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

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

Epidemiology

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

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

In Europe, 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 Childhood Cancer Classification (ICCC), a child’s throat cancer can be detected, and most often it is rhabdomyosarcoma.

In men, throat cancer occurs five to seven times more often than women.

The National Cancer Registry of Ukraine states that laryngopharyngeal cancer accounts for just over 5% of oncodiagnosis per 100 thousand inhabitants (for comparison: in Scandinavian countries this figure is at 1.4%).

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

[1], [2], [3], [4],

Causes of the throat cancer

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

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

Doctors determine the risk factors for oncology of the larynx and pharynx, such 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).

It increases the risk of laryngopharyngeal and HPV cancer — a human-transmitted human papilloma DNA virus that can be infected through oral sex — with the development of  laryngeal papillomatosis  or vocal folds. Oncogenic HPV types are dangerous (31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, 68, 73). According to experts of the American Cancer Society, in 60% of cases, throat cancer in non-smokers is associated with infection with this virus.

Throat cancer is also more likely to develop in the presence of inherited  Plummer-Vinson syndrome  or genetically caused  Fanconi anemia.

Can pregnancy trigger throat cancer? The growth of malignant neoplasias of this localization does not apply to hormonally induced processes, and its etiological connection with pregnancy has not been identified (although there are receptors of sex hormones in the tissues of the vocal cords). It has been hypothesized that, 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? Today, scientific research has shown that cancer is a non-contagious disease: cancer cells cannot be transmitted. That is, cancer does not spread as an infectious disease. Only herpes and HPV viruses mentioned above are contagious.

[5], [6], [7]

Symptoms of the throat cancer

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

Further development of the pathological process with the advent of new signs occurs as the stage of the disease increases, which is determined in accordance with the International Cancer Classification (TNM). Thus, the typical symptoms of throat cancer in the early stages (stage I) include a nonproductive (dry) paroxysmal cough.

When stage II and III come in, the patients are noted: constant feeling of a coma in the throat and pressing pain, headache and earache; prolonged cough and difficulty swallowing; slight 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 visualization reveals metastases.

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

Useful information also in the material -  Symptoms of throat cancer

Forms

In oncology, the following types of malignant tumors of the lower part of the pharynx are distinguished: zavistnevidnoy area, lame fold, cancer of the posterior throat (pharynx) and lymphadenoid pharyngeal ring. Read more -  Malignant tumors of the pharynx

And  laryngeal cancer  - parts of the throat from the root of the tongue to the trachea - is distinguished by localization of the vocal folds on the tumor or cancer of the ligaments of the throat (including false or vestibular), sub-or supra-connective tumors (in 70% of cases), as well as in the epiglotis ( epiglottic cartilage). Read also -  Cancer of the larynx - Classification

In addition, tumors of the pharyngeal or palatine tonsils — tonsillary cancer — are listed as throat cancer.

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

Depending on the histology differ:

• - squamous cell carcinoma of the throat - keratinizing, non-horny and highly differentiated squamous carcinoma - the main type of tumor in adult patients;
• - adenocarcinoma or glandular cancer;
• - lymphoepithelioma (Schminke tumor), formed in the tissues of the pharyngeal tonsils.

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

[8]

Complications and consequences

Among the complications and consequences of laryngopharyngeal cancer tumors, experts note:

• severe breathing problems down to persistent narrowing of the lumen of the larynx;
• violation of innervation of the larynx with the development of its paralysis;
• metastases in the lymph nodes of the  trachea, pulmonary gates, jugular lymph system - with retrograde spread to more distant structures.

Having a common risk factor in the form of smoking increases the likelihood that lung and throat cancer can develop simultaneously or sequentially. Therefore, patients with laryngopharyngeal cancer should undergo regular chest x-rays or CT for early detection of lung cancer.

According to 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 advanced laryngeal cancer, the relapse rate is approximately 30-50%.

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

[9], [10], [11], [12], [13]

Diagnostics of the throat cancer

In ENT oncology diagnosis of malignant laryngopharyngeal tumors is carried out in a complex.

First of all, you need a full history and blood tests to detect tumor markers for throat cancer: SCC antigen, CYFRA 21-1, antibodies E6 and E7. See more -  Blood test for the presence of cancer cells in the body

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

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

The accuracy of the diagnosis and, therefore, the correct treatment strategy should, as expected, be confirmed by a differential diagnosis, in which ENT are distinguished from throat cancer: tuberculosis and laryngeal syphilis; papillomas, granulomas or hemangiomas of the larynx; dyskeratosis and leukekeratosis of the laryngeal mucosa, as well as benign thickening (hyperplasia) in the chronic form of its inflammation (laryngitis); atrophic or phlegmonous laryngitis; fibroids and vocal folds; subglottic scleroma, etc. Read also -  Cancer of the larynx. Diagnostics

In addition, inflammatory etiology of edema of the throat mucosa and pain in the larynx should be excluded . For example, how to distinguish pharyngitis from throat cancer, as well as throat cancer from sore throat - with obvious similarity of many symptoms? For acute inflammation of the pharyngeal mucosa - pharyngitis - there is a burning sensation inside the nasopharynx, nasal congestion and ears (the latter is removed with several swallowing movements); with its chronic form, mucus runs down the back of the pharynx.

In case of a sore throat (tonsillitis) caused by a bacterial infection, the throat (tonsils and palatine arches) is hyperemic, purulent plaque often forms on the pharyngeal mucosa and glands, and in lacunar quinsy - purulent congestions on the tonsils.

Also, doctors pay attention to such a non-specific symptom as a feeling of coma in the throat. And they point, for example, to the difference between neurotic coma in the throat and cancer. Frequent or almost constant feeling 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 conditions of nervous tension. Diagnostic significance is the fact that this sensation disappears when swallowing either solid food or liquid.

[14],

Treatment of the throat cancer

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

Oncologists know what to do in case of cancer of the throat, 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 in the publication -  Radiation Therapy for Cancer.

For later stages, irradiation can be combined with chemotherapy or surgery.

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

Surgery for cancer of the throat, which is limited to the surface of the laryngopharynx or vocal connections, can be endoscopic - using a laser. An operation for cancer of the throat stage 0 may involve stripping the vocal folds (removing the upper layers of the tissue on the vocal cords) or resection of the affected vocal cords (chordectomy).

For more extensive tumors, partial or complete laryngectomy is used - the removal of part of the larynx above the vocal folds. After this operation, it is necessary to perform a tracheostomy, in which the breathing tube is installed.

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

In the later stages, surgery is impossible, so radiation and chemotherapy are used. At the stage of the disease that cannot be treated, patients are given palliative medical care when painkillers and drugs are needed to reduce the intensity of other symptoms.

How is throat cancer being treated in Israel, read -  Cancer treatment in Israel

Alternative treatment

No alternative treatment, in the first place, popular treatment, does not eliminate throat cancer. However, some additional, that is, aids may provide some assistance to patients.

Sodium bicarbonate or baking soda for throat cancer according to Neumyvakin alkalizes cancers that have a lower pH compared with healthy tissues. And, indeed, caused by taking soda (twice a day for a glass of its solution - half a teaspoon per 200 ml of water, half an hour before or one hour after eating), the pH improves the therapeutic effectiveness of cytostatics and protects the body of cancer patients from their toxic side effects. Moreover, in vitro it was found that, by increasing the pH of the tumor, sodium bicarbonate makes it difficult for it to grow and spread cancer cells.

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

How to take a lemon for throat cancer? Peel is removed from a thoroughly washed fruit with a fine grater, juice is squeezed from the pulp; zest, juice and honey are mixed in equal proportions or 2: 1. You can take this mixture in a teaspoon per day (not drinking), or put in a glass of water (and using a drink). One "but": it is necessary to rinse your mouth after this, as lemon juice spoils the enamel of the teeth.

Not intended for the treatment of cancer and homeopathy, however, homeopathic doctors recommend as additional funds: Hepar Sulfur (200), Nitric Acid (30), Hydrastis Canadensis (200), Thuja, Kali Muriaticum, Mercurius Cyanatus.

The tincture of the odorous secretion of the tizonia glands of the beavers, with which they mark their territory, contains salicylic acid, alkaloid nufaramin and steroids. Previously, the beaver jet tincture was used to treat seizures and epilepsy, for menstrual disorders, insomnia, headaches, and as a sedative. In the XIX century, this tincture was sold in pharmacies and was recommended for ear and toothache, colic and gout. Today this remedy is used only by homeopaths.

The oncologists do not appoint Dorogov’s antiseptic-stimulator or ASD fraction in throat cancer, as this is not an anti-cancer agent, but divided into fractions and condensed sublimate of meat and bone meal, which was used in animal husbandry.

With this cancer, treatment with herbs can be used (after consultation with the doctor), in particular,  cancer immunotherapy  using adaptogen plants.

The collection of herbs from throat cancer also includes plants with immunostimulating properties and the ability to inhibit the pathological proliferation of mutant cells due to the activation of protein-splitting cysteine proteolytic enzymes. This is the herb of the burdoble figure (Pulicaria crispa), various types of wormwood (Artemisia species), high calotropis (Calotropis procera), colocinth (Citrullus colocynthis), black cumin (Nigella sativa), the famous Ayurvedic ashwagandha plant (Withania somnifera).

It is possible to use antioxidant flavonoids, phenolic acids and tannins of fireweed (Chamerion angustifolium) or thyroid cancer from the throat: decoction of the flowers of this plant helps to remove free radicals, reduces inflammation and reduces pain.

Doctors recommend drinking at least three cups of green tea a day. Scientific research on the effects of green tea on throat cancer is not available, but laboratory results, the results of which were published in 2003 in Folia Histochemica et Cytobiologica, show that green tea epigallocatechin-3-gallate inhibits the growth of cancer cells. Subsequent studies (their results were published in 2009 in Archives of Pharmaceutical Research) confirm this effect.

Nutrition and diet for cancer of the throat

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 : nutrition should be high-calorie, high in protein and trace elements.

You may have to use a gastrostomy tube for eating for some time. In such cases, the patient and his relatives should know that it is impossible to eat spicy, fatty, hard, and fried foods during throat cancer; vegetables and fruits in their raw form; sharp cheeses and sausages; whole wheat bread; very hot or very chilled dishes; alcohol, sour juices and soda water.

Such a diet is called soft, and it includes pureed soups and broths, boiled cereals, cottage cheese and sour cream, yogurt and butter, vegetable oil, steamed or boiled (and pureed) vegetables and fruits. Gentle meat and fish dishes, boiled and shredded chicken and other low-fat poultry are allowed.

Experts advise to sit up straight while eating and not to tilt your head forward: this facilitates the process of swallowing and can reduce the load on the throat. Liquid can be drunk through a straw.

[15], [16]

Prevention

Prevention is better than cure for any disease. 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 (first of all, smoking); eat well, giving preference to food of plant origin; strengthen the immune system; protect against HPV infection.

[17], [18], [19],

Forecast

Survival depends on the stage of the cancer and the affected area. Early diagnosis - at stage I - and treatment make it possible for at least five years to live, 85% of patients.

The prognosis for survival over five years is reduced in stage III to 30–32% of patients, and at the last stage prospects are extremely unfavorable.

[20], [21], [22], [23], [24], [25]