Throat cancer

What is throat cancer?

The throat (also called the pharynx) is a hollow tube that starts behind the nose and leads to the food pipe (oesophagus) and the windpipe (trachea).

Throat cancer is a head and neck cancer and refers to cancer that can start in the pharynx or larynx (voice box), but may also refer to cancers beginning in the oesophagus or thyroid.

About 600 people in Victoria are diagnosed with cancer of the throat each year.

The two main types of throat cancers are:

• pharyngeal cancer (of the pharynx)
• laryngeal cancer (of the larynx or voice box)

Mouth cancer is also a head and neck cancer.

Cancers that begin in the tissue or lymph nodes in the throat and occur in the mouth, tongue, salivary glands, sinuses, nose or ear are grouped under the term – head and neck cancers.

Pharyngeal cancer

This type of throat cancer can affect 3 parts of the pharynx, including the:

• Nasopharynx (known as nasopharyngeal cancer) – affects the upper part, behind the nose and soft palate.
• Oropharynx (known as oropharyngeal cancer) – affects the middle part, including the soft palate, base of the tongue and the tonsils.
• Hypopharynx (known as hypopharyngeal cancer) – affects the lower part around the voice box (larynx).

Oropharyngeal cancer is on the rise in Victoria – 70% of oropharyngeal cancers are caused by the human papillomavirus (HPV), the same virus that causes cervical cancer.

Laryngeal cancer

Cancer that starts in the larynx (voice box) is called laryngeal cancer.

The larynx (or voice box) is a short passage connecting the lower part of the throat (hypopharynx) with the windpipe (trachea). The thyroid gland sits in front of the trachea under the voice box.

Parts of the larynx include the:

• Epiglottis – the small flap of tissue that moves to cover the larynx to prevent food going into the trachea and lungs when you swallow.
• Glottis – contains the vocal cords that vibrate when air passes through them to produce the sound of your voice.
• Subglottis – located below the vocal cords.

How throat cancer spreads

The membranes of the throat are lined with flat, firm cells called squamous cells. Throat cancers can originate in these surface cells.

Without treatment, squamous cell carcinoma can spread into deeper tissue – including muscle and bone, or to the lymph glands in the neck.

Some types of thyroid cancers can quickly invade nearby structures (such as the trachea). If not treated, the enlarging tumour can compress the trachea and cause breathing problems.

Throat cancer can also migrate to parts of the body (such as the lungs), so it’s important to diagnose and treat early.

Symptoms of throat cancer

Throat cancer can be treated if diagnosed at an early stage, so it’s important to see your doctor immediately if you notice any changes to your throat or neck.

In early stages, symptoms of throat cancer may not be noticeable.

Some throat cancer symptoms can be like symptoms of other illnesses, so it doesn’t necessarily mean you have cancer. The only way to tell, is to make an appointment with your GP and have the necessary tests to confirm a diagnosis.

Symptoms of throat cancer may include:

Risk factors for throat cancer

Throat cancer risk factors include:

• smoking or chewing tobacco
• heavy alcohol consumption
• human papillomavirus (HPV)
• Epstein-Barr virus (EBV) – the virus that causes glandular fever
• family history of cancer (a genetic predisposition)
• Poor diet
• chronic goitre (enlargement of the thyroid gland)
• radiation exposure
• being overweight or obese.

Tobacco, alcohol, and throat cancer risk

Smoking and drinking alcohol are major risk factors for throat cancer. Using tobacco (including smoking cigarettes or cigars), exposes your mouth to cancer-causing substances (known as carcinogens).

If you smoke and drink, your risk of developing throat cancer is significantly higher.

Alcohol may enable other carcinogens, (including tobacco), to enter and damage cells.

While smoking and drinking are major risk factors for throat cancer, younger people who are non-smokers and non-drinkers are increasingly being diagnosed with this type of cancer.

HPV and throat cancer risk

The human papillomavirus (HPV) – the same virus that causes cervical cancer – causes 70% of oropharyngeal cancers.

Exposure to HPV primarily through vaginal, anal and oral sex, and it usually clears from the body by itself.

For some people, HPV spread through oral sex can cause persistent oral HPV, which damages cells and leads to oropharyngeal cancer. Symptoms can take months to develop.

The best protection from HPV is by vaccination, given prior to sexual activity commencing.

