Brief overview
- What is pharyngeal cancer? Tumors in the area of the pharynx, mostly mutated cells of the mucous membrane
- Symptoms: Unilateral swollen lymph nodes that do not cause pain, hoarseness, difficulty swallowing, depending on the affected region also problems with the nasal cavity or pain in the ears
- Treatment: surgery, radiation therapy, chemotherapy, targeted therapies
- Causes: Previous precancerous lesions, alcohol and nicotine consumption, viral diseases.
- Diagnostics: laryngoscopy, imaging techniques, examination of tissue samples
- Prevention: avoidance of alcohol and nicotine, strengthening the immune system
What is throat cancer?
Pharyngeal carcinomas are differentiated by the area of the pharynx in which they occur:
- Upper section: the upper pharynx is the nasopharynx. It has an upper wall and a lower wall. While the upper wall extends between the junction of the hard and soft palate to the base of the skull, the lower wall is defined as the upper surface of the soft palate. Cancer there is called nasopharyngeal cancer or nasopharyngeal carcinoma.
- Middle pharyngeal area: this refers to the pharyngeal area behind the oral cavity that can be seen when the mouth is opened wide. Physicians call it the mesopharynx or oropharynx. This includes not only the posterior wall of the pharynx, but also the tonsils and the anterior surface of the soft palate. Oropharyngeal carcinomas most commonly occur around the tonsils. The oropharynx is the region most commonly affected by throat cancer.
How can you recognize pharyngeal cancer?
In the early stages, pharyngeal carcinoma is rarely noticeable due to symptoms. Only when the disease slowly spreads do noticeable changes occur. Often, swollen lymph nodes in the neck are the first pharyngeal cancer symptoms, and the suspicion of cancer is particularly high if the lymph nodes do not hurt and are only enlarged on one side. In addition, the signs depend on which region in the throat is affected. The symptoms occur in different combinations.
Nasopharyngeal carcinoma
Although nasopharyngeal carcinoma often leads to very distinct symptoms, these usually do not appear in the early stages, but only as the disease progresses. The pharyngeal cancer appearance usually does not play a role in the self-observation of the affected person, since these body regions are hardly visible in front of the mirror. Possible signs of this form of pharyngeal cancer are:
It is possible that pharyngeal carcinoma spreads in the connection between the pharynx and the middle ear. This is called the Eustachian tube or Eustachian tube (Tuba Eustachii). This often triggers similar complaints to a middle ear infection, i.e. hearing loss and an unpleasant feeling of pressure in the ear, which is often associated with pain, or ringing in the ears develop. If the complaints are unilateral, the suspicion of a malignant disease is particularly high.
Pharyngeal cancer also frequently damages the base of the skull. If necessary, this is associated with paralysis of certain cranial nerves. As a result, those affected may suffer from headaches and facial pain or see double images (diplopia). In many cases, there is numbness and loss of vision.
Oropharyngeal carcinoma
The focus is on the pharyngeal area behind the oral cavity. Even in the early stages, the appearance of the mucous membrane changes as a result of the pharyngeal cancer. However, redness, swelling and later growths or even sores are rarely noticed by those affected unless they are accompanied by other symptoms.
Again, enlarged lymph nodes in the area of the neck or head are considered important signs for early detection.
As it progresses, there is a sore throat that may radiate to the ears.
If the throat cancer continues to spread, the growths often cause difficulty swallowing.
Unusual bad breath is also an indication of carcinoma.
Hypopharyngeal carcinoma
Hypopharyngeal carcinoma is also usually not noticeable in the early stages. This makes early detection difficult, although rapid diagnosis significantly improves the chances of cure.
- It is only when the growths enlarge that sufferers often experience the feeling of having a “lump in their throat”. They clear their throat without it doing any good. In the next step, swallowing becomes difficult.
- If the cancer attacks the vocal cords, hoarseness usually occurs.
- Shortness of breath is also a possible throat cancer symptom.
- If necessary, those affected discover discolored or sore areas in the throat.
- Bad breath is a common additional symptom.
- Sufferers cough up sputum, which sometimes contains blood.
When to see a doctor if throat cancer is suspected?
The above symptoms are not unique to throat cancer. Most of the time, signs such as difficulty swallowing, hoarseness or sore throat have a harmless cause. In addition to a cold or flu, local inflammations or an allergy are possible triggers.
What does throat cancer look like? Many patients with typical symptoms ask themselves this question while standing in front of the mirror. In most cases, however, a harmless disease is behind the supposed pharyngeal cancer symptoms and changes are rarely detectable anyway. However, if it is actually pharyngeal carcinoma, early diagnosis is all the more important.
The chances of cure are usually very good in the early stages. In addition, operations, for example, are much smaller and less stressful. Nevertheless, specialists repeatedly experience that those affected ignore the symptoms out of fear of a cancer diagnosis – and lose time for effective therapy.
Is throat cancer curable?
