive effect. There is no vaccination against the viruses that can promote the development of throat cancer.

Epidemiology

Depending on where exactly the throat cancer is located, there are different frequencies. Gender also plays a role. It is noticeable that older men are predominantly affected. However, due to the changing lifestyle of women, the number of women affected is increasing.

The reason for this should be the changed smoking and drinking habits. In the case of nasopharyngeal carcinoma, about 0.5 new cases per 100,000 inhabitants can be recorded, whereby the affected people are mostly men over the age of 60.
An oropharyngeal carcinoma, i.e. a throat cancer in the area of ​​the oropharynx, causes 0.5-2 new cases per 100,000 inhabitants per year, with a significantly more frequent occurrence in older men.
Throat cancer in the lower areas of the throat, consequently hypopharyngeal carcinoma, is the most common with 3.5 new cases per 100,000 inhabitants per year. Again, the male sex is more affected than the female sex.