Throat Cancer

Diagnosis

To diagnose throat cancer, your doctor may recommend several procedures:

Using a scope: During an endoscopy, a special lighted scope (endoscope) with a camera is used to examine the throat for abnormalities. Laryngoscopy uses a magnifying laryngoscope to inspect the vocal cords.

Tissue sampling: If abnormalities are found, a biopsy may be taken through the scope. Pathologists examine the tissue for cancer cells and may test for HPV, which can influence treatment options.

Imaging tests: CT, MRI, and PET scans may be performed to determine the extent of cancer beyond the throat or voice box.

Staging

After diagnosis, determining the stage of cancer is essential for guiding treatment. Throat cancer stages are classified using Roman numerals I through IV. Stage I usually indicates a small tumor confined to one area, while stage IV indicates advanced disease that may have spread.

Treatment

Treatment for throat cancer depends on tumor location, stage, HPV status, overall health, and personal preferences. Treatment options include radiation therapy, surgery, chemotherapy, targeted drug therapy, immunotherapy, and rehabilitation.

Radiation therapy: High-energy beams from X-rays or protons target and kill cancer cells. External beam radiation comes from outside the body, while brachytherapy involves placing radioactive material near the cancer. Radiation may be used alone for small cancers, combined with surgery or chemotherapy for more advanced tumors, or to relieve symptoms in very advanced cases.

Surgery: Surgical options vary depending on the tumor’s size and location.

• Endoscopic surgery: Removes small surface tumors using a scope and laser or surgical instruments.
• Laryngectomy: Partial removal preserves some of the voice box, while total removal requires a stoma and may involve speech rehabilitation.
• Pharyngectomy: Removes parts of the throat, with reconstruction to maintain swallowing function.
• Neck dissection: Removes lymph nodes if cancer has spread to the neck.

Surgery carries risks including bleeding, infection, and potential speech or swallowing difficulties.

Chemotherapy: Uses drugs to kill cancer cells, often combined with radiation to enhance effectiveness. Side effects are higher when combined therapy is used.

Targeted drug therapy: Targets specific defects in cancer cells. Drugs like cetuximab (Erbitux) inhibit proteins prevalent in certain throat cancers. Targeted therapies may be used alone or with chemotherapy or radiation.

Immunotherapy: Boosts the immune system to attack cancer cells that hide from immune responses. Generally reserved for advanced, treatment-resistant throat cancer.

Rehabilitation after treatment: Specialists may help with swallowing, eating, speech, and care of a stoma if present. Neck stiffness, pain, and other post-treatment complications may also be addressed.

Supportive (palliative) care: Focuses on symptom relief and quality of life, provided alongside curative treatments. Palliative care teams work with patients, families, and other doctors to improve overall well-being during and after treatment.