Diagnosing throat cancer

Diagnosis depends on the nature of your symptoms. Your GP or dentist may do some general tests and refer you to a specialist. A diagnosis of throat cancer may include:

• Your medical history.
• Physical examination of the mouth, throat and neck by your dentist, doctor, specialist
• Blood tests
• Biopsy - a sample of cells or tissue for examination in a laboratory).
• Larynogoscopy – a procedure done under general anaesthetic where a tube with a light and a small camera (laryngoscope) is inserted into your mouth and throat to get a close-up view of any abnormalities.
• Endoscopy of the larynx – a thin tube with a light on the end (known as an endoscope) is inserted through the nose to examine any physical changes.
• Nasendoscopy – a procedure done under local anaesthetic to examine the nose and throat using a thin flexible tube with a light and camera on the end called a nasendoscope.
• Videostroboscopy – a topical anaesthetic is used to numb the nasal passages, then , where a small flexible tube with a camera and strobe light is passed through the nose and down the throat to view the larynx and record vocal cord movements.
• X-ray.
• Ultrasound.
• CT scan.
• MRI (magnetic resonance imaging) scan.
• PET (position emission tomography) scan.
• Thyroid scan (a special x-ray of the thyroid following an injection of radioactive material).

Test results can take a few days to come back.

It is natural to feel anxious waiting to get your results. It can help to talk to a close friend or relative about how you’re feeling. You can also contact Cancer Council on 13 11 20 and speak with a cancer nurse.

Treatment for throat cancer

Treatment depends on the size, type and location of the cancer and whether it has spread. It can include:

• Surgery – the tumour is surgically removed. This may require the partial or total removal of the thyroid, tissue or muscle, or the entire larynx (laryngectomy) or tongue (glossectomy), depending on the location and size of the tumour. Nearby lymph glands may also need to be removed if the cancer has spread.
• Radiation therapy– small, precise doses of radiation target and destroy cancer cells.
• Chemotherapy – the use of cancer-killing drugs, often in combination with radiotherapy. Chemotherapy can be helpful in controlling cancers that have spread (metastases) because the whole body is treated.
• Multi-modal treatments – surgery on larger tumours may be followed with radiation therapy. Chemo-radiotherapy may also be used.
• Long term monitoring – this may include regular examinations and x-rays to make sure the cancer hasn’t come back.
• Ongoing care – this may include speech therapy, dietary advice, regular medical follow-up and counselling.

All treatments have side effects. These will vary depending on the type of treatment you are having. Many side effects are temporary, but some may be permanent. Your doctor will explain all the possible side effects before your treatment begins.

When throat cancer can’t be cured

If your throat cancer has spread to other parts of the body and it is not possible to cure it by surgery, your doctor may still recommend treatment.

Treatment for control of cancer may include:

• chemotherapy
• radiotherapy
• surgery
• immunotherapy
• symptom-relieving medications (or a combination of these).

Treatment may help to relieve symptoms – might make you feel better and may allow you to live longer.

Palliative care for throat cancer

You may hear your doctor call your treatment 'palliative care'. This treatment is not just for people nearing the end of their lives and is designed to manage symptoms rather than cure. The goal is to improve your quality of life and that of your family, friends and carers.

You can receive palliative care at the same time as cancer treatment. The Cancer Council booklet Living with advanced cancer may be helpful to read.

Reducing your risk of throat cancer

Regularly attending your doctor and dentist for check-ups, and flagging any changes to your throat and neck is important.

You can reduce your risk of throat cancer by:

• Quitting smoking – find out more about smoking, vaping and oral health.
• Reducing your alcohol intake.
• Eating a healthy diet – including plenty of non-starchy vegetables and fruit (which are thought to help lower the risk of cancers of the oropharynx and larynx).
• Maintaining a healthy body weight.
• Practising safer sex – using condoms on penises, internal (or female) condoms and dental dams on vulvas and anuses.
• Getting vaccinated against HPV – the vaccine is available for free to all Victorians aged 12 to 25 years. People (under 26 years) who missed the vaccine at secondary school can access free catch-up HPV vaccine from their GP, some pharmacies or local council immunisation provider. The vaccine can significantly reduce the chances of developing HPV-related illnesses (including cervical and oropharyngeal cancers).

Following this advice doesn’t mean that you will never get throat cancer, but it can reduce your risk, and has other health benefits too.

Where to get help

• Your GP (doctor)
• Cancer Council Victoria, Cancer Information and Support Service Tel. 131 120
• Peter MacCallum Cancer Institute Tel. (03)8559 5330
• Victorian Comprehensive Cancer Centre Tel. 03 8559 7160
• Speech Pathology Association of Victoria Tel. (03) 9462 4899
• Multilingual Cancer Information Line Victoria Tel. 13 14 50
• WeCan website helps people affected by cancer find the information, resources and support services they may need following a cancer diagnosis
• Head and Neck Cancer Australia