For tumors in the lower pharynx and nasopharynx, about 40 percent (hypopharyngeal carcinoma) and about 40 to 50 percent (nasopharyngeal carcinoma) of patients live five years after diagnosis, respectively. For oropharyngeal carcinoma, the numbers are slightly better at 50 to 60 percent. However, these figures say nothing about personal life expectancy for pharyngeal cancer. This is because the disease is completely curable if treated early enough.
Three paths are available for treatment: Surgery, radiation therapy and medication. Oncologists put these options together individually and tailor them to each patient’s situation.
Surgery
The most effective throat cancer treatment is to completely remove the tumor tissue via surgery. Exactly what that means depends on the location and spread of the throat cancer. For some patients, it is enough for surgeons to remove a small section of the throat. For others, larger portions of the pharynx need to be operated out.
If the cancer has affected the larynx, it will also be partially or completely removed. The doctors treating the patient will try to avoid this in order to preserve as much functionality as possible in this region of the body, so that the patient is subsequently still able to breathe, swallow and speak without artificial support.
Minimally invasive procedures are often possible. In this so-called keyhole surgery, the doctor inserts the instruments through tiny incisions and controls them through a small camera. As a particularly gentle surgical technique, he has a laser at his disposal, which he uses to remove diseased tissue (laser microsurgery).
If larger areas of the pharynx or larynx need to be removed, the laser is usually not sufficient for this, which is why the surgeon then resorts to conventional surgical procedures. If necessary, he reconstructs a part of the removed pharynx using the patient’s own tissue in order to preserve its functionality. The tissue is taken from the skin of the forearm, for example.
Patients often require a period of training afterwards before they are able to speak and swallow independently again. If the doctor has to remove the larynx completely, artificial aids are required afterwards.
Radiotherapy
In radiation therapy (radiotherapy), medical professionals direct ionizing rays directly at diseased tissue. The aim is to damage the cells so severely that they die and stop dividing. Radiation therapy also attacks healthy tissue. Although this regenerates to a certain extent, it is still very important in this throat cancer treatment to limit the attack on the cancer cells locally and not to choose too high a dose.
At an early stage, radiation therapy may be sufficient as the sole treatment method. However, it is usually used in combination with chemotherapy or the doctor applies it after surgery to eliminate any remaining cancer cells.
Chemotherapies and targeted therapies
Still relatively new in cancer medicine are the so-called targeted therapies. They are called such because they attack more selectively. This is why they have fewer side effects. For throat cancer, which originates in the mucous membranes, cetuximab is an important active ingredient. This is a so-called monoclonal antibody. Put simply, it blocks a specific signaling pathway that tumor cells need to grow.
How is throat cancer diagnosed?
During diagnosis, the doctor checks whether pharyngeal cancer is actually the cause of the symptoms. In the next step, he examines the extent to which the pharyngeal carcinoma has already spread. In addition, he uses laboratory tests to determine whether human papilloma viruses (HPV-16) may be the cause of the cancer. This may influence the choice of therapy. This is essentially what happens when pharyngeal cancer is diagnosed:
Laryngoscopy: The doctor examines the throat visually with mirrors, using several mirrors that he turns against each other to look around the corner, so to speak (indirect laryngoscopy). Alternatively, he uses a so-called magnifying laryngoscope. This is a type of tube at the end of which there is a prism that the doctor turns in different directions. If these examinations confirm the suspicion of throat cancer, a direct laryngoscopy under anesthesia usually follows. For this, the doctor pushes a tube into the pharynx, fixes it and passes another tube with a camera through it.
Tissue sampling (biopsy): During laryngoscopy, the doctor carefully removes a tissue sample, which is later analyzed in the laboratory. Among other things, this determines how aggressive the pharyngeal carcinoma is and whether HPV-16 was involved in its development.
How does throat cancer develop?
Pharyngeal cancer develops when healthy cells in the pharynx mutate into malignant cancer cells that grow uncontrollably. Genetic changes in the genetic material are to blame. However, it is not exactly clear how these arise. Therefore, it is not possible to name causes for pharyngeal cancer. However, medicine has identified some risk factors:
Certain changes in the mucous membrane are considered to be precursors to pharyngeal cancer. These include so-called white callus disease (leukoplakia), in which the mucosal layer thickens. It can be recognized by whitish spots in the throat.
There is a link between the development of pharyngeal carcinoma and infections with certain viruses. These are human papillomavirus (HPV-16) and Ebstein-Barr virus (EBV). HPV is sexually transmitted, and studies have shown that frequent oral sex increases the risk of throat cancer.
Prevention
It is not possible to prevent pharyngeal cancer with certainty until the exact causes are determined. Genetic changes cannot always be prevented. However, you can significantly reduce the likelihood of developing carcinoma by taking care to consume alcohol in moderation and refraining from smoking. It also helps to prevent the . The most important factors for this are:
- a balanced diet
- regular exercise
- sufficient sleep
- not too much stress
