throat cancer

Throat Cancer 101: Symptoms, Causes, Types, Treatment & Prevention

Find out more about throat cancer, a type of head and neck cancer, and its related signs and symptoms and treatment options.

by Grace Koh

Throat cancer often refers to cancers in the neck and throat region. Nine times more common in men than women, find out more about how it is diagnosed, and about its treatment and prevention. 

What is Throat Cancer?

Throat cancer is a type of head and neck cancer. It has different names, depending on which part of the throat is affected, either the throat itself or the voice box. The throat is a muscular tube that begins behind the nose and ends in the neck.  Situated below the throat is the voice box, and it contains the mechanisms which help us to make sounds when we talk. Throat cancer usually begins in the flat cells that line the insides of the throat. You can find out more about how cancers occur in our Cancer 101 article. 

In Singapore, throat cancer is nine times more likely to occur in men than women. A report in 2018 on cancers in Singapore, throat cancer was among the top 10 cancers in Chinese and Malay male populations, and is 20 to 30 times more common in Chinese populations, especially the Cantonese dialect group. It also usually affects male adults aged  30 years to 59 years old in males, and for females between age 40 to 49 years. With early detection, throat cancer is curable

Types of Throat Cancer

To identify the type of throat cancer one has, the region where the cancer is found determines the type of throat cancer. Below are the various types of throat cancer: 

  • Nasopharyngeal cancer begins in the part of the throat just behind your nose. 
  • Oropharyngeal cancer begins in the part of the throat right behind your mouth that includes your tonsils. 
  • Hypopharyngeal cancer begins in the lower part of your throat, just above your esophagus and windpipe.
  • Glottic cancer begins in the vocal cords, the mechanisms in your voice box to help you produce sounds when you speak. 
  • Supraglottic cancer begins in the upper portion of the voice box and includes cancer that affects the epiglottis, which is a body part preventing food from going into your windpipe as you eat. 
  • Subglottic cancer begins in the lower part of your voice box, below your vocal cords.

In Singapore, the most commonly diagnosed type of throat cancer is nasopharyngeal cancer. 

What Are the Causes of Throat Cancer? 

Throat cancer occurs when cells in your throat mutate, and cause cells to grow uncontrollably and continue living after the usual time health cells should die. These cells gather together and form a tumour in your throat or voice box. There are no known causes of throat cancer, but there are risk factors which are highly related to instances of getting the cancer. Read below for signs and symptoms of throat cancer, and also its associated risk factors.

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Symptoms of Throat Cancer 

Some symptoms of throat cancer are listed below. To suspect throat cancer, a person does not need to present with all the symptoms below.

  • Coughing 
  • Difficulty swallowing 
  • Voice changes, such as hoarseness and not being able to speak clearly 
  • Pain in ears
  • Sudden unexplained weight loss 
  • Persistent sore throat 
  • Painless lump in the neck, which is the most common symptom 
  • Blood in saliva 
  • Excessive mucus secretions
  • Hearing loss or blocked ear/ears which do not resolve
  • Blocked nose
  • Blood stained nasal discharge
  • Ringing sound in the ear 
  • Discharge from the ears 

Risk Factors of Throat Cancer

A risk factor is anything which increases your chances of getting a disease. Some risk factors can be changed, and some cannot, such as family history. Do note that risk factors do not determine that you will get the disease, but rather puts you at higher risk of it. In fact, most people who get the disease may not have many of these risk factors. 

Some common risk factors for throat cancer include: 

  • Having a family history of throat cancer 
  • Being male; throat cancer is three times more likely to be found in males than females 
  • Viral infections, including the Epstein Barr Virus and human papillomavirus (HPV), which has been shown to have some link to throat cancer
  • Consuming preserved foods, such as salted fish, meat and vegetables. Some examples include salted soy beans, canned pickled vegetables, and szechuan vegetables – cooking such foods releases toxic substances into the fumes which are then inhaled into the body 
  • Smoking and tobacco use 
  • Excessive alcohol consumption 
  • Vegetable and fruit-deficient diet
  • Exposure to toxic substances at work 

Diagnosing Throat Cancer

If you notice any persistent signs and symptoms, do make an appointment with your doctor. As most throat cancer symptoms are not unique to cancer, your doctor will likely look into other more common causes first, before suspecting cancer. 

