Tumor in the throat

Tumors in the throat include neoplasms, which are:

• in the throat,
• on the larynx
• or on the tonsils.

Symptoms of throat cancer vary depending on the location of occurrence.
The throat is a muscular tube that begins behind the nose and ends in the throat.

The larynx forms the transition from the throat to the trachea in the anterior neck area. This is where a tumor can develop.
The larynx consists of:

• Cartilage
• Vocal cords that create vibrations to develop sounds when speaking.

The tumor in the neck area can also hit the cartilage of the epiglottis (epiglottis), which is located above the trachea.
Another form of throat cancer is a tumor on the tonsils (lymphoma) in the back of the neck.

Causes of tumors in the neck area

Alcohol and tobacco Excessive alcohol and tobacco
consumption (including chewing and snuff) are considered to be the two main risk factors for head and neck tumours, especially for:

• oral cavity cancer,
• oropharyngeal cancer (oropharyngeal carcinoma),
• throat cancer (hypopharyngeal carcinoma),
• Laryngeal cancer (laryngeal carcinoma).

At least 75% of head and neck tumors are due to excessive consumption of tobacco and alcohol.

A combination of smoking and regular alcohol consumption increases the risk compared to those who only consume alcohol.

Papillomavirus Infection by human papillomavirus
(HPV) can cause cancer, especially some subspecies of the virus, such as HPV type 16. Papilloma virus is a risk factor for certain head and neck tumors, especially tumors in the oropharynx that affect the tonsils and the base of the tongue.

During oral sex with people infected with papillomavirus, there is a risk of developing a tumor in the neck area.

Risk factors for neck tumors:

• Paan (betel quid) – an Asian dish that may contain tobacco.
• Consumption of very hot drinks (hotter than 65°C), the high temperatures damage the mucous membrane.
• Salty foods and preservatives.
• Inadequate oral hygiene is one of the risk factors for tumors in the oral cavity.
• Occupational hazard. If you are exposed to wood or metal dust, fumes from paints and other chemical solvents at the workplace, the risk of cancer in the nasopharynx (nasopharyngeal carcinoma) increases.
  Asbestos and synthetic fibers can cause throat cancer, but increasing the risk remains controversial.
• Radiation exposure.
• Infection by the Epstein-Barr virus.
• People of Asian and especially Chinese descent have an increased risk of throat cancer, especially in the nasopharynx.

These risk factors do not apply to children, who are practically unaffected by this serious disease.
As a rule, throat cancer occurs after the age of 40.

Initial symptoms of throat cancer

In contrast to many other tumors, the symptoms of a benign or malignant tumor in the throat are already obvious in the early stages.
Above all:

• If the cancer affects the vocal cords in the glottis (laryngeal cancer), the symptoms are noticeable by persistent hoarseness.
  Hoarseness is an early warning sign that comes directly from the vocal cords.
• White or red plaques (or fleks) in the mouth, may be precancerous lesions or indicate a tumor in the mouth.
• Sometimes a non-healing sore or ulcer in the mouth is the first sign of a tumor.

What do you feel about throat cancer?

• Often patients suffer from a sore throat or foreign body sensation in the throat.
• The feeling of having a lump in your throat is a very common symptom.
  Psychological and neurological disorders are to blame in most cases.
  This symptom is called globus syndrome or globus hystericus and is characterized by the sole feeling of a lump in the throat and not by a real existing lump or tumor.
  However, throat and throat cancer can also cause the feeling of having a lump in the throat, in this case it is a real lump.
• These sore throats are typical symptoms of throat cancer, but they are more common in conjunction with other, benign conditions.
  Catarrh is not a symptom of a tumor on the larynx or throat.

Symptoms of advanced throat cancer

• In the advanced stages of the disease, patients suffer from difficulty swallowing and they feel the frequent urge to clear their throat.
• Hoarseness, difficulty swallowing (even in combination) lasting longer than 4 weeks with or without treatment are to be considered suspect, possibly symptoms of throat cancer and must therefore be examined by an otolaryngologist.
• With the development of cancer symptoms, the tumor causes severe sore throat, especially when swallowing.
  It can sometimes radiate into the ears and into the head.
  Severe sore throat can hinder eating and swallowing.
• Cough is a typical symptom of laryngeal cancer: Due to the foreign body or the stimulation of throat cancer, patients usually have a dry cough.
• If the throat cancer becomes ulcerative and bloody, blood or purulent, foul-smelling secretions may occur in the cough sputum.
  Forced coughing to clear throat and a foreign body sensation in the throat can occur as symptoms of a throat tumor.
• A larger laryngeal carcinoma can lead to laryngeal whistling (stridor laryngealis), a high-pitched tone that occurs when speaking.
  The cause of this is the narrowing of the larynx or airways due to throat cancer.
• At a later stage of the disease, the neck tumor can lead to shortness of breath or even suffocation.

Symptoms of throat cancer in the fourth stage

In the fourth phase, throat cancer presents itself with symptoms such as fatigue, weakness, fever, enlarged lymph nodes and rapid weight loss.
These symptoms are also noticeable in the final stages of other cancers.

Diagnosis of throat cancer

For the determination of stages, different examinations are carried out, depending on the type of tumor:

Physical exams Physical exams
are performed to gather information about the cancer.
The doctor examines the patient, examining the throat, palpating and listening to the throat to detect anything unusual.
In this way, the position, size and possible spread of the cancer to lymph nodes and/or other organs can be determined.

Imaging techniques Diagnostic imaging techniques
show images of the examined areas from inside the body. These studies are important tools in the detection phase of the disease.
The following tests can show where the cancer is located, its extent and whether it has spread:

• Laryngoscopy
• X-ray examination
• Computed tomography (CT)
• Magnetic resonance imaging (MRI)
• Positron emission tomography (PET)

Ultrasound
Anyone who suffers from pain or swelling of the neck goes to the doctor to be prescribed an ultrasound examination. Ultrasound can detect enlarged lymph nodes and is often used to assess the thyroid, but less so for an examination of the neck.

Laboratory analyses
Laboratory tests include analyses of:

• Blood
• Urine
• other liquids,
• removed body tissue (biopsy).

For example, the examinations that are intended to determine the functioning of the liver and look for tumor markers (substances that are present in higher concentrations in cancer) can give a lot of information about the tumor.

Blood tests Blood tests
cannot diagnose tumours in the oral cavity or oropharynx.
The doctor may schedule routine blood tests to determine general health, especially before starting therapy (e.g. surgery). These tests help detect:

• Malnutrition
• decreased concentration of red blood cells in the blood (anaemia),
• Liver
• Kidney disease.

Already a few years before the onset of the first symptoms of the disease, antibodies against the human papillomaviruses (HPV), which can cause a neck tumor, can be detected with the help of a specific blood analysis.

Pathological diagnostics
Pathological studies provide information:

• the size and growth behaviour of the tumour in other tissues and organs,
• the type of tumour cells,
• the degree of tumor (the similarity of tumor cells to normal tissue cells).

A biopsy (removal and examination of cells or tissues under a microscope) can be performed to obtain the necessary information about the cancer.
Cytological examinations (cell studies) also describe the results obtained by the analysis of the cells in the body fluids.

Therapy for throat cancer

The therapy can be different depending on tumor size, tumor type, tumor location and tumor stage:

1. The tumor is surgically removed. Depending on the location and size of the tumor, partial or complete removal of the tissue, thyroid, entire larynx (laryngectomy) or tongue (glossectomy) may be performed. It may also be necessary to remove the nearby lymph nodes if the cancer has spread there.
2. An inoperable tumor in the neck is treated with chemotherapy and possibly radiotherapy.
3. Radiotherapy: Small beams of radiation are precisely directed at the tumor cells in order to destroy them.
4. Chemotherapy: The cancer cells are killed with the help of drugs, often in combination with radiation therapy. Chemotherapy can be used helpfully for tumors that have spread (metastases) because the drugs reach the whole body.
5. The metastases of a neck tumor are usually found in the lymph nodes.
6. Complementary or supportive therapeutic measures, such as surgery followed by radiotherapy or chemotherapy, especially for large tumors.
7. Nutrition. Cancer diets are always recommended, but should be discussed with the doctor if there are other underlying diseases that require dietary restrictions.
8. Long-term aftercare. Regular examinations are intended to monitor the recurrence of the tumor.
9. Rehabilitation: This may require the helpful support of a dietician, speech therapist or physiotherapist.
   After a tracheotomy, the patient must complete many voice training and movement exercises in order to regain the best possible voice and to be able to eat correctly.
   Nurses, counselors and psychologists at the clinic can help patients accept the postoperative changes that:
   • the financial situation,
   • social and professional life.
   • affect appearance.

What is the survival rate? (Forecast)

Neck tumors can be cured in 90% of cases if the diagnosis was made at an early stage.

• If the cancer has spread to the surrounding tissues or cervical lymph nodes, the recovery rate is 50-60%.
• If the cancer has spread to the areas of the body outside the head and neck (metastasis), it is not curable.

The therapy tries to prolong and improve the quality of life.
After treatment, patients usually need therapeutic measures to regain their ability to speak and swallow.
A small percentage (about 5%) will not be able to swallow again and must be fed with the help of a tube.

Prognosis for throat cancer and life expectancy by stage

Incipiency
For laryngeal cancer, the five-year survival rate in the first stage of throat cancer is about 80-95%.
After surgical intervention for neck cancer at the first stage, the survival rate increases to 90-95%.

Second stage The five-year survival rate in the second stage
of throat cancer with only radiotherapy is 60-85%.
Mortality from neck tumor increases in the later stages of the disease.

Third stage
At this stage, patients often have enlarged lymph nodes on the neck and elsewhere.
Therapy for throat cancer is based on:

• radiotherapy before surgery,
• subsequent radical surgical removal (resection).

Patients in the advanced stage of cancer have a significantly lower five-year survival rate of 50-60%.

Fourth stage
The doctor recommends a combination of:

• preoperative radiotherapy,
• surgical intervention,
• postoperative chemotherapy.

The five-year survival rate of patients with stage 4 throat cancer is about 30%.

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