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Most commonly, throat cancer refers to cancer of the following structures:
Pharynx, the tube through which we swallow. It is divided into three major sections:
- Nasopharynx: The upper section, which is behind the nose
- Oropharynx: The middle section, which is behind the mouth and includes the tonsils, soft palate and base or posterior-most portion of the tongue
- Hypopharynx: The bottom section, which marks the transition between the pharynx behind the voice box (larynx)
Larynx, also called the voice box. It contains the vocal cords and allows us to speak. It is critical in protecting our airway. It also acts as a valve that opens for us to breathe, and makes sure things we swallow go into the stomach. The larynx is divided into three major parts:
- Glottis: The middle portion that contains the vocal cords
- Supraglottis: The area above the vocal cords
- Subglottis: The area below the vocal cords and above the trachea (windpipe)
Most cases of throat cancer are found in the oropharynx.
The number of new cases of smoking-related cancers, such as cancer of the larynx, hypopharynx and oropharynx, is declining. The number of new oropharynx throat cancers is dramatically increasing, however, because the discovery of the association with the human papillomavirus (HPV).
The HPV virus has been identified with cervical cancer in women for many years, but has become a newly identified cause of throat cancer. Patients with HPV-related throat cancer are generally younger and are less likely to smoke. HPV-related throat cancers may have a better outcome than the non-HPV, smoking-related throat cancer.
Types of Throat Cancer
The lining of the throat is made up of squamous cells. Thus, most throat cancers are squamous cell carcinomas.
Other less frequent types of throat cancer include cancers of the minor salivary glands.
Throat Cancer Causes and Risk Factors
Anything that increases your chance of getting throat cancer is a risk factor. Tobacco use is the most notable risk factor for developing throat cancer, and when combined with drinking alcohol, can increase the risk even more. Read more about MD Anderson's smoking cessation clinical trials.
Throat cancer can be discovered in the nonsmoker as well. Today, the human papilloma virus (HPV) this is the most common risk factor for cancer found in the oropharynx. HPV is spread through sexual contact, including oral sex, though the development of cancer is usually not seen for many years after the original viral exposure. Not all patients who are infected with HPV are subject to cancer.
Other risk factors include:
- Gender: Men are up to five times more likely to get cancer of the throat than women.
- Age: Traditionally, most cases occur over the age of 60, but HPV-related cancers commonly occur in the 50s.
- Exposure to certain chemicals, including nickel, asbestos and sulfuric acid fumes
Behavioral and lifestyle changes can help prevent throat cancer. Visit our prevention and screening section to learn how to manage your risk.
Throat cancer symptoms vary from person to person and depend on where the cancer first develops. Early signs of throat cancer may include:
- Hoarseness or other change in the voice
- Difficulty swallowing or the feeling that something is caught in the throat
- Persistent sore throat
- Ear pain
- Lump in the neck
- Breathing problems
- Unexplained weight loss
These symptoms do not always mean you have throat cancer. However, it is important to discuss them with your doctor, since they may signal other health problems.
Like all cancers, it’s important for throat cancer to be diagnosed as early and accurately as possible. This helps increase your chances for being cured while at the same time limiting the effect of cancer treatment on your quality of life, including ability to speak and swallow.
The experts at MD Anderson are among the most skilled and experienced in the nation in diagnosing and treating throat cancer. They use specialized, advanced technology that has pinpoint focus and reliable results, including three-dimensional imaging that provides detailed information.
Throat Cancer Diagnostic Tests
If you have symptoms that may signal throat cancer, your doctor will examine you and ask you questions about your health and lifestyle, including smoking and drinking habits, sexual history, and family medical history.
The tests used to diagnose throat cancer and find out if it has spread depend on the type of cancer. Tests also may be used to find out if treatment has damaged other tissues or organs. One or more of the following tests may be used.
Different methods are used to obtain tissue for a biopsy, depending on where the tumor is located. Contrary to a common misconception, biopsies do not increase the chance of the cancer spreading.
- Conventional incisional biopsy: This is the traditional, most frequently used type of biopsy. The doctor surgically removes part of the tissue where cancer is suspected.
- Excisional biopsy: A type of biopsy which removes most or all of the tissue suspected of having cancer. This is frequently done with tonsillectomy in the operating room.
- Fine-needle-aspiration biopsy (FNA): This type of biopsy may be used if you have a lump in your neck that can be felt. A thin needle is inserted into the area, and then cells are withdrawn and examined under a microscope. This is often coupled with an ultrasound in order to verify the placement of the needle.
Imaging tests, which may include:
- CT or CAT (computed axial tomography) scans
- PET (positron emission tomography) scans
- MRI (magnetic resonance imaging) scans
- Chest and dental X-rays
Barium swallow: Also called an upper GI (gastrointestinal) series, evaluates the passage from the throat to the stomach and is used to look for abnormal changes in structure and muscle movement. The patient drinks liquid barium, which allows for certain areas of the body to show up more clearly during X-rays. It's called a series because the X-rays in this test will be of the pharynx, esophagus, stomach and duodenum. All X-rays will be taken during a single test.
Modified barium swallow: During this procedure, the patient swallows liquid, pudding, and solid food consistencies with barium in them. By observing the swallow during a real-time form of X-ray called flurorscopy, the speech pathologist and radiologist can evaluate the structures and movements associated with swallowing in order to determine what foods an individual can eat.
Laryngeal videostroboscopy: An evaluation of the overall appearance and movements of the voicebox (larynx) and vocal cords (folds) during sound production (phonation) using a lighted tube placed into the mouth or nose.
Fiberoptic endoscopic examination of swallowing (FEES): A small, flexible endoscope is inserted through the nose, allowing the doctor or speech pathologist to examine swallowing.
Throat Cancer Staging
(Source: National Cancer Institute)
Staging is the process of defining and describing the primary tumor as well as whether it has metastasized (spread) into the lymph nodes or bloodstream. Staging is a universal language for the physicians treating cancer to discuss the treatment options, and to know which treatments will be most effective. It also helps to define what the overall prognosis will be once the treatment is completed.
The staging system most often used for throat cancer is the TNM staging system, also known as the American Joint Committee on Cancer (AJCC) system.
This system gives three key pieces of information:
- T stands for tumor (how far it has spread within the larynx or pharynx and to nearby tissues).
- N describes whether the cancer has spread to lymph nodes.
- M stands for metastasis (spread of the cancer) to distant organs.
All of this information is combined to arrive at a disease stage. After stage 0 (which is carcinoma in situ or cancer that has not grown beyond the lining layer of cells), stages are labeled using Roman numerals from I through IV (that is, 1 through 4). The smaller the number, the less the cancer has spread. A higher number, for example, stage IV, means a more advanced stage of the disease.
MD Anderson takes special care to customize your throat cancer treatment so that we maximize the chances of cure while minimizing the impact on your body and lifestyle. Keep in mind that all cancer treatments have side effects, both short term and long term, but it is the MD Anderson physicians’ goal to factor in the effect of each treatment on a person’s quality of life as part of the treatment decision-making for any throat cancer.
Your care is provided by a team of health care professionals, led by a doctor, typically a head and neck surgeon, who specializes in treating throat cancers. Other members of your team may include:
- Medical oncologists: Doctors who give drug treatments including chemotherapy and immunotherapy
- Radiation oncologists: Doctors who give radiation treatments
- Head and Neck Surgeons: Doctors who remove tumors with specialized operations
- Plastic and Reconstructive surgeons: Doctors who replace tissues removed during cancer surgery to restore function and appearance
- Speech pathologists and swallowing experts
- Physical, occupational and speech therapists
Depending on the type of throat cancer and how far it has spread, you may be treated with one or a combination of therapies.
Throat cancer surgery
Our skilled surgeons are experts at performing surgery for patients with throat cancer. Revolutionary new technologies in robotics and laser surgery have ushered in a new era of throat cancer surgery. Our surgeons have the most advanced equipment and technology to perform advanced surgeries such as the following:
Minimally invasive or endoscopic surgery: This technique allows surgeons to remove whole tumors through the mouth, without external incisions and limited change in speech and swallowing function.
Transoral Laser Microsurgery (TLM): This procedure lets surgeons reach tumors in tight locations that were previously not accessible. Thanks to a flexible, hollow-core fiber that transmits CO2 laser energy, surgeons are able to remove these tumors with minimal damage to surrounding tissue.
Transoral Robotic Surgery (TORS): Robotic-assisted surgery offers the advantages of computer technology, specialized surgical instruments and advanced three-dimensional imaging. This device has made it possible to have a “two-handed cancer surgery” with 3D vision in small spaces without making large incisions to reach the tumor. At MD Anderson, the da Vinci® Surgical System is the latest addition to our surgical tools for head and neck cancer, particularly in the oropharynx.
Supracricoid Partial Laryngectomy: This is an alternative to complete voice box removal for some tumors of the supraglottis and vocal cords. In this surgery, the upper portions of the voice box are removed while preserving the structures that are necessary for swallowing and speaking.
Throat cancer chemotherapy
Chemotherapy may be used to shrink a tumor before surgery or kill lingering cancer cells after surgery and/or radiation treatment. A combination of chemotherapy and radiation therapy may be used as a primary treatment for patients with larger tumors or those who cannot tolerate surgery.
Throat cancer immunotherapy
Immunotherapy is a very promising new form of drug treatment for cancers that stimulates the body’s own immune system to attack cancer cells.
A patient’s overall health, whether this is a new cancer or a recurrent cancer, what treatments have been tried before, as well as the type of cancer determines which immunotherapies are available to patients. Sometimes two different types of immunotherapies are combined during treatment. Other times, a single immunotherapy is used with another type of therapy, such as chemotherapy. These combination approaches are used to improve treatment.
Throat cancer targeted therapy
Targeted therapy is another newer form of cancer treatment with drugs that stops or slows the growth or spread of cancer by targeting specific aspects of a tumor’s biology . Targeted therapies can be given in pill form or through an infusion and are often given along with another treatment like chemotherapy or radiation.
MD Anderson offers the most advanced drug combination regimens, which optimize the benefit of reducing the cancer while trying to have the least impact on the body.
Throat cancer radiation therapy
New radiation therapy techniques, such as intensity-modulated radiotherapy (IMRT) and proton therapy, and remarkable skill allow MD Anderson doctors to target throat cancer tumors more precisely, delivering the maximum amount of radiation with the least damage to healthy cells.
Radiation treatments include:
- Brachytherapy: Tiny radioactive seeds are placed in the body close to the tumor
- 3D-conformal radiation therapy: Multiple radiation beams are given in the exact shape of the tumor
- Intensity-modulated radiotherapy (IMRT): Treatment is tailored to the specific shape of the tumor
Throat cancer proton therapy
Proton therapy delivers high radiation doses directly to the tumor site, with limited, if any, damage to nearby healthy tissue. This pencil-beam technology pioneered by the cancer experts at MD Anderson’s Proton Therapy Center – and available at only a few other centers worldwide – is an important tool for fighting certain head and neck cancers. For some patients, this therapy results in better cancer control with fewer side effects.
The Proton Therapy Center at MD Anderson offers the most advanced form of radiation treatment available in the Southwest. This means that this cutting-edge therapy is backed by all the expertise and compassionate care for which MD Anderson is known.
Speech: The Section of Speech Pathology and Audiology at MD Anderson offers patients the most advanced techniques for restoring speech after larynx (voice box) cancer and its treatment. Experts provide specialized therapies to help patients regain their voice after partial or total removal of the larynx.
Swallowing: Experts in the Swallowing Outcomes Research Laboratory are dedicated to evaluating and treating patients who have difficulty after treatment. MD Anderson’s swallowing service is one of the leaders in the country and serves as a model for the management of patients treated for throat cancers.
Survivorship: Throat cancer patients are strongly urged not to smoke or drink alcohol during and after treatment. Drinking and smoking can make treatments less successful and worsen side effects during treatment, and they can also greatly increase the chance of the cancer returning. MD Anderson has a survivorship clinic dedicated to the needs of head and neck cancer patients.
Regular follow-up and screening is vital due to the high risk of throat cancer returning to the throat or other areas in the head and neck region. Patients need to see their doctors every three to six months for the first two years after treatment, since the majority of cancers that recur, or come back, do so within that time period.
Our Throat Cancer Clinical Trials
Because of its status as one of the world’s premier cancer centers, MD Anderson develops and participates in clinical trials of new therapies for throat cancer. Sometimes they are your best option for treatment. Other times, they help researchers learn how to treat cancer and improve the future of cancer treatment. Learn more about clinical trials.
Why choose MD Anderson for throat cancer care?
MD Anderson has led the way in developing the multidisciplinary approach to cancer therapy. The doctors of different specialties, therapists and other members of your care team take time to appropriately stage the cancer and assess the effect of the cancer on your overall function and wellbeing. They then meet to discuss your individual situation to create the best treatment plan to attack and defeat your cancer. This individualized approach to cancer care has led to the development of new methods to treat throat cancer. We tailor your care to include advanced therapies that give you the highest chance for successful treatment while keeping the ability to eat, speak and live a normal, healthy life.
Innovative treatments include minimally invasive surgical techniques, new radiation treatment approaches and targeted and immune-based therapies that help your body fight the cancer.
Because throat cancer and its treatment often affect breathing, hearing, talking and appearance, we make sure every patient receives full rehabilitation support, including occupational, physical and speech therapy, and/or reconstructive surgery. Dental experts design and place highly specialized implants. Surgeons and oncologists work closely with experts in Speech Pathology and Audiology who have special expertise in restoring speech and swallowing after throat surgery.
Because the highly skilled specialists at MD Anderson have the opportunity to treat patients from all over the world, our Head and Neck program is one of the most active programs in the United States. This means we are able to offer a wide range of clinical trials (research studies) for various types and stages of disease. Our physicians primarily focus their knowledge and skills on treating only cancer patients, and therefore have the most up-to-date information and technology for this disease.
And at MD Anderson you're surrounded by the strength of one of the nation's largest and most experienced cancer centers, which has all the services needed to treat the whole person – not just the disease.
I feel there has to be some reason why I was left here. I think part of it was to share my story.
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HPV-Related Cancers Moon Shot
More than 70% of oropharyngeal cancer cases are caused by human papillomavirus (HPV) infection, for which a safe and effective vaccine currently exists. MD Anderson’s HPV-Related Cancers Moon Shot® aims to improve outcomes for oropharyngeal cancer patients through prevention initiatives and new treatments.Learn more