If throat cancer is suspected, your doctor may refer you for a nasal endoscopy. This involves inserting a thin flexible tube, less than a centimetre in diameter, mounted with a camera on one end, through your nostril to the back of the throat. The doctor can then check the throat for any lumps or ulcers in the voice box and surrounding areas. Alternatively, your doctor may place an angled mirror against the back of the throat. This angled mirror faces downwards, so your doctor can examine the voice box and surrounding organs.  A simple tissue sample, otherwise known as a biopsy, may also be removed for laboratory testing. 

Stages of Throat Cancer

Stage 0 Throat Cancer

This is the beginning of the scale. At this stage, there are abnormal cells in the throat lining, which can potentially become cancerous.

Stage I Throat Cancer

At this early stage, the tumour is not more than two centimetres large, and the cancers have not reached the lymph nodes, which are the parts of the body’s immune system to protect and fend off foreign invaders, such as viruses. 

Stage II Throat Cancer

The tumour is larger than two centimeters but not more than four centimeters in size. Like Stage I, the cancer has not reached the lymph nodes.

Stage III Throat Cancer

Stage III throat cancer describes cancer that is either larger than four centimeters or has spread to a lymph node on the neck, on the same side as the tumour. That lymph node is also smaller than three centimeters.

Stage IV Throat Cancer

The most advanced stage of throat cancer, the tumour could be at any size, but has spread:

  • Beyond the neck to other neighbouring parts of the body, such as the jaw, food pipe etc
  • To one large lymph node greater than three centimetres in size, on the same side of the neck as the tumour
  • To many lymph nodes of any size on the same side of the neck as the tumour
  • To one lymph node of any size on the side of the neck opposite the tumor
  • Beyond the neck to parts of the body beyond the throat, such as the lungs 

Throat cancers at stage III and IV are more likely to recur after initial treatment than earlier stage cancers. 

Throat Cancer Treatment

Treatment for throat cancer involves various methods, such as radiotherapy, surgery, or chemotherapy. They can be used individually, or are sometimes combined with other treatments to help to get rid of the cancer. 

Radiotherapy uses a high dosage of x-rays at a targeted site to destroy cancer cells, while chemotherapy is the use of toxic drugs to kill cancer cells. 

Depending on the stage of cancer and the type of throat cancer, appropriate treatment forms will be chosen for maximum effectiveness. Below are some of the common treatment types for this form of cancer.

Treatment for Throat Cancer

Nasopharyngeal Cancer 

Nasopharyngeal cancer responds well to radiotherapy. If the cancer is detected early, it is possible to cure it with radiotherapy. The back of the throat, and sometimes to the lymph glands in the neck are often targeted for radiotherapy. 

Surgery plays a limited role in nasopharyngeal cancer as it is difficult to remove the tumour without causing harm to the neighbouring organs. If there is a return of nasopharyngeal cancer in an area which once received radiotherapy, surgery can be used to remove the recurrence. 

Chemotherapy is sometimes used in treating nasopharyngeal cancer. Its role in nasopharyngeal cancer treatment is limited to 2 situations: Advanced nasopharyngeal cancer which has spread to the bones, liver, and lungs, and in combination with radiotherapy to improve treatment effectiveness.

Oropharyngeal Cancer 

The usual treatment of oropharyngeal cancer is surgery, to remove the cancerous growth. 

Radiotherapy may be used as well, and chemotherapy as an option in earlier stages of the cancer. 

Surgery is used to remove the cancerous tumours. 

Chemotherapy with or without radiotherapy may be offered at later stages, especially if the cancer has spread and cannot be removed by surgical means, or if the individual is too weak for surgical options.

Immunotherapy, the use of medicines that help a person’s own immune system find and destroy cancer cells, may also be recommended at later stages. 

