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Throat Cancer

Throat Carcinoma

Throat cancer refers to soft tissue carcinomas that are located within the pharynx, the larynx, and the tonsils. Throat cancers are commonly brought about by the chronic intake of alcohol and the chronic use of tobacco.


Presentation

The following signs and symptoms are associated with throat cancer:

Lymphedema
  • Physical rehabilitation and occupational therapy services, including wound care , voice therapy and swallowing therapy , lymphedema therapy , balance and vestibular rehabilitation , yoga and more.[scripps.org]
Collapse
  • Expand All Collapse All Throat cancer support groups This support group is open to all patients with cancers affecting the mouth, throat, head and neck.[scripps.org]
Hypothermia
  • Read This Next: Craig Strickland Died From Hypothermia:…What You Need to Know About the Condition[yahoo.com]
Yawning
  • By Roni Caryn Rabin Ask Well Photo Credit Why Do We Yawn? Reading about yawning makes people yawn. You are probably yawning right now. By Roni Caryn Rabin[nytimes.com]
  • She experienced pain when yawning. A sensitive throat made swallowing food uncomfortable. A visit to her general practitioner resulted in a referral to the Ear Nose and Throat department at Christchurch Hospital.[scoop.co.nz]
Sighing
  • You can go ahead and breath a sigh of relief, because it looks like Janet is cancer-free.[hollywoodlife.com]
Choking
  • “I have a phobia of choking. I’m just doing the best I can, taking it day by day.” And she’s giving her life a healthy overhaul. “It’s hard to just put down the cigarette and never look back. I enjoyed smoking. I miss it so much.[people.com]
  • Pain and palliative care specialists develop plans to manage a person's pain, difficulty eating, choking on secretions, and other troublesome symptoms. Treatment may include surgery, radiation, or chemotherapy.[merckmanuals.com]
  • Mucous can erupt in your throat so effusively that you need a pump to get it out to stop from choking. You lose your taste buds and then your appetite. You lose 10-15 pounds, or even more.[briantracy.com]
  • The difficulty in swallowing can lead to a person to choke on their food in the early stages of digestion and interfere with the food’s smooth travels down into the esophagus and beyond.[en.wikipedia.org]
Jaw Pain
  • Common throat cancer symptoms may include: Difficulty swallowing, also known as dysphagia Changes in your voice Sore throat Ear or jaw pain A dull pain behind the breastbone Difficulty breathing Ringing in the ears Frequent nosebleeds Headaches A lump[cancercenter.com]
Osteoporosis
  • Special alert for women with bone loss: If you have osteoporosis, your drug treatment may raise your risk of cancer of the esophagus (the tube that connects your mouth to your stomach).[prevention.com]
Photosensitivity
  • About 10% of some 1000 patients treated worldwide had photosensitivity reactions – mostly only mild erythema. Photosensitivity takes 2–3 weeks to resolve, during which time patients must avoid bright light.[texasoncology.com]
  • ., Dizdaroglu, M. 1992 Substrate specificity of the Escherichia coli Fpg protein formamidopyrimidine-DNA glycosylase: excision of purine lesions in DNA produced by ionizing radiation or photosensitization Biochemistry 31 106 –110 14 Gajewski, E., Rao,[doi.org]
Neck Mass
  • […] throat which lasts more than several hours or days Neck masses that do not go away after one to two weeks should be evaluated by an otolaryngologist – head and neck surgeon.[bcm.edu]
  • A fine-needle aspiration (FNA) or biopsy may be an alternative for a neck mass; lesions that are harder to reach may require endoscopy.[patient.info]
  • “They might superficially look similar — a patient comes in with a neck mass and their throat hurts — but I realized what drove the pathogenesis was completely different in the two cases.” By then, all doubts had faded.[nature.com]

Workup

The following diagnostic modalities and tests are performed on a patient with throat cancer:

  • Endoscopy
  • Tissue biopsy: A throat sample can be taken during endoscopic and laryngoscopic examination for histopathologic examination. 
  • Imaging: Imaging tests include X-ray, computerized tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography (PET). These test will elucidate the extent of the cancer in throat area.

Treatment

The treatment options available for throat cancer cases depends on many factors like location and stage of the cancer, overall health status, and patient’s preference [3]. The following treatment options are available for the treatment of throat cancer:

  • Radiation therapy: Radiation therapy makes use of X-ray beams to focus and kill cancer cells on the throat region. Radiation therapy can be done using an external beam in to the body, or this can come from small radioactive wires or seeds that is apposed next to the cancer cells or brachytherapy. 
  • Surgical approaches: The type of surgical procedure used in throat cancer is grossly dependent on the location of the tumor. Lasers and endoscopic surgery can be used to scrape off early stage cancers within the throat [4]. For larger tumors of the larynx, a complete laryngectomy may be necessary as treatment [5]. Pharyngectomy involves the removal of some portions of the voice box thereby leaving the speech faculty intact [6]. A radical neck dissection of the throat lymph nodes is performed with stage 3 throat cancers to prevent it from metastasizing further. 
  • Chemotherapy: Chemotherapy can be used in combination with radiotherapy [7] [8].
  • Targeted drug therapy: A drug agent like cetuximab can be used to alter the protein synthesis of a certain protein that is more pronounced in the throat cancer cells to control its apparent growth. 
  • Rehabilitation after treatment: Treatment and surgical options for throat cancers may leave some complications that may need rehabilitation [9]. Tracheostomy care is one avenue that needs daily attention post operatively. Patients may need rehabilitation to address their eating, swallowing, and speech difficulties after the throat operation [10]. 

Prognosis

Throat cancers that are detected and treated early carries a good outlook. In throat cancers with regional lymph node involvement almost half of them are still curable. However, for throat carcinomas cases with distant organ metastasis prognosis is almost always grim. Therapeutic approaches for throat cancers are geared towards the prolongation and the improvement of the quality of life.

