Throat cancer (larynx cancer) facts*
HPV infection, cigarette smoking, alcoholism, and asbestos exposure are risk factors for throat cancer.
*Throat cancer (larynx cancer) facts author: Melissa Conrad Stöppler, MD
- The larynx is the voice box located at the top of the windpipe (trachea).
- Cancer of the larynx occurs most often in people over the age of 55 years.
- People who stop smoking can greatly reduce their risk of cancer of the larynx.
- Painless hoarseness can be a symptom of cancer of the larynx.
- The larynx can be examined easily with a viewing tube called a laryngoscope.
- Treatment of cancer of the larynx depends on the location and size of the tumor, as well as the age and health of the patient.
- Cancer of the larynx usually is treated with radiation therapy or surgery. Chemotherapy can also be used for cancers that have spread beyond the larynx.
Throat Cancer Symptoms and Signs
Throat cancers may not cause any symptoms if they are very small and have not spread at the time of diagnosis. Sometimes, an area of irritation or discoloration on the lining issues of the throat is the only sign of an abnormality. Depending upon the extent of spread of the cancer, other symptoms can include:
- swelling of nearby tissues,
- enlarged lymph nodes,
- trouble breathing,
- difficulty speaking,
- neck or throat pain,
- ear pain,
- painful swallowing, and
Pain or ringing in the ears may occur in some cases. Bleeding can occur from some throat cancers.
What is throat (larynx) cancer?
Throat cancer (laryngeal cancer) is a general term that usually refers to cancer of the pharynx and/or larynx (voice box). Regions included when considering throat cancer include the pharynx (nasopharynx, oropharynx, hypopharynx [cancers that occur in the tissues of the throat adjacent to the larynx], glottis, supraglottis, and subglottis); about half of throat cancers develop in the larynx (the part of the throat with the vocal cords), and the other half in the pharynx (pharyngeal cancer). Consequently, any cancers (growth and/or spread of abnormal cells that form tumors or metastasize to other parts of the body) that develop in these regions of the throat are considered throat cancers. For this article, the terms throat cancer and larynx cancer will be interchangeable. The term laryngeal cancer also is used to refer to larynx cancer. Nasopharyngeal cancer and oropharyngeal cancer (mouth and pharynx) or will not be discussed in this article.
Some investigators consider throat cancers a subset of esophageal cancers. For this article, only throat cancers will be discussed. Esophageal cancers have the potential to cause throat symptoms such as burning or pain (pressure) in the throat as well as the chest since they can extend throughout the esophagus from just below the pharynx to the junction of the esophagus and stomach. Moreover, esophageal cancers may include all of the throat cancer signs, symptoms, and most diagnostic and treatment protocols discussed in this article -- particularly when they are located high in the esophagus.
The American Cancer Society statistics suggest that about 12,410 new cases of laryngeal cancer will occur in 2019 (9,860 in men and 2,550 in women), with about 3,760 deaths. Five-year survival rates vary somewhat with the location of the cancer and its stage (see below). Most types have a 5-year survival rate in stage I and/or II that range from about 53%-64% except for those that occur in the glottis (the part of the larynx including the vocal cords), which is about 74%-90%. Stages III-IV 5-year survival varies from about 6%-24%, with stage IV having the lowest 5-year survival rate.
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What causes throat cancer?
Although it is not clear exactly what causes throat cancers, the cancerous cells develop when genetic mutations allow the cells to grow uncontrollably to form tumors (masses of cancer cells) that may metastasize (spread) to other areas in the body. Some of the factors that can lead to genetic mutations in the cells of the throat include cigarette smoking, infections with the human papillomavirus (HPV [or HPV-related infections]), and exposure to toxic substances like asbestos or large quantities of alcohol.
What are the risk factors for throat cancer?