Hypopharyngeal Cancer

Like oropharyngeal cancer, the main treatment for this kind of cancer is surgery. As hypopharyngeal cancer tends to spread to the lymph nodes, removal of lymph nodes is often recommended as well. 

Treatment means surgery with or without radiotherapy as treatment options. Surgery may remove all or part of the throat, as well as lymph nodes on one or both sides of the neck. The voice box is often removed as well. If post surgery, it is suspected that the cancer has a high chance of returning after the surgery, radiotherapy or chemotherapy combined with radiation will be offered as treatment. 

Radiotherapy can be used too, in conjunction with chemotherapy to treat the cancer. If there are any remains of the cancer after treatment, surgery can be done to try to remove it. Radiotherapy is also done for cancers which are too big or have spread too far to be completely removed by surgery. 

Chemotherapy is also sometimes used as a standalone treatment choice, with the involvement of radiotherapy and surgery as needed. 

Laryngeal Cancer (Glottic Cancer, Supraglottic, Subglottic Cancer)

Radiotherapy is often used to treat early stages of laryngeal cancer. This allows for the voice box to be preserved for use of speech. Surgery is used when radiotherapy fails to destroy the cancer. Surgery removes the patient’s voice box.  More advanced tumours can be treated with a mix of radiotherapy and chemotherapy, or surgery followed by radiotherapy. 

Throat Cancer Prevention

There’s no proven way to prevent throat cancer from occurring, however, you can reduce your risk of this cancer by doing the following:

  • Stop smoking if you do, and don’t smoke if you don’t.
  • Drink, but in moderation. This means up to one drink a day for women and two drinks a day for men. 
  • Eat a wide variety of fruits and vegetables. The vitamins and antioxidants in fruits and vegetables may reduce the risk of throat cancer, and it keeps you healthy as well. 
  • Practise safe sex. HPV has been linked to some throat cancers. Limit the number of sexual partners you have, or use protection before any sexual intercourse. You can ask your doctor about the HPV vaccine as well.

Find out more about other cancer related resources in our Cancer 101 article

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References
  1. National Registry of Diseases Office. (2018). Singapore Cancer Registry Annual Report 2018. https://www.nrdo.gov.sg/docs/librariesprovider3/default-document-library/scr-annual-report-2018.pdf?sfvrsn=bcf56c25_0
  2. National University Cancer Institute Singapore. (2021). Head and Neck / Nasopharyngeal Cancer. National University Hospital. https://www.ncis.com.sg/Cancer-Information/About-Cancer/Pages/Head-and-Neck-or-Nasopharyngeal-Cancer.aspx
  3. Laryngeal and Hypopharyngeal Cancer. (2021). American Cancer Society. https://www.cancer.org/cancer/laryngeal-and-hypopharyngeal-cancer.html
  4. Mayo Foundation for Medical Education and Research. (n.d.). Throat Cancer. Throat Cancer. https://www.mayoclinic.org/diseases-conditions/throat-cancer/symptoms-causes/syc-20366462?p=1
  5. Nasopharyngeal Cancer. (2016). Singapore Cancer Society. https://www.singaporecancersociety.org.sg/learn-about-cancer/types-of-cancer/laryngeal-cancer.html
  6. Oral Cavity (Mouth) Cancer Treatment Options, by Stage. (2021). American Cancer Society. https://www.cancer.org/cancer/oral-cavity-and-oropharyngeal-cancer/treating/by-stage.html
  7. Throat Cancer. (2021, February 23). Throat Cancer | Throat Cancer Symptoms | MedlinePlus. https://medlineplus.gov/throatcancer.html
  8. Throat Cancer Stages. (n.d.). Memorial Sloan Kettering Cancer Center. https://www.mskcc.org/cancer-care/types/throat/throat-cancer-diagnosis/throat-cancer-stages
About the Writer
Grace Koh
Apart from reading, singing, and plodding up muddy trails, Grace enjoys scribbling notes and thinking up a storm. Her day job as a speech therapist involves helping children communicate, educating parents, and playing with lots of bubbles.
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