Etiology

Throat cancer is brought about by chronic tobacco exposure either by smoking or chewing. Patients consuming 2 packs of cigarette smokes per day are more prone to develop this malignancy. In the same way, chronic intake of alcohol in up to more than 6 fluid ounces of alcohol per day dramatically increases the risk for throat cancer.

The human papilloma virus (HPV) has become one of the causative agents that leads to throat warts because of the increasing popularity of oral sex today [2]. Oral and throat warts increases the likelihood of developing squamous cell malignancies in this early segment of the digestive tract. There are other less common causes of throat cancers like, ill-fitting dentures, chronic candidiasis, poor oral hygiene, and previous exposure to ionizing radiation in the neck area.

Epidemiology

In the United States, there are at least 41,000 new cases of throat cancers and leading to approximately 6,000 deaths per year. The majority of people who develop throat cancer are beyond the age of 50 years old. The age adjusted incidence is 36 cases per one million population with a mortality rating of 13 deaths per one million population. Squamous cell carcinoma is the leading cancer cell type found in throat cancer. Almost 95% of the diagnosed throat cancer cases are all tobacco smokers.

Sex distribution
Age distribution

Pathophysiology

The impending tumor growth seen in malignancies of the throat can adversely affect normal laryngeal physiology in swallowing and air flow. In the same way, an enlarging supraglottic tumor can lead to airway obstruction as its first presenting sign. In glottic tumors, voice changes may be notable in the early stages which usually leads to its early discovery and intervention. The alteration in the swallowing physiology will lead to either dysphagia or aspiration. The multistep histological progression from the normal mucosa to the development of invasive carcinoma represents a complex genetic mutation in its tumorigenesis.

Prevention

There are no known direct way to prevent the occurrence of throat cancer but there are ways to lower the risk of having one. Cessation and abstinence from smoking can significantly lower the risk for throat malignancies. Alcoholic beverages must be drank in moderation to decrease the chronic irritation of the throat. High risk patients must adopt a healthy diet of fruits and vegetables to accumulate antioxidants and vitamins to combat cancer cells and prevent its development. Human papilloma virus warts can be prevented by an active vaccination.

Summary

Throat cancer is the collective term used to describe cancers of the pharynx, the larynx, and the tonsils. Throat cancer as aerodigestive neoplasm is one of the leading cause of malignancy death in the United States today. Its treatment and surgical approach remains basically the same in the last 30 years. The main thrust in the researches done on throat cancer is geared towards the development of a better therapeutic approach that increases survival rating, while decreasing cosmetic and functional disability [1].

Patient Information

Definition

Throat cancer refers to soft tissue carcinomas that are located within the throat region.

Cause

Tobacco smoking and chronic alcoholism is the major etiologic cause of throat cancers. Less common causes like HPV infection, ill-fitting dentures, oral candidaiasis, and poor oral hygiene.

Symptoms

Patients will present with cough with bloody expectoration. Neck pain with lumps and hoarseness of voice can also herald throat cancers.

Diagnosis

Patients may be examined using direct endoscopy and tissue biopsy of the neoplastic lesion. Imaging studies are also used to determine the location and extent of the cancer.

Treatment and follow-up

Throat cancers can be treated with chemotherapy or radiation therapy or a combination of both. Targeted drug therapy has been proven to be promising in the treatment of throat malignancies. Surgical resection of the tumor with pharyngectomy or laryngectomy can primarily remove the tumor. Rehabilitation are frequently required post- operatively to improve quality of life.

References

Article

  1. Hoffman HT, Porter K, Karnell LH, Cooper JS, Weber RS, Langer CJ. Laryngeal cancer in the United States: changes in demographics, patterns of care, and survival. Laryngoscope. Sep 2006; 116(9 Pt 2 Suppl 111):1-13.
  2. American Cancer Society. Cancer Facts and Figures 2005.
  3. Edge S, Byrd DR, Compton CC, Fritz AG, Greene FL, Trotti A. American Joint Comittee on Cancer - Head and Neck cancer staging 2007. 7th. Philadelphia: Springer; 2010.
  4. Cohen JI, Clayman G. Atlas of Head and Neck Surgery. 1st. 2011.
  5. Laccourreye O, Ishoo E, de Mones E, Garcia D, Kania R, Hans S. Supracricoid hemilaryngopharyngectomy in patients with invasive squamous cell carcinoma of the pyriform sinus. Part I: Technique, complications, and long-term functional outcome. Ann Otol Rhinol Laryngol. Jan 2005; 114(1 Pt 1):25-34.
  6. Wen WP, Su ZZ, Zhu XL, Jiang AY, Chai LP, Wang ZF, et al. Supracricoid partial laryngectomy with cricothyroidopexy: A treatment for anterior vocal commissure laryngeal squamous carcinoma. Head Neck. Feb 24 2012.
  7. Induction chemotherapy plus radiation compared with surgery plus radiation in patients with advanced laryngeal cancer. The Department of Veterans Affairs Laryngeal Cancer Study Group. N Engl J Med. Jun 13 1991; 324(24):1685-90.
  8. NCCN Practice Guidelines in Oncology - v.2.2013 - Head and Neck Cancers. National Comprehensive Cancer Network. Accessed December 10, 2014.
  9. De Santis M, Tripodi D. [The laryngectomized patient as a psychologically maladjusted person]. Valsalva. Jun 1968; 44(3):138-45.
  10. Williamson JS, Ingrams D, Jones H. Quality of life after treatment of laryngeal carcinoma: a single centre cross-sectional study. Ann R Coll Surg Engl. Nov 2011; 93(8):591-5.

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Last updated: 2019-07-11 22:08