Most people who are diagnosed with throat cancer won’t see anything unusual if they look in the mirror, open their mouths and say, “Ahhhh.”
“That’s because there’s usually not much to see,” says head and neck surgeon Miriam Lango, M.D. “These tumors are often buried deep in the throat, or hidden under the surface of the tissue. Throat cancers are usually quite small, too, and they can be very difficult to see, even by trained experts. So, only about 20% to 30% of patients will notice something visible.”
Symptoms of throat cancer
When a throat cancer is visible to the naked eye, here are some of the features it could have:
Asymmetry: when one side looks odd or just noticeably different from the other
Lesions: might appear as red or white patches
Swelling: may or may not involve lesions
Throat cancers are usually found in the oropharynx, which includes the tonsils, the uvula (the small structure dangling in the middle), the soft palate, and the hind-most portion of the tongue, which is not visible without a scope. But they can also develop in the larynx (voice box) and the nasopharynx (the area behind the nose).
“Normally, it doesn’t hurt,” notes Lango. “But it’s there for longer than it should be, it’s only on one side, and it’s too large to be a swollen lymph node.”
Rarely, patients may report pain in the back of the throat or difficulty swallowing. But most have no symptoms at all, and are very surprised to hear that they have throat cancer.
Throat cancer and HPV: the viral connection
Almost all throat cancers that doctors see at MD Anderson are squamous cell carcinomas. Roughly 80% of them are caused by the human papillomavirus, or HPV, though this figure may be lower at other hospitals.
“I can’t even remember the last time I saw a throat cancer that wasn’t HPV-positive,” says Lango. “Before the year 2000, we hardly saw any at all. Now, we’re seeing a ton. It really is an epidemic.”
That’s why Lango encourages everyone ages 9-26 to get vaccinated against HPV. The HPV vaccine is most effective when given at ages 11-12. But unvaccinated men and women ages 27-45 should talk to their doctors about the benefits of receiving the vaccine.
“The amount of throat cancer caused by tobacco has dropped exponentially in the last 20 years,” Lango notes. “That’s partially because people aren’t smoking as much as they used to. But if we could get more young people vaccinated against HPV now, that would really go a long way toward reducing future cases of throat cancer.”
“Both of these issues can affect your quality of life and your ability to enjoy food,” Lango says. “So, it’s very worthwhile to make sure you’re getting the right treatment.”
Throat cancer treatment
With early stage throat cancers, surgery alone might be all that’s needed. With more advanced cases, patients will likely be offered some combination of chemotherapy, surgery and/or radiation therapy.
“In the old days, everybody got chemotherapy and radiation,” notes Lango. “But trans-oral robotic surgery (TORS) has become a very effective tool to treat some patients. The survival rate is just phenomenal.”
Options to reduce the intensity of treatments — and potentially decrease long-term side effects by participating in “de-escalation” clinical trials — may also be available. Studies may incorporate immunotherapy or highly targeted proton therapy.
“Some treatments are conducted through clinical trials because they’re promising, but not yet the standard of care,” says Lango. “But some of our patients’ responses were very good. So, the way we treat patients now may not be the same way we treat patients in a couple of years. And classical chemo has been such a mainstay of throat cancer treatment for so long, that not needing to have it is kind of a big deal.”