Throat Cancer Quick Action is Key

Although not as common as other cancers, throat cancer will affect some 53,000 Americans this year and nearly 11,000 will die of the disease.

This cancer can start in the mouth or tongue, as we witnessed in rock guitarist Eddie Van Halen, who succumbed to the disease this year. It spreads locally and can metastasize as well—reaching other parts of the body via the bloodstream and lymphatic system.

For decades, the typical throat cancer patient was a male about age 60 with a history of alcohol and tobacco use. That population remains at risk, but trends are changing.

We’re seeing more throat cancers in younger men and women, even when alcohol and tobacco are not involved. The culprit? Mostly HPV, human papillomavirus, a family of common viruses to which nearly everyone in the world is exposed, usually in adolescence.

The link between HPV and cervical cancer in women is well established. But in recent decades, HPV has also become implicated in cancers of the head and neck. And, like many head and neck cancers, the resulting throat cancer can be aggressive, debilitating and, frequently, deadly.

The Risk Factors

Your throat is a complex system that supports breathing, swallowing, talking and our sense of taste and smell. “Throat cancers” may include many different areas of the head and neck, however, they are most commonly cancers of the oropharynx, a muscular tube in the middle part of the throat that controls swallowing. Cancer in this region can affect the back of the mouth, tonsils, back of the tongue and soft palate. (Throat cancers may also refer to cancers of the oral cavity, the voice box and the hypopharynx, the area of the throat just above the voice box.)

The most common form of cancer in these areas, squamous cell carcinoma, is a disease of the surface lining of the throat. With time, it can invade into deeper tissues such as muscle, fat and bone and can be quite dangerous.

Throat cancer generally appears in patients over 50, although it’s certainly not unusual for HPV-related cancers to affect younger people. Non-HPV cancers tend to be diagnosed in people over 60, and men continue to be at higher risk than women; this is often the result of lifestyle choices, specifically alcohol and tobacco use. Men are also at higher risk for HPV-related cancers of the throat, but we’re not sure why.

We’ve mentioned tobacco, alcohol and HPV infection, but other risk factors for this disease can include exposure to workplace chemicals, and even poor nutrition or unhealthy teeth. Those with immune systems suppressed by illness, radiation or medication are also at a slightly higher risk.

Frequency of oral sex is also suspect; research suggests people with up to five lifetime oral sex partners are about twice as likely to experience throat cancers. The risk is five times higher for people with six or more lifetime partners.

The HPV Connection

HPV is a sexually transmitted disease. One of the most common infections in the world, it causes warts on the skin and genitals. Some 79 million Americans have HPV, and an estimated 14 million more contract it annually. Most become exposed as adolescents and young adults. Although many strains of HPV exist in the environment, only a few are associated with cancer.

Evidence linking HPV and cervical cancer, mounting since the 1960s, led to development of an HPV vaccine, initially targeted at adolescent girls. Today, we know that infection is linked to head and neck cancer as well, and vaccination guidelines have been expanded to include girls, boys and transgender people.

Signs and Symptoms

Because there is no lab test or single screening tool for throat cancer, most instances are discovered after the disease is underway. Classic symptoms include:

• A mass or growth in the neck that can be felt or seen
• Hoarseness or a change in the voice that doesn’t go away
• A sore throat that doesn’t improve
• Difficulty swallowing or painful swallowing
• Neck or ear pain
• A mass or ulceration visible in the back of the throat
• Bleeding
• Unexplained weight loss

Of course, it’s important to note that many other problems can cause similar symptoms, including infections, allergies, gastric reflux, benign cysts or a swollen lymph node or salivary gland, so it’s important to let a specialist make the correct diagnosis.

We conduct a physical exam and detailed medical history, and we also perform a scope study in which a camera mounted on the end of a small flexible tube is passed through the nose and into the back of the throat. Done in the office with a local anesthetic to numb the nose and throat, this procedure gives us a clear view of mucosal surfaces that can harbor hidden cancers or other issues.

If we spot anything warranting further investigation, we order imaging tests, typically an ultrasound or CT scan, to look deeper. A biopsy of any suspicious mass or lesion will confirm cancer. But, depending on the stage of the disease, we can often suggest if cancer exists even without the biopsy.

If throat cancer is confirmed, it’s critical to begin treatment immediately to improve the patient’s odds of survival.

Don’t Delay Treatment

Quick action is key because head and neck cancers can be aggressive and fast-growing. Discovered early, they are often curable—but can become a lot more dangerous in just a few months’ time. Left untreated, they are virtually guaranteed to progress.

Throat cancer treatment can have significant effects on quality of life. It can affect breathing, speaking, eating and swallowing—and can even alter appearance. All of this is less likely to happen if the disease is caught and managed at its earliest stage.

Treatment is unique for each patient and may involve surgery, radiation, chemotherapy or some combination of these. Our approach depends on the specific site of the cancer, its stage and the patient’s specific preferences, overall health and tolerance. Minimally invasive, robotic surgery techniques are often an option with smaller tumors.

Each patient case is carefully reviewed at our tumor board conference by our multi-disciplinary team of surgical, oncology, radiology, pathology, social work, nutrition and other specialists. We collaborate with the goal of finding the most effective treatment options that will offer the best possible quality of life for the patient.

Be Vigilant

Because most cancers of the throat are not diagnosed until symptoms appear, prevention remains the best strategy. Here are some recommended precautions:

• