Throat cancer

All content is checked by medical journalists.

Throat cancer is a malignant disease of the throat. In most cases it is caused by altered cells in the mucous membrane. In the event of symptoms, those affected should consult a doctor immediately because throat cancer is easier to cure in the early stages. Read here how the doctor treats throat cancer!

ICD codes for this disease: ICD codes are internationally recognized codes for medical diagnoses. They can be found, for example, in doctor's letters or on certificates of incapacity for work. C10

Brief overview

What is throat cancer? Tumors in the area of the throat, mostly mutated cells of the mucous membrane
Symptoms: lymph nodes swollen on one side and causing no pain, hoarseness, difficulty swallowing, depending on the region also problems with the nasal cavity or pain in the ears
Treatment: surgery, radiation therapy, chemotherapy, targeted therapies
Causes: Previous preliminary stages, alcohol and nicotine consumption, viral diseases
Diagnostics: laryngoscopy, imaging procedures, examination of tissue samples
Prevention: Avoid alcohol and nicotine, strengthen the immune system

What is throat cancer?

Throat cancer is a head and neck cancer. This means all types of cancer that occur in this area of the body. The throat, also known as the throat, is called the pharynx in technical terms, which is why doctors speak of pharyngeal cancer when it comes to throat cancer. Malignant diseases usually develop from cells in the mucous membrane in this region of the body. For various reasons, there are errors in the genetic material of the cells or the genetic information is incorrectly read. As a result, the cells grow uncontrollably - and throat cancer develops. The technical term for this type of cancer is squamous cell carcinoma. Other types of cancer, such as those in the throat area, only make up a small proportion.

Pharyngeal carcinomas are differentiated according to the area of the throat in which they occur:

Upper section: The upper throat is the nasopharynx. It has an upper and a lower wall. While the upper wall extends between the transition of the hard and soft palate to the base of the skull, the upper surface of the soft palate is defined as the lower wall. Cancer there is known as nasopharynx cancer or nasopharyngeal cancer.
Middle throat area: This means the throat area behind the oral cavity that can be seen when the mouth is opened wide. Doctors call it the mesopharynx or oropharynx. This includes not only the back wall of the throat, but also the tonsils and the anterior surface of the soft palate. Oropharyngeal cancers mostly occur around the tonsils. The oropharynx is the region most commonly affected by throat cancer.
Lower Throat: The lower part of the throat is called the hypopharynx. It lies very deep, below the epiglottis. If cancer develops there (hypopharyngeal carcinoma), it is often not possible to spatially differentiate the degenerated cells from a carcinoma in the area of the vocal cords, i.e. from a cancer of the larynx (laryngeal carcinoma).

How do you recognize throat cancer?

In the early stages, carcinoma of the throat is rarely noticeable through symptoms. Only when the disease spreads slowly do noticeable changes occur. Often, swollen lymph nodes in the neck area are the first symptoms of throat cancer, although the suspicion of cancer is particularly high if the lymph nodes are not painful and are only enlarged on one side. In addition, the signs depend on which region in the throat is affected. The symptoms appear in different combinations.

Nasopharyngeal cancer

The nasopharyngeal carcinoma often leads to very clear symptoms, but these usually do not show up in the initial stage, but only in the further course. The appearance of throat cancer does not usually play a role in the self-observation of those affected, as these parts of the body are hardly visible in front of the mirror. Possible signs of this form of throat cancer include:

The cancer sometimes closes the inner nostrils. It is difficult for those affected to breathe through their nose, and their nose may bleed from time to time. It happens that the voice sounds nasal. The typical secretion formation of a cold is missing, however.

It is possible for throat cancer to spread to the junction between the throat and the middle ear. This is known as the Eustachian tube or Eustachian tube (Tuba Eustachii). This often triggers symptoms similar to those of an otitis media, so it comes to hearing loss and an unpleasant feeling of pressure in the ear, which is often associated with pain, or there are noises in the ears. If the symptoms are one-sided, the suspicion of a malignant disease is particularly high.

Throat cancer also often damages the base of the skull. This may be associated with paralysis of certain cranial nerves. As a result, those affected may suffer from headaches and facial pain or they may see double vision (diplopia). In many cases, numbness and failure symptoms occur.

Oropharyngeal cancer

In oropharyngeal cancer, too, it is usually difficult to diagnose the disease early because the throat cancer symptoms very rarely appear at the beginning.

The focus is on the throat area behind the oral cavity. Even in the early stages, the appearance of the mucous membrane changes there due to throat cancer. However, those affected rarely notice redness, swelling and later also growths or even wounds if they are not accompanied by other symptoms.

Once again, enlarged lymph nodes in the neck or head area are important signs for early detection.

As the disease progresses, it comes to a sore throat, which may radiate to the ears.

As the throat cancer spreads, the growths often cause difficulty swallowing.

Unusual bad breath is also an indication of cancer.

Hypopharyngeal carcinoma

Hypopharyngeal carcinoma is also usually not noticeable in the early stages. This makes early detection difficult, although a quick diagnosis significantly improves the chances of recovery.

In this form of throat cancer, the lymph nodes are again the most important warning sign. If they swell, possibly only on one side, without causing pain, the cause is often cancer.
It is only when the growths enlarge that the patient often feels like they have a “lump in their throat”. You clear your throat without it doing anything. In the next step, it is difficult to swallow.
If the cancer attacks the vocal cords, hoarseness is most common.
Difficulty breathing is also a possible throat cancer symptom.
If necessary, those affected discover discolored or sore spots in the area of the throat.
Bad breath is also common.
The sick cough up sputum, which is sometimes mixed with blood.

When to see a doctor if you suspect throat cancer?

The symptoms mentioned do not only occur in throat cancer. Most of the time, signs such as difficulty swallowing, hoarseness or sore throat have a harmless cause. In addition to a cold or flu, local inflammation or an allergy are other possible triggers.

Those affected should pay attention if the symptoms do not improve after two to three weeks. Then you should see an ear, nose and throat doctor.

What does throat cancer look like? Many patients with typical complaints ask themselves this question while standing in front of the mirror. In most cases, however, there is a harmless disease behind the alleged throat cancer symptoms and changes are seldom seen anyway. However, if it is actually pharyngeal cancer, early diagnosis is all the more important.

The chances of recovery are usually very good in the early stages. In addition, operations, for example, are much smaller and not as stressful. Nevertheless, specialists repeatedly find that those affected ignore the symptoms out of fear of a cancer diagnosis - and lose time for effective therapy.

Is throat cancer curable?

As with most cancers, throat cancer has the best chance of cure if it is detected at an early stage. The chance of survival is lower than with some other cancers because throat cancer symptoms often only appear after the cancer has spread.

For tumors of the lower throat and nasopharynx, around 40 percent (hypopharyngeal cancer) and around 40 to 50 percent (nasopharyngeal cancer) of patients are alive five years after diagnosis. For oropharyngeal cancer, the numbers are slightly better at 50 to 60 percent. However, these figures say nothing about personal life expectancy with throat cancer. Because the disease is completely curable if it is treated early enough.

There are three ways of treatment: surgery, radiation therapy, and medication. Oncologists put these options together individually and adapt them to the situation of the respective patient.

Throat cancer treatment depends, among other things, on where exactly the tumor is and how much it has spread. Has the cancer already spread? His aggressiveness is also taken into account. The general condition of the person concerned also plays a role. For example, in the case of previous illnesses, chemotherapy may be too stressful in relation to the expected success of the treatment.

surgery

The most effective treatment for throat cancer is to have the tumor tissue completely removed through surgery. What this means exactly depends on the location and spread of the throat cancer. For some patients, it is sufficient for the surgeon to remove a small section of the throat. In other affected people, larger parts of the throat have to be removed.

If the cancer has affected the larynx, it is also partially or completely removed. The treating physicians will try to avoid this in order to maintain the greatest possible functionality in this region of the body so that the patient is then still able to breathe, swallow and speak without artificial support.

Operations are mainly used for oropharyngeal and hypopharyngeal carcinomas, since nasopharyngeal carcinomas are usually difficult to access. The location of the throat cancer determines whether the surgeon performs the procedure through the oral cavity or whether he gains access from the outside.

Minimally invasive procedures are often possible. In this so-called keyhole surgery, the doctor inserts the instruments through tiny incisions and controls them with a small camera. A laser is available to him as a particularly gentle surgical technique, with which he removes diseased tissue (laser microsurgery).

If larger areas of the throat or larynx have to be removed, the laser is usually not sufficient, which is why the surgeon uses conventional surgical procedures. If necessary, he reconstructs part of the removed throat using the body's own tissue in order to maintain functionality. He takes the tissue, for example, from the skin of the forearm.

Patients often need a period of training afterwards before they are able to speak and swallow independently again. If the doctor has to remove the larynx completely, artificial aids are necessary afterwards.

As a rule, the doctor also carries out a so-called neck dissection. This means that he removes the lymph nodes on the neck in the affected area. This is usually the case even if they are not swollen. Because the risk is relatively high that cancer cells are also located there.

radiotherapy

In radiation therapy (radiotherapy), medical professionals direct ionizing radiation directly onto the diseased tissue. The cells are said to be so badly damaged that they die and no longer divide. Radiation therapy also attacks healthy tissue. Although this regenerates itself to a certain extent, it is very important in this throat cancer treatment to limit the attack on the cancer cells locally and not to choose too high the dose.

In the early stages, radiation therapy may be sufficient as the sole treatment method. Mostly, however, it is used in combination with chemotherapy or the doctor uses it after an operation to remove any remaining cancer cells.

Chemotherapy and targeted therapies

As a third treatment for throat cancer, various drugs are available to the oncologist. Similar to radiation therapy, the following applies to chemotherapy: Doctors carefully weigh up in which cases and at what point in time they use chemotherapy - for example before or after an operation. Because the active ingredients also attack healthy body cells, which is why this throat cancer treatment is usually associated with severe side effects.

So-called targeted therapies are still relatively new in cancer medicine. They are so called because they attack more punctually. Because of this, the side effects are also lower.Cetuximab is an important active ingredient for throat cancer that originates in the mucous membranes. This is a so-called monoclonal antibody. Put simply, it blocks a certain signaling pathway that tumor cells need to grow.

How is throat cancer diagnosed?

During the diagnosis, the doctor checks whether throat cancer is actually the cause of the symptoms. In the next step, he examines how much the throat cancer has already spread. In addition, he uses laboratory tests to clarify whether human papillomaviruses (HPV-16) could possibly trigger the cancer. Because that may influence the choice of therapy. This is essentially what happens when diagnosing throat cancer:

Inventory: In a detailed discussion (anamnesis), the doctor asks about the complaints and the patient's history. He also wants to know whether there are any risk factors such as excessive alcohol consumption or nicotine consumption.

Laryngoscopy (laryngoscopy): The doctor visually examines the pharynx with mirrors, using several mirrors that he turns against each other in order to look around the corner, so to speak (indirect laryngoscopy). Alternatively, he uses a so-called magnifying laryngoscope. This is a kind of tube with a prism at the end that the doctor turns in different directions. If throat cancer is suspected during these examinations, a direct larynxoscopy under anesthesia usually follows. To do this, the doctor pushes a tube into the pharynx, fixes it and guides another tube with a camera through it.

Tissue removal (biopsy): During a larynxoscopy, the doctor carefully takes a tissue sample that is later analyzed in the laboratory. Among other things, it is determined how aggressive the throat cancer is and whether HPV-16 was involved in its development.

Imaging procedures: Various imaging procedures are used to narrow down the location and spread of the tumor more precisely. They are also important in preparing for the operation if necessary. Ultrasound (sonography), magnetic resonance tomography (MRT) and computed tomography (CT) are mainly used. There is also the option of combining CT with positron emission tomography (PET). PET shows the sugar metabolism, which is increased in tumor tissue.

How does throat cancer develop?

Throat cancer occurs when healthy cells in the throat mutate into malignant cancer cells that grow uncontrollably. Genetic changes in the genome are to blame. How these arise, however, is not exactly clear. It is therefore not possible to name the causes of throat cancer. However, medicine has identified some risk factors:

Certain changes in the mucous membrane are considered to be a preliminary stage for throat cancer. This includes the so-called white callous disease (leukoplakia), in which the mucous membrane thickens. It can be recognized through whitish spots in the throat.

Excessive alcohol and nicotine consumption are among the few risk factors that can be avoided. In combination, they are particularly dangerous. Since their harmful effects only become apparent over time, throat cancer becomes more common after the age of 60. Doctors suspect that these risk factors also contribute to the fact that throat cancer symptoms are increasingly discovered in women. Because the proportion of female smokers has increased over the past few decades.

There is a relationship between developing throat cancer and infections with certain viruses. These are human papilloma viruses (HPV-16) and Ebstein-Barr virus (EBV). HPV is sexually transmitted, and studies have shown that frequent oral sex increases the risk of throat cancer.

Prevent

It is not possible to reliably prevent throat cancer until the exact causes are clarified. Genetic changes cannot always be prevented. However, you can significantly reduce the likelihood of developing cancer by using alcohol in moderation and refraining from smoking. It also contributes to prevention that. The most important things for this are: