Throat cancer: who is at risk, typical symptoms, treatment methods

Although the common name "throat" does not appear in anatomy, and the medical term "larynx" is used, throat cancer or laryngopharyngeal cancer is diagnosed when malignant tumors form in the pharynx and larynx.

Epidemiology

The data used by oncological statistics may have some differences. Thus, according to some information, laryngopharyngeal tumors account for about 4% of cases, according to other data, up to 12-15%.

According to the American Cancer Society, cancer of the larynx is diagnosed in 25-28% of clinical cases, and 90-95% of tumors are squamous cell carcinoma.

In European countries, almost 50 thousand new cases of this disease are reported annually. The main age category is between 45 and 65 years, although, according to the International Classification of Childhood Cancer (ICCC), throat cancer can be detected in a child, and most often it is rhabdomyosarcoma.

Throat cancer occurs five to seven times more often in men than in women.

The National Cancer Registry of Ukraine indicates that oropharyngeal cancer accounts for slightly more than 5% of oncodiagnoses per 100,000 residents (for comparison: in Scandinavian countries this figure is at the level of 1.4%).

In 43% of patients with laryngopharyngeal oncology, life expectancy does not exceed 12-15 months. Thus, it is pointless to ask the question - do people die from throat cancer?

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Causes throat cancer

The specific causes of laryngopharyngeal cancer are unknown, more details - Causes of Cancer

And the pathogenesis of the malignant tumor process consists of DNA mutations (erroneous replication) in the cells of the tissues lining the laryngopharynx with an increase in the formation of the polymerase enzyme PARP-1 (poly-ADP-ribose type 1). As a result, increased uncontrolled proliferation of cells and tissue growth begins, forming a focus of atypical, that is, structurally abnormal cells (which form the tumor itself). At the same time, translocation of the apoptosis-inducing factor (AIF) from the mitochondria to the nucleus occurs in the cells, as well as depletion of the coenzyme of oxidation-reduction reactions (NAD), which leads to cell death.

Doctors identify such risk factors for laryngeal and pharyngeal cancer as smoking; alcohol abuse; exposure to air pollutants (asbestos, lead, nickel, sulfuric acid, formaldehyde, etc.); GERD (gastroesophageal reflux disease); herpes virus type IV (Epstein-Barr virus).

The risk of oropharyngeal cancer is also increased by HPV – a contact-transmitted DNA human papillomavirus that can be contracted through oral sex – with the development of papillomatosis of the larynx or vocal folds. Oncogenic types of HPV (31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, 68, 73) are dangerous. According to experts from the American Cancer Society, 60% of cases of throat cancer in non-smokers are associated with infection with this virus.

Throat cancer is also more likely to develop in people with inherited Plummer-Vinson syndrome or genetic Fanconi anemia.

Can pregnancy provoke throat cancer? The growth of malignant neoplasms of this localization does not relate to hormonally induced processes, and its etiological connection with pregnancy has not been identified (although there are receptors for sex hormones in the tissues of the vocal cords). A hypothesis has been put forward according to which, against the background of gestational weakening of the immune system, latent papillomavirus (including oncogenic types) can be activated.

Is throat cancer transmitted from a sick person to a healthy one? To date, scientific research has proven that cancer is a non-contagious disease: cancer cells cannot be transmitted. That is, cancer does not spread as an infectious disease. Only the above-mentioned herpes virus and HPV are contagious.

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Symptoms throat cancer

The initial stage of development of a laryngopharyngeal malignant tumor may be asymptomatic. And the generally recognized first signs of throat cancer are a feeling of discomfort in the larynx and pharynx and a change in the timbre of the voice (hoarseness or raspiness). It should be taken into account that in the case of subglottic localization of the neoplasm, this symptom is absent, and if the tumor grows above the vocal folds, then a sore throat and pain when swallowing are noted, as well as a sensation of a foreign body in the throat.

Further development of the pathological process with the appearance of new symptoms occurs as the stage of the disease increases, determined in accordance with the international classification of cancer (TNM). Thus, typical symptoms of throat cancer in the early stages (stage I) include a non-productive (dry) cough of a paroxysmal nature.

When stages II and III occur, patients experience: a constant sensation of a lump in the throat and pressing pain, headache and otalgia; prolonged cough and difficulty swallowing; slightly elevated body temperature; swelling of the throat or neck; weight loss and general weakness. At the same time, stage III is characterized by dysphonia and aphonia due to limited mobility of the larynx, and metastases are detected during visualization.

The tumor continues to grow, and stage IV – with intense pain, bloody sputum when coughing, shortness of breath, severe dysphagia, halitosis and enlarged regional lymph nodes, with metastases (including distant ones) – is considered an advanced form of the disease.

Useful information is also in the material - Symptoms of throat cancer

Forms

In oncology, the following types of malignant neoplasms of the lower part of the pharynx are distinguished: the retrocricoid region, the aryepiglottic fold, cancer of the back wall of the throat (pharynx) and the lymphadenoid pharyngeal ring. For more details, see - Malignant tumors of the pharynx

And cancer of the larynx - the part of the throat from the root of the tongue to the trachea - is distinguished by localization into tumors of the vocal folds or cancer of the laryngeal cords (including false or vestibular), sub- or supraglottic tumors (in 70% of cases), as well as in the area of the epiglottis (supraglottic cartilage). Read also - Laryngeal Cancer - Classification

In addition, based on their location, tumors of the pharyngeal or palatine tonsils are classified as throat cancer – tonsillar cancer.

If the tumor grows inward, with infiltration into the structures of the laryngopharynx, endophytic laryngopharyngeal cancer is diagnosed, if tissue growth occurs towards the lumen of the respiratory tract - exophytic (52%). Often there is a combination of both.

Depending on histology, the following are distinguished:

• - squamous cell carcinoma of the throat - keratinizing, nonkeratinizing and highly differentiated squamous epithelial carcinoma - the main type of tumor in adult patients;
• - adenocarcinoma or glandular cancer;
• - lymphoepithelioma (Schminke's tumor), which forms in the tissues of the pharyngeal tonsils.

In children, the most common type of throat tumor is a malignant neoplasm in the muscle tissue of the walls of the pharynx and larynx – rhabdomyosarcoma.

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Complications and consequences

Among the complications and consequences of cancerous tumors of the laryngopharynx, experts note:

• serious breathing problems, including persistent narrowing of the larynx;
• disruption of the innervation of the larynx with the development of its paralysis;
• metastases in the lymph nodes of the trachea, pulmonary hilum, jugular lymphatic system - with retrograde spread to more distant structures.

Having a common risk factor such as smoking increases the likelihood that lung and throat cancer may develop simultaneously or sequentially. Therefore, patients with laryngopharyngeal cancer should undergo regular chest X-rays or CT scans to detect lung cancer early.

According to studies by European oncologists, the recurrence of stage I throat cancer during the first three years after the start of treatment is 5-13%, stage II – 25-27%, stage III – almost 36%, stage IV – 21%. For patients with progressive laryngeal cancer, the recurrence rate is approximately 30-50%.

A tonsillar tumor in the throat can destroy the walls of blood vessels, which is manifested by severe bleeding; it can grow into neighboring organs, affecting the anatomical structures of the facial skull (paranasal sinuses) and its base.

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Diagnostics throat cancer

In ENT oncology, diagnostics of malignant tumors of the laryngopharynx is carried out in a comprehensive manner.

First of all, a complete medical history and blood tests are required to identify tumor markers for throat cancer: SCC antigen, CYFRA 21-1, E6 and E7 antibodies. See more details - Blood test for the presence of cancer cells in the body

During laryngoscopy, a biopsy is performed (a tissue sample is taken) to conduct a histological examination of the neoplasm.

Instrumental diagnostics uses X-rays, ultrasound, CT, MRI, as well as electroglottography and stroboscopy of the vocal folds.

The accuracy of the diagnosis, and therefore the correct treatment strategy, should be confirmed by differential diagnostics, during which ENT oncologists distinguish from throat cancer: tuberculosis and syphilis of the larynx; papillomas, granulomas or hemangiomas of the larynx; dyskeratosis and leukokeratosis of the laryngeal mucosa, as well as benign thickening (hyperplasia) in the chronic form of its inflammation (laryngitis); atrophic or phlegmonous laryngitis; fibroma and nodules of the vocal folds; subglottic scleroma, etc. Read also - Laryngeal cancer. Diagnostics

In addition, it is necessary to exclude the inflammatory etiology of the swelling of the mucous membrane of the throat and pain in the larynx. For example, how to distinguish pharyngitis from throat cancer, and throat cancer from tonsillitis - with the obvious similarity of many symptoms? Acute inflammation of the mucous membrane of the pharynx - pharyngitis - is characterized by a burning sensation inside the nasopharynx, nasal congestion and ears (the latter is removed by several swallowing movements); in its chronic form, mucus flowing down the back of the throat bothers.

In the case of a sore throat (tonsillitis) caused by a bacterial infection, the throat (tonsils and palatine arches) is hyperemic, a purulent coating often forms on the mucous membrane of the pharynx and glands, and in the case of lacunar tonsillitis, purulent plugs form on the tonsils.

Doctors also pay attention to such a non-specific symptom as the sensation of a lump in the throat. And they point out, for example, the difference between a neurotic lump in the throat and cancer. A frequent or almost constant sensation of something foreign in the throat (when there is nothing there) is known as globus pharyngis - a symptom that occurs in the presence of persistent neurosis, emotional disorders (increased anxiety, phobias) and states of nervous tension. Of diagnostic significance is the fact that this sensation disappears when swallowing either solid food or liquid.

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Treatment throat cancer

The main question that worries patients is whether throat cancer is curable or not. This depends on a number of factors, including the location and stage of the tumor process, the type of cells involved, and the general health condition.

Oncologists know what to do with throat cancer, and taking into account these factors and possible risks, they will prescribe treatment, including, first of all, radiation therapy, which is especially effective at an early stage of the disease. All the details are in the publication - Radiation therapy for cancer.

For later stages, radiation may be combined with chemotherapy or surgery.

Chemotherapy for throat cancer uses drugs to eliminate cancer cells - cytostatics: Carboplatin, Cisplatin, Paclitaxel, 5-fluorouracil (Fluorouracil), Docetaxel, Epirubicin, etc. More information - Chemotherapy for cancer; more information about the methods of use and side effects of these pharmacological agents - Chemotherapy drugs

Surgery for throat cancer that is limited to the surface of the laryngopharynx or vocal cords may be endoscopic – using a laser. Surgery for stage 0 throat cancer may involve stripping the vocal folds (removing the upper layers of tissue on the vocal cords) or resecting the affected vocal cord (chordectomy).

For more extensive tumors, partial or total laryngectomy is used – removal of the part of the larynx above the vocal folds. After this operation, a tracheostomy must be performed, in which a breathing tube is installed.

But if the tumor blocks swallowing, then after removing part of the affected pharynx (pharyngectomy), a gastrostomy tube is installed to carry food into the stomach. In addition, the lymph nodes to which the metastases have spread are removed; this operation is usually performed simultaneously with the resection of the tumor itself.

At later stages, surgical intervention may not be possible, so radiation and chemotherapy are used. At a stage of the disease that is not amenable to treatment, patients receive palliative care, when painkillers and drugs that reduce the intensity of other symptoms are needed.

How throat cancer is treated in Israel, read – Cancer Treatment in Israel

Alternative treatment

No alternative treatment methods, primarily folk remedies, can cure throat cancer. However, some additional, i.e. auxiliary means can provide some help to patients.

Sodium bicarbonate or baking soda for throat cancer according to Neumyvakin alkalizes cancerous tumors, which have a lower pH compared to healthy tissues. And, indeed, the increase in pH caused by taking soda (twice a day, a glass of its solution - half a teaspoon per 200 ml of water, half an hour before or an hour after meals) helps improve the therapeutic effectiveness of cytostatics and protect the body of cancer patients from their toxic side effects. Moreover, it has been established in vitro that, by increasing the pH level of a tumor, sodium bicarbonate hinders its growth and the spread of cancer cells.

It is clear that vitamin C, which is an antioxidant and which lemons are so rich in, helps to strengthen the immunity of patients weakened by chemotherapy. In addition, lemon peel contains a whole set of phenolic compounds. And these phytophenols, as studies in recent years have shown, have great therapeutic potential for diseases associated with the action of free radicals and mutations of cellular DNA.

How to take lemon for throat cancer? The zest is removed from the thoroughly washed fruit with a fine grater, the juice is squeezed out of the pulp; the zest, juice and honey are mixed in equal proportions or 2:1. You can take this mixture one teaspoon a day (without washing it down), or put it in a glass of water (and drink the drink). One "but": you must rinse your mouth afterwards, as lemon juice spoils tooth enamel.

Homeopathy is not intended for the treatment of oncological diseases, however, homeopathic doctors recommend the following as additional remedies: Hepar Sulphur (200), Nitric Acid (30), Hydrastis Canadensis (200), Thuja, Kali Muriaticum, Mercurius Cyanatus.

Tincture of the odorous secretion of the tysonium glands of beavers, which they use to mark their territory, contains salicylic acid, the alkaloid nufaramine and steroids. In the past, tincture of castoreum was used to treat seizures and epilepsy, menstrual irregularities, insomnia, headaches and as a sedative. In the 19th century, this tincture was sold in pharmacies and recommended for earaches, toothaches, colic and gout. Today, this remedy is used only by homeopaths.

Oncologists do not prescribe Dorogov's antiseptic stimulator or ASD fraction for throat cancer, since it is not an anticancer agent, but a sublimate of meat and bone meal divided into fractions and condensed, which was used in animal husbandry.

For this oncological disease, herbal treatment can be used (after consultation with a doctor), in particular, cancer immunotherapy using adaptogenic plants.

The herbal collection for throat cancer also includes plants with immunostimulating properties and the ability to inhibit the pathological proliferation of mutant cells by activating protein-splitting cysteine proteolytic enzymes. These are the herb of the figured fleabane (Pulicaria crispa), various types of wormwood (Artemisia species), calotropis procera, colocynth (Citrullus colocynthis), black cumin (Nigella sativa), and the well-known Ayurvedic plant ashwagandha (Withania somnifera).

You can use fireweed (Chamerion angustifolium), which contains antioxidant flavonoids, phenolic acids and tannins, or Ivan tea for throat cancer: a decoction of the flowers of this plant helps remove free radicals, relieves inflammation and reduces pain.

Doctors recommend drinking at least three cups of green tea a day. There are no scientific studies on the effects of green tea on throat cancer, but a laboratory study published in 2003 in Folia Histochemica et Cytobiologica showed that green tea epigallocatechin-3-gallate inhibited the growth of cancer cells. Subsequent studies (published in 2009 in the Archives of Pharmaceutical Research) confirmed this effect.

Nutrition and diet for throat cancer

Treatment for throat cancer has side effects including weight loss, anemia, fatigue, nausea, diarrhea or constipation, so you should follow the general principles of the Cancer Diet: food should be high in calories, protein and micronutrients.

It may be necessary to use a gastrostomy tube for some time to eat. In such cases, the patient and his relatives should know that the following foods should not be eaten with throat cancer: spicy, fatty, hard and fried foods; raw vegetables and fruits; spicy cheeses and sausages; whole grain bread; very hot or very cold dishes; alcohol, sour juices and carbonated water.

This diet is called soft, and it includes strained soups and broths, boiled grain porridges, cottage cheese and sour cream, yogurt and butter, vegetable oil, steamed or boiled (and strained) vegetables and fruits. Tender meat and fish dishes, boiled and chopped chicken and other lean poultry are allowed.

Experts advise sitting up straight and not tilting your head forward while eating: this makes swallowing easier and can reduce the strain on your throat. You can drink liquids through a straw.

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Prevention

For any disease, prevention is better than cure. However, there is no proven way to prevent throat cancer. But in order to reduce the risk of its development, it is necessary to avoid all known carcinogens (primarily smoking); eat a balanced diet, giving preference to plant-based foods; strengthen the immune system; protect yourself from HPV infection.

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Forecast

Survival depends on the stage of cancer and the affected area. Early diagnosis – at stage I – and treatment give 85% of patients the opportunity to live for at least another five years.

The prognosis for five-year survival decreases at stage III to 30-32% of patients, and at the last stage the outlook is extremely unfavorable.

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