THROAT CANCER

Throat cancer is a layman's term that usually refers to cancer of the back of the mouth(oropharynx), the voice box (larynx) and the food pipe (hypopharynx). The most common symptoms of throat cancer are non-specific, and not all patients exhibit all of them.

OROPHARYNX

The soft palate, uvula, tonsils, posterior pharyngeal wall and posterior one-third of tongue constitute the oropharynx. Foreign body sensation of the throat, persistent one-sided ear aches and difficulty in swallowing are some of the subtle symptoms which herald cancers of the oropharynx. They can grow unnoticed before being diagnosed, because these tumours lie in an area which is relatively spacious. A lump in the neck may be present, indicating that it has spread to the neck nodes, and may be the first indication that something is wrong.

HYPOPHARYNX

This is that part of the throat that directs our food into the food-pipe without letting it enter the airway. It shares common boundary walls with the voice box (larynx), and at times it is difficult to discern where the tumour originally arose from. Throat discomfort, feeling of something caught in the throat, difficulty in swallowing certain foods, a mass or lump in the neck, change of voice, difficulty in breathing, cough, repeated throat clearing, unilateral earache and unintentional weight loss can be features of hypopharynx cancers.

CERVICAL OESOPHAGUS

It is the part of the food pipe that is present in the neck(main part is in the chest). Its cancers are very common in Indian women who are malnourished and anemic, starting in the form of oesophageal webs and progress to life threatening cancers. Sadly, it is also a preventable cancer. Cancers of the foodpipe present with difficulty in swallowing dry solid foods initially, later progressing to include semisolid and liquids too. There may be vomiting or regurgitation of food, unexplained weight loss, coughing or hoarseness and feeling of food stuck in the throat.

LARYNX (VOICE BOX)

The voice box has three parts-- the supraglottis, the glottis and the subglottis, named as the part above the vocal cords, the vocal cords themselves, and the part below the vocal cords, which continue as the trachea. The symptoms of the supraglottis growths overlap with those of the hypopharynx. (see above). The glottis is the narrowest part of the airway, and any growth here typically cause persistent progressive hoarseness of voice and difficulty in breathing. Subglottis cancers usually do not occur in isolation, but spread from tumours above, and cause difficulty in breathing as their predominant symptom.

As stated above, these symptoms and signs are not diagnostic for throat cancer because many other problems can mimic the throat cancer. However, any person who develops these signs and symptoms and has risk factors for throat cancer should immediately discuss them with his or her physician.

DIAGNOSIS

The person's individual history (especially the presence of potential risk factors) and physical examination may provide a physician with enough suspicious information that the physician will consider throat cancer as a possible diagnosis.

Consequently, the physician may strongly suggest doing additional tests, like endoscopies to confirm or exclude the diagnosis. Endoscopes are narrow flexible or rigid tubes with a light and camera attachment, which are introduced through the nose or mouth. They can look into the various nooks and corners, and project a picture on a computer screen. Imaging tests such as CT and MRI give an indication of the depth and extent of disease, and hence the stage.

This is generally followed by a biopsy if any growth is seen. The biopsy is usually done under general anesthesia because the tumours are not easily accessible. If a neck node can be felt, it is easier and cheaper to perform an FNAC (fine needle aspiration cytology), rather than a formal biopsy. Either way, a tissue testing is a must to establish the diagnosis.

Tests for general fitness are then ordered, so that the patients ability to tolerate the treatment is assessed.

TREATMENT

According to the current guidelines, the treatment of choice in these cases is non-surgical. Radiation and/or chemotherapy with modern drugs and technology, tailored to the individual, provide him/her with the best chance for a successful outcome. Treatment strives to preserve the patient's ability to eat, speak, and live a normal healthy life.

The role of surgery may be limited to biopsy alone. Sometimes, it is possible that the growth can be entirely removed in the process, and can be considered complete treatment in itself. These come under the purview of minimally invasive surgeries, including transoral laser microsurgery, endoscopic and robotic surgeries.

At the other extreme, the role of surgery is magnified in cases of advanced tumours, where primary surgery and reconstruction, followed by radiotherapy is the protocol. Surgery also has a major role in chemoradiation failures, where residual and recurrent tumours. This is known as salvage surgery, and always carries more morbidity in terms of wound healing and outcomes.