What is throat cancer?

Laryngeal cancer, also known as throat cancer, occurs in the region between the base of the tongue and the trachea, where the vocal cords are located, in the head and neck area. Throat cancer, also referred to as larynx or laryngeal cancer, is one of the most common types of cancer among head and neck cancers.

What are the symptoms of throat cancer?

Persistent hoarseness lasting more than 3 weeks: Persistent hoarseness is one of the most common symptoms of laryngeal cancer. However, hoarseness is not the sole cause of laryngeal cancer. Various factors such as acute laryngitis, excessive yelling, smoking, reflux, nasal congestion, allergies, thyroid issues, and aging can lead to hoarseness. Sudden changes in voice tone should also be noted alongside hoarseness.

Difficulty swallowing: Difficulty swallowing can be described in various ways. Feeling like there's something stuck in the throat, inability to swallow food completely, pain or burning sensation while swallowing, and the sensation that food is sticking in the throat are all indicative of swallowing problems.

Not every difficulty in swallowing signifies throat cancer. A harmless narrowing of the esophagus known as a stricture can also lead to swallowing difficulties. However, it's important to remember that advanced laryngeal tumors can also cause difficulty in swallowing.

Unintended weight loss: Uncontrolled weight loss can be a symptom not only of throat cancer but also of many other cancers. It's more commonly observed in advanced stages of throat cancer. In cases where 4-5 kg is lost in a short period without intentional effort, seeking routine check-ups can be life-saving.

Shortness of breath: Shortness of breath or wheezing during breathing is also among the symptoms of throat cancer. Particularly if there's a progressively worsening wheezing and shortness of breath, throat cancer should be considered.

Feeling of lump or swelling in the throat

Fatigue

Bad breath

Earache

Unintended weight loss

Many of these symptoms can stem from non-cancerous health issues. Especially in individuals who have smoked and consumed alcohol for many years, similar symptoms may arise.

These symptoms, indicative of throat cancer, can also arise from non-cancerous causes.

Chronic laryngitis, smoking, reflux, vocal strain, non-malignant benign tumors, growths of tissue known as laryngeal nodules on the vocal cords, and wart-like growths caused by HPV in the larynx can be mistaken for throat cancer symptoms. However, getting the necessary check-ups based on the symptoms can be life-saving.

What are the causes of throat cancer?

There are risk factors that may contribute to the development of throat cancer.

Tobacco and alcohol use: Alcohol and tobacco use are the most significant risk factors that increase the risk of throat cancer. The amount and duration of tobacco and alcohol use directly correlate with the level of risk. Individuals who smoke more than 25 cigarettes a day or have been smoking for more than 30 years are about 40 times more likely to develop throat cancer compared to non-smokers. Similarly, those who have been consistently and regularly using alcohol for a long time are 3 times more at risk compared to non-drinkers. The majority of head and neck cancers, including throat cancer, are caused by smoking. Additionally, individuals who are constantly exposed to secondhand smoke are also at an increased risk of throat cancer.

Gender: The risk of throat cancer in males is 4-5 times higher compared to females. However, the increasing prevalence of smoking among women in recent years has led to a higher incidence of throat cancer in females as well.

Genetic factors: Individuals with a family history of head and neck cancer or throat cancer have a higher risk of developing throat cancer compared to those without such a history.

Age: As with many other cancer types, advancing age is a significant risk factor for throat cancer. Throat cancer is rare in individuals under the age of 40.

Dietary habits: Those who consume red meat, processed foods, or fried foods excessively are at a higher risk of developing throat cancer. Moreover, studies have shown that inadequate intake of vitamins A and E through diet can contribute to throat cancer. Adhering to a Mediterranean diet rich in fresh fruits and vegetables, which provides adequate amounts of vitamins A and E, can help reduce the risk of throat cancer.

HPV virus: Scientific studies suggest that the Human papillomavirus (HPV) infection, which is primarily transmitted sexually and causes genital warts, cervical, and vaginal cancers in women, may also contribute to throat cancer. HPV is a common infection that often resolves on its own without causing any issues in most individuals.

Exposure to harmful substances: Prolonged exposure to certain harmful or chemical substances due to occupational reasons can lead to throat cancer.

• Wood dust

• Coal or charcoal dust

• Paint fumes

• Formaldehyde, commonly used in industries such as paint production and cosmetics

• Nickel Isopropyl alcohol, used as a cleaning solvent

• Sulfuric acid mist

• Asbestos

• Poor oral hygiene and acid reflux disease can also contribute to throat cancer.

How is throat cancer diagnosed?

Early diagnosis of throat cancer provides significant advantages in treatment. Individuals with one or more symptoms should promptly seek the expertise of an otolaryngologist (ear, nose, and throat specialist), as timely diagnosis is crucial.

Doctor's examination: A doctor's examination can provide insights into the presence of throat cancer. The doctor evaluates lifestyle and occupational risk factors such as smoking and alcohol use. Since throat cancer may manifest as a lump-like swelling in the throat, a physical examination is performed. During the examination, the doctor inspects the inside of the mouth, including cheeks and lips, as well as the base of the mouth, back of the throat, nose, and ears. Various tests and imaging methods can be used to clarify the diagnosis of throat cancer.

Nasendoscopy: Nasendoscopy is a type of endoscopy used by the doctor to better visualize the throat. An elongated, flexible tube with a light and a small camera at its end is inserted through the patient's nostrils to examine the presence of any abnormal structures in the throat. There is no need for any special preparation before a nasendoscopy procedure.