Some of the risk factors for throat cancer are related to lifestyle. For example, individuals can increase the risk of such cancers by smoking or using other tobacco products, chewing betel nuts (a common practice by South Asians), drinking excess alcohol, and consuming insufficient vitamin A. Exposure to asbestos, poor dental hygiene, and especially exposure to HPV human papillomavirus are also risk factors in some case-control studies. HPV exposure is significant because about 50% to 90% of squamous cell carcinomas (squamous cell cancer), the most common type of throat cancers, have been linked to HPV infections that can be acquired with oral sex. Some researchers think infection with the Epstein-Barr virus is a risk factor. In addition, being male and/or having an African-American heritage also increases risk.
Cancer is the result of the uncontrolled growth of abnormal cells anywhere in the body.
What are the types of larynx (throat) cancer?
The types of larynx (throat) cancers are as follows:
What are the symptoms and signs of throat cancer?
The symptoms and signs of throat cancer often vary from person to person. The most common signs and symptoms of throat cancer are nonspecific. Not every patient will exhibit each sign and symptom of these throat cancer symptoms, but each patient will usually have at least one or two of the following:
As stated above, these symptoms and signs are not diagnostic for throat cancer because many other problems can mimic the throat cancer. However, any person who develops these signs and symptoms and has risk factors for throat cancer should immediately discuss them with his or her physician.
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How do health care professionals diagnose throat cancer?
The person's individual history (especially the presence of potential risk factors) and physical examination may provide a physician with enough suspicious information that the physician will consider throat cancer as a possible diagnosis. Consequently, the physician may strongly suggest doing additional tests to confirm or exclude the diagnosis of throat cancer. Although imaging tests such as CT, MRI, PET scan, and others like chest X-rays, laryngoscopy, and barium swallows provide very useful information about extent and location of the cancer, the definitive diagnosis of throat cancer is made by biopsy of the tumor. Biopsy may be done by surgical incision in the neck, fine needle aspiration of the tumor, or by an endoscopic biopsy.
How do health care professionals determine throat cancer staging?
Throat cancer staging is determined by a TNM staging system. The system was developed by the American Joint Committee on Cancer (AJCC) and is presented below.
AJCC Cancer Staging
- T stands for tumor (how far it has spread within the larynx or pharynx and to nearby tissues).
- N describes whether the cancer has spread to nearby lymph nodes.
- M stands for metastasis (spread of the cancer) to distant organs.
All of this information is combined to arrive at a disease stage. After stage 0 (which is carcinoma in situ or cancer that has not grown beyond the cells lining the throat), stages are labeled using Roman numerals from I through IV (that is, 1 through 4). The smaller the number, the less the cancer has spread. A higher number, for example stage IV, indicates a more serious stage of the disease.
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What kinds of specialists treat throat cancer?
Most institutions take a team approach to each individual with throat cancer. In general, depending upon the extent of the individual's cancer (see, TMN system above), a person's team of specialists (usually board-certified) may include the following:
- Plastic surgeons
- Radiation oncologists
- Swallowing experts
- Speech pathologists
- Therapists (physical, occupational, and speech)
The involvement of many specialists has been found to provide an individual with the best chance of treating and/or surviving the various types of throat cancers, follow-up treatments, and reducing symptoms. These specialists also can identify local support groups that can help the patient and family members cope with the lifestyle changes needed to live well with the disease.
What is the treatment for throat cancer?
The treatment for throat cancer depends upon the extent and seriousness of the disease. As stated by the MD Anderson Cancer Center and others, treatment is tailored to the individual to provide him or her with the best chance for a successful outcome. Treatment strives to preserve the patient's ability to eat, speak, and live a normal healthy life. Treatment plans for throat cancers usually include one or more of the following techniques: surgery, radiation therapy, chemotherapy, proton therapy, targeted therapies, and possibly participation in throat cancer clinical trials. Brief descriptions of the major components for throat cancer therapy are as follows:
- Surgery: There are many types of surgery for throat cancer, including minimally invasive, transoral laser microsurgery, endoscopic, laser, robotic, and tumor excision surgery, like supracricoid partial laryngectomy to allow more normal function in swallowing and speech without a stoma (a surgically made opening in the neck that allows breathing).
