Nasopharyngeal and Throat Cancer: Comprehensive Cancer Information

Nasopharyngeal and Throat Cancer: A Comprehensive Guide

This information is intended to provide a general overview of nasopharyngeal and throat cancer. It is not a substitute for professional medical advice, diagnosis, or treatment. Always consult with a qualified healthcare provider for any health concerns or before making any decisions related to your health.

General Information

Nasopharyngeal cancer is a disease of the nasopharynx, the structure situated behind the nasal cavity that channels air from the nostrils to the windpipe (trachea). The cancer develops when a cell in this structure mutates and begins to multiply rapidly.

The nasopharynx is the uppermost section of the pharynx, which is a tube extending down from the back of the nasal cavity, connecting to the oral cavity (mouth), and then continuing to the oesophagus and trachea. The pharynx is vital for both breathing and swallowing.

Almost all nasopharyngeal cancers originate in the structure's lining, which is composed of thin, flat cells known as squamous cells. Consequently, most cases of this cancer are classified as squamous cell carcinoma.

While nasopharyngeal cancer is an aggressive disease, it is one of the most common cancers in India.

Nasopharyngeal Cancer Risk Factors

A risk factor is any element that increases a person's likelihood of developing a disease. Risk factors for nasopharyngeal cancer include:

Infection with the Epstein-Barr virus (EBV)

EBV is a common virus. While most individuals recover with no long-term effects, in some, it can contribute to the development of cancer, including Hodgkin Lymphoma and nasopharyngeal cancer.

Sex

Men have a higher propensity to develop nasopharyngeal cancer than women.

Alcohol use

Heavy consumption of alcohol is also considered a risk factor for this cancer.

Symptoms

Symptoms of throat cancer can vary from person to person and are often determined by where the cancer first develops.

Early Signs of Oropharyngeal Cancer

Most throat cancers are oropharyngeal cancers, occurring in the back of the tongue and the tonsils. The initial symptoms of oropharyngeal cancer may include:

  • A persistent sore throat.
  • A dull earache on one side.
  • One tonsil being larger and/or shaped differently than the other (tonsil asymmetry).
  • Difficult and/or painful swallowing.
  • Blood-tinged mucus.

Late Signs of Oropharyngeal Cancer

Symptoms that may signal a more advanced stage of throat cancer include:

A painless lump in the neck that can often be seen or felt externally. This lump is typically a lymph node swollen with cancer cells and can sometimes grow larger than the primary tumour. As swollen lymph nodes are also a common sign of infection, patients are often initially treated with antibiotics. If the lump does not respond to these medications, doctors will look for other causes, including oropharyngeal cancer that has spread to the lymph nodes.

  • Persistent coughing.
  • Difficulty moving the tongue or opening the mouth.
  • Spitting up blood.
  • Hoarseness or other voice changes.

Other Conditions with Similar Symptoms

Nearly all symptoms associated with throat cancer can also be caused by much less serious conditions such as allergies, bronchitis, laryngitis, and strep throat. If a symptom resolves on its own or with standard treatment like antibiotics, it is almost always one of these common conditions. If a symptom persists for more than two weeks or does not improve despite appropriate treatment, it is crucial to consult a specialist, such as an ear, nose, and throat (ENT) doctor, for a proper evaluation.

How Does Throat Cancer Feel?

Throat cancer is often painless and does not cause symptoms in its very early stages. When patients do experience sensation, they commonly describe a pinpoint pain on a single spot of the throat or a dull earache, typically on the same side as the cancer. Painful swallowing is another frequently reported symptom.

Diagnosis

As with all cancers, early and accurate diagnosis is essential for throat cancer to maximise the chance of cure while preserving quality of life, including the ability to speak and swallow.

If symptoms suggest throat cancer, your doctor will perform a physical examination and ask detailed questions about your health, lifestyle (including smoking and drinking habits), and family medical history. The diagnostic tests used to confirm throat cancer and determine if it has spread depend on the suspected cancer type. Tests are also used to monitor the disease and its response to treatment.

One or more of the following tests may be used for a throat cancer diagnosis:

Fiberoptic Laryngoscopy

This is often the first test. A doctor passes a small camera through the nose to examine the nasopharynx, oropharynx, and larynx, which helps determine if a biopsy is necessary.

Biopsy

A biopsy is the only way to definitively diagnose throat cancer. Doctors retrieve suspected cancerous tissue for microscopic study. Different methods are used depending on the tumour's location:

  • Fine-Needle-Aspiration Biopsy (FNA): Used for lumps in the neck that can be felt externally. A thin needle extracts cells for examination, often guided by an ultrasound.
  • Conventional Incisional Biopsy: The doctor surgically removes a part of the suspected tissue.
  • Excisional Biopsy: A procedure that removes most or all of the suspected cancerous tissue, often performed during a tonsillectomy in the operating theatre.
  • Endoscopic Biopsy: An endoscope (a thin, lighted tube) is inserted through the mouth, nose, or an incision to view organs and tissue and remove tissue samples. This is primarily used for nasal cavity or nasopharyngeal cancers.

Imaging Exams

These help locate the suspected cancer, show if it has spread, and monitor its progression and response to treatment. They may include:

  • CT or CAT (Computed Axial Tomography) scans
  • PET (Positron Emission Tomography) scans
  • MRI (Magnetic Resonance Imaging) scans
  • Ultrasound
  • Chest and dental X-rays

Swallowing Tests

These tests help doctors understand the throat's performance and plan treatment:

  • Barium Swallow: The patient drinks liquid barium, which improves visibility during X-rays. This evaluates the passage from the throat to the stomach for changes in structure and muscle movement.
  • Modified Barium Swallow: The patient ingests liquid, pudding, and solid food containing barium. A speech pathologist and radiologist observe the swallowing in real-time using a specialised X-ray exam (fluoroscopy) to evaluate the associated structures and movements.
  • Fiberoptic Endoscopic Examination of Swallowing (FEES): A small, flexible endoscope is inserted through the nose, allowing the doctor or speech pathologist to examine the swallowing process.

Treatment

SSCHRC takes special care to customise throat cancer treatment with the goal of maximising the chance of cure while maintaining the patient's quality of life. As the throat is critical for speaking, breathing, and swallowing, treatment often focuses on preserving these functions while eliminating the cancer. Treatment plans are customised for each individual patient.

Care is provided by a multidisciplinary team of experts, including a medical oncologist, radiation oncologist, head and neck surgeon, and plastic surgeon. Depending on the type of throat cancer and the extent of its spread, one or more therapies may be recommended:

Throat Cancer Surgery

Surgery is a common treatment for most throat cancers, including oropharyngeal, hypopharyngeal, and laryngeal cancer, but is rarely used for nasopharyngeal cancer. For oropharyngeal cancer, less invasive surgical techniques have resulted in much shorter recovery times. Procedures include:

  • Transoral Robotic Surgery: The most common surgery for oropharyngeal cancer. It is a minimally invasive procedure that uses robotic tools and advanced 3D imaging to completely remove the tumour without the need for large incisions in the mouth and jaw area.
  • Transoral Laser Microsurgery: This procedure enables surgeons to access tumours in tight or previously inaccessible locations using a flexible, hollow-core fibre that transmits CO2 laser energy, minimising damage to nearby tissue.

Throat Cancer Chemotherapy

Chemotherapy drugs kill cancer cells, control their growth, or relieve symptoms. Treatment may involve a single drug or a combination. Chemotherapy may be used to shrink a tumour before surgery, or to kill lingering cancer cells after surgery and/or radiation. A combination of chemotherapy and radiation therapy may also be used as the primary treatment for patients with larger tumours or those who cannot undergo surgery.

Throat Cancer Immunotherapy

Immunotherapy works by enhancing the body's own immune system to recognise and eliminate cancer cells, which are often able to evade the immune response. At this time, only immune checkpoint inhibitors are approved to treat throat cancers. These drugs prevent the immune system from prematurely turning off before the cancer is fully eliminated.

Throat Cancer Targeted Therapy

Targeted therapy drugs are designed to halt or slow the growth or spread of cancer at a cellular level. These therapies interfere with specific molecules (proteins) that cancer cells need to survive, multiply, and spread.

Throat Cancer Radiation Therapy

This uses focused, powerful beams of energy, typically photons, to destroy cancer cells. Types of radiation therapy used include:

  • Intensity Modulated Radiation Therapy (IMRT): This focuses multiple radiation beams of different intensities directly on the tumour to deliver the highest possible dose. A variation, Volumetric Modulated Arc Therapy (VMAT), uses a rotating machine to deliver radiation from multiple angles.
  • MR LINAC Radiotherapy: Uses a specialised device to adjust treatment on a daily basis, which can reduce side effects and effectively treat changing tumours.
  • Stereotactic Body Radiation Therapy (SBRT): Also known as stereotactic ablative radiotherapy, SBRT precisely targets tumours with very high doses of radiation using several beams of various intensities aimed from different angles.

Throat Cancer Clinical Trials

As a premier cancer centre, SSCHRC develops and participates in clinical trials for new throat cancer therapies. These can sometimes be the best treatment option and help researchers improve future cancer care.

Specialised Care for Throat Cancer Patients

Speech Therapy

SSCHRC speech pathologists and audiologists offer advanced techniques for restoring speech after cancer treatment.

Swallowing Therapy

Experts in the Speech Pathology and Audiology Section are dedicated to evaluating and treating patients with difficulty eating, drinking, and swallowing after treatment. SSCHRC's swallowing service is a leader in this field.

Reconstructive Surgery

To address any impact on a patient's appearance, SSCHRC is home to renowned reconstructive surgeons who perform procedures to help restore appearance.

Dental Care

The teeth and jaw can be damaged by the disease and its treatments. SSCHRC dentists specialise in designing implants and performing procedures to restore appearance and function.

Survivorship

SSCHRC has a survivorship clinic dedicated to the unique needs of head and neck cancer patients.

Regular follow-up and screenings are vital due to the high risk of the cancer returning (recurring) in the throat or other areas of the head and neck. Patients need to see their doctors every three to six months for the first two years after treatment, as most recurrences happen within this timeframe. Patients are also strongly urged to refrain from smoking or drinking alcohol during and after treatment, as these habits can reduce the success of treatments, worsen side effects, and greatly increase the chance of the cancer returning.

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