The term Throat cancer is a general terminology where cancer cells can be along anywhere from the oral cavity to below the larynx. The change in the normal lining of cells in each of these areas to a level of continuous mutation happens when cancer in the specific area occurs.
Differentiating areas
Nasopharynx
This is the area behind the nose till the roof of your mouth, lined by pseudo-stratified columnar epithelial cells. When the character of this lining changes, it may be considered as cancer cells.
Oropharynx
The area from the back of your mouth till the tonsils is Oropharynx. The occurrence of cancer is similar to that of nasopharynx changes. But the lining is the stratified squamous non-keratinising epithelium.
Hypopharynx
Hypopharynx is the part of the pharynx just till the opening of the oesophagus or trachea, lined by stratified squamous epithelium.
Other areas include - Glottis, the supraglottis (till the vocal cords) and subglottis.
Common symptoms
They are similar to all cancers.
- Unexplained loss of weight in a short amount of time.
- Decreased appetite.
- A sore or a lump with continuous pain and a non-healing ulcer growing bigger in size as the day passes.
- Unable to swallow even liquids, difficulty in swallowing solids.
- General myalgia.
- Easy fatiguability.
- May be associated with cough, cold, on and off high fever, vomiting, Diarrhoea or any other opportunistic infections.
Risk factors
The cause of any cancer is the mutation of cells. In Throat carcinoma, the mutations can be triggered by the following lifestyle living/conditions:
- Smoking cigarettes.
- Chewing tobacco or other forms like quid (Indian oral cancer).
- Alcohol substance abuse.
- Exposure to toxic substances - e.g. Asbestos
- Non-healing oral ulcer either caused by bad diet or sharp molar teeth.
- Chronic gastritis led by GERD.
- Viral infections that affect the oral region like - HPV, EBV, etc.
- Can occur as secondary cancers.
- Family history.
What can you do to prevent Throat cancer?
- Exercise - Exercising releases T-cell mediated cells, which help in creating immunity against cancer cells.
- Diet - A balanced diet can help, especially including fibre-rich vegetables and a lot of fruit intake.
- Abstinence - From smoking, tobacco chewing, quid, ghutka, etc.
- Reduced intake of alcohol.
- Protection from viral infection by taking proper precautions. E.g. - contraceptive protection methods.
Diagnoses and staging
1. Endoscopy
2. Laryngoscopy
3. Biopsy - taken during the scope procedures; if any, the abnormal lining of cells is located. The test looks out for cancer and viral cells.
4. Scans - CT (plain or contrast), MRI, PET - These help in determining the spread of cancer. With the metastasis known, along with lymph nodes involved, the staging is predicted accordingly.
5. Staging - It is a theoretical value with which the doctors determine the type of anti-cancer therapy the patient can undergo. It also helps to see if the patient is improving with treatment or not, plus if there can be a recurrence in the near timeline.
6. TNM - Staging involves three factors - Tumour size, number of nodes involved and amount of Metastases.
7. It can range from Stage 0, which is benign, to Stage 4, an advanced staging where morbidity and mortality are high.
Treatment modes
The therapy is determined after staging the tumour through proper examination.
Surgical procedures
It varies from focal removal of the tumour and a single node to wide dissection of nodes and tumour cells. Doctors prefer proper surgery to lasers or robotic techniques. It may or may not be followed by radiotherapy and chemotherapy, depending on the extent of spread and condition of the patient.
Laryngectomy, pharyngectomy and tracheotomy may be done depending on the metastases and easy approachability for the doctors during the procedure.
Complications in all the procedures
Certain common complications may occur, which include,
- Injury to recurrent laryngeal nerve - incessant cough with change in voice.
- Speech difficulty.
- On-table excessive bleeding.
- Infection
- Leaving behind any affected node or part of the tumour - which can metastasise again, probing recurrence.
- Difficult in chewing and swallowing both liquids and solids.
Radiotherapy
Radiation focused on the particular tumour area, causing the cancer cells to rot away. It may require a few sitting, after which a PET scan is done again to determine the reduction of cancer cells in the targeted area.
Side effects
- Skin changes occur in the targeted area.
- Stiffness of neck.
General myalgia and easy fatigue ability due to the treatment session. Suppose there are any vomiting or other side effects; consult a doctor before starting any medications.
Chemotherapy
It is used side by side with radiotherapy. Drugs used to make the tumour cells more sensitive to the radiation, thus killing them in the process. The side effects are similar but the feeling is doubled. In case of any major issues, you may approach the consulting physician.
Other drugs, which are called targeted drug therapy, are used in certain cases of Throat cancer either alone or in combination with the other two modalities.
Both radio and chemo are used sometimes before surgery to reduce the area of removal; then, a dissection procedure is done, and then again, the therapy is given to make sure the cancer cells are completely killed.
Immunotherapy - Used in certain patients where the immune system is advanced in damage.
Palliative care - It is all-around counselling for both the patient and the concerned family members. As the treatment for cancer can take a toll on the mental health of all family members, proper counselling, pain and side effect management and nutrition support by the health care professionals provide the appropriate supportive care needed.
Recurrence - The recurrence rate is high during the early phase of recovery, but with proper follow-up with the oncologist, the 5-year survival range is made plausible.
Conclusion
Preventive care regime can help you with the prevention of cancer. You can follow proper health care routine like a good diet and regular exercise, no substance abuse and care for a viral infection such as preventive vaccinations (HPV). Need not necessarily mean that people who follow these can’t get oral cancer, so follow up with your doctor on a regular basis to intervene as early as possible.