- Chemotherapy: These are anti-cancer drugs used to shrink tumors and/or kill cancer cells after surgery and/or radiation treatment. Chemotherapy (for example, cetuximab [Erbitux]) often is used in combination with other therapies.
- Radiation therapy: Brachytherapy involves placement of radioactive beads close to a tumor. 3-D radiation beam therapy and intensity-modulated radiotherapy may be tailored to the specific shape of the tumor. Often, radiation may be used as a first-line treatment; high-energy radiation beams may destroy or shrink the tumor.
- Proton therapy: This radiation doses using pencil beam technology directed at the tumor while preserving nearby healthy tissue.
- Targeted therapies: These drugs are used to stop the growth of cancer cells by interfering with proteins and/or other receptors on cancer cells.
- Cancer clinical trials: This involves the use of experimental drugs or other methods that may show promise in survival and/or reduction in clinical symptoms.
Side effects of treatment vary from person to person. However, some of the most common side effects include inflammation of mucous membranes, dry mouth, skin changes (especially after radiotherapy), nausea and vomiting (especially with chemotherapy), fatigue, sore throat, difficulty swallowing, increased sticky phlegm production, loss of appetite, loss of taste, hair loss, and breathing difficulties. In many patients who develop side effects, most effects will last from a few weeks to a few months although in a few patients they may remain indefinitely.
Are there home remedies for throat (larynx) cancer?
There are no home remedies that can cure throat cancers. However, there are home remedies that might reduce some of the symptoms in some patients. They are not medically recommended as initial or first treatments but like most home remedies may reduce some symptoms in certain patients. They are as follows:
Patients should discuss with their doctors the use of these home remedies before trying them.
What kind of support is available for those with throat cancer?
Most treatment methods involve continued support for those with throat cancer. Patients receive rehabilitation support such as physical, occupational, and speech therapy. Other patients may require additional surgical treatment such as reconstructive surgery and/or dental implants. In addition, speech pathologists, audiologists, and experts in swallowing rehabilitation may be needed. Support groups may provide additional helpful advice about coping with the disease.
What is the prognosis for patients with throat cancer?
The prognosis or outcome for patients with throat cancer varies with the stage and location of the cancer. Most prognostic indicators are based on a 5-year relative survival rate that varies with the type of cancer and its stage. The best survival is in cancer of the glottis (90%) and worst is in cancer of the hypopharynx (53%), both beginning at stage I over a 5-year period. Unfortunately, in all individuals with throat cancer, the 5-year survival rate declines as the stages progress from 1 to IV. Consequently, the earlier the cancer is diagnosed (early-stage) and treated the better the potential outcome.
Is it possible to prevent throat cancer?
Although general throat cancer screening is not available, those individuals that are at higher risk for throat cancer may need to see their physicians if any signs and symptoms raise suspicion of throat cancer. Consequently, those who are at increased risk such as individuals who smoke or who may have been exposed to HPV, asbestos, nickel, or sulfuric acid fumes are at higher risk. Avoiding such risky situations can reduce the risk of throat cancer but there is no guarantee that it can be prevented. However, one excellent way to reduce the cancer risk is to have young men and women be vaccinated with the HPV vaccine.
American Cancer Society. "Key Statistics for Laryngeal and Hypopharyngeal Cancers." Jan. 8, 2019. <https://www.cancer.org/cancer/laryngeal-and-hypopharyngeal-cancer/about/key-statistics.html>.
"Survival Rates for Laryngeal and Hypopharyngeal Cancers by Stage." American Cancer Society. Aug. 8, 2016. <https://www.cancer.org/content/cancer/en/cancer/laryngeal-and-hypopharyngeal-cancer/detection-diagnosis-staging/survival-rates.html>.