Laryngoscopy: Laryngoscopy is performed when the throat cannot be adequately examined using nasendoscopy or when a suspicious formation is detected. The endoscope used in laryngoscopy is longer, and the procedure is conducted through the mouth. In preparation for laryngoscopy, the use of blood-thinning medications can be stopped. The procedure is usually carried out under general anesthesia.

Video Laryngostroboscopy: This procedure can be employed in cases where general anesthesia is not suitable or for diagnosing tumors affecting the vocal cords. The endoscope used has a camera and a fiber-optic strobe light. It can be performed before, during, and after treatment to assess the condition of the vocal cords. The procedure lasts around 30 minutes and can be conducted under local anesthesia.

Biopsy: If a suspicious structure is observed during nasendoscopy or laryngoscopy, a tissue sample can be taken and sent to a laboratory for examination. In cases of suspected cancer, a portion or the entire suspicious tissue can be surgically removed for biopsy. Fine-needle aspiration biopsy can also be performed when a palpable lump is felt in the neck.

Imaging methods can also be utilized for diagnosing throat cancer. Imaging techniques such as X-rays, ultrasound, Computed Tomography (CT), Magnetic Resonance Imaging (MRI), and Positron Emission Tomography (PET) provide insights into the precise location and size of the cancer.

What are the treatment methods of throat cancer?

The treatment of throat cancer can vary depending on factors such as the location, stage, grade of the tumor, and the patient's overall health. Generally, surgical procedures, radiation therapy, and chemotherapy are used in the treatment of throat cancer. Sometimes, a combination of these options is employed.

Surgical Treatment of Throat Cancer

Endoscopic Resection (Endoscopic Laser Surgery) for Partial Throat Removal

This method is suitable for early-stage and locally advanced throat cancer patients.

Known colloquially as endoscopic laser surgery, it is performed through the mouth without any incisions.

The use of a laser during the procedure reduces bleeding.

The surgery takes place in an operating room under general anesthesia.

Surgical tools and lasers are passed through a tube inserted from the mouth to the vocal cords. The surgeon, aided by a microscope, can clearly see the cancerous tumor.

Depending on the tumor's condition, the surgeon can use the laser to remove a portion or completely eliminate it with high energy.

Patients must be evaluated for suitability before undergoing endoscopic laser surgery. Suitable oral and throat structures are necessary due to the oral approach.

Hospitalization duration after oral laser surgery varies based on the tumor's location and size. Swelling after major tumor removal through endoscopic laser surgery can cause breathing and feeding problems.

Generally, oral laser surgery does not lead to permanent speech or swallowing problems. There might be speech restrictions for a few days after the surgery. Working with a speech therapist can yield positive results for prolonged speech issues.

Throat Laryngectomy Surgery for Throat Cancer

Depending on the tumor's size and location, either the affected part or the entire larynx can be surgically removed.

Partial laryngectomy, involving the removal of only a portion of the larynx, can be performed with a small neck incision or through the mouth without incisions.

For partial laryngectomy, a small hole is created in the neck to ensure breathing. This hole usually closes after surgery.

Temporary speech issues might arise after partial laryngectomy, but usually, speech and breathing are not affected after the recovery period.

In total laryngectomy, where the entire larynx is removed, the trachea is connected to an opening in the throat for breathing.

The opening in the throat is permanent after total laryngectomy.

Patients lose their voice after total laryngectomy. Speech prostheses or voice devices can help with communication.

Total laryngectomy can lead to swallowing, taste, and smell issues, in addition to voice problems.

Neck Dissection Surgery

Throat cancer can spread to lymph nodes in the neck. Often, cancer cells first spread to the lymph nodes. In some cases of throat cancer treatment, removal of a part or all of the lymph nodes might be necessary, depending on the affected area and tumor size.

Neck dissection surgery involves removing muscles, nerves, and adjacent tissues.

Due to its side effects, not every patient is a candidate for neck dissection surgery.

Although lymph node removal is an essential measure to prevent cancer spread, it can lead to side effects such as numbness in the ear, loss of movement in the lower lip, movement and sensation loss in the tongue, shoulder movement impairment, and arm movement impairment, depending on the removed lymph nodes.

After neck dissection surgery, radiation therapy can be applied.

Consult a doctor if you experience any swelling, fullness, pressure, difficulty swallowing, or changes in voice.

Radiation Therapy for Throat Cancer

In early-stage throat cancer, radiation therapy is often the first choice. Radiation therapy, which uses high energy to destroy cancer cells, can be used alone or combined with surgery and chemotherapy, depending on the tumor's location and size.

Radiation therapy can also be applied after throat cancer surgeries. It can be used after surgery to prevent the recurrence of throat cancer, when the entire tumor cannot be removed, or when tumors grow along the throat wall.

For advanced-stage throat cancer patients, radiation therapy combined with chemotherapy might yield better results.

Advanced-stage throat cancer treated with radiation therapy can alleviate problems like swallowing and breathing difficulties.

During radiation therapy, side effects such as fatigue, skin redness or darkening, sore throat, difficulty swallowing, or swelling might occur.

Chemotherapy Treatment for Throat Cancer

Chemotherapy for throat cancer can be administered before or after surgery and is often used in conjunction with radiation therapy.

Preoperative chemotherapy can reduce tumor size, making it easier for surgery to be performed.

Chemotherapy can also be used to prevent throat cancer recurrence.

Targeted therapies, smart drugs that focus on specific targets, have gained prominence in recent years for chemotherapy treatment. Targeted therapies reduce chemotherapy's side effects while increasing its effectiveness.

FREQUENTLY ASKED QUESTIONS ABOUT THROAT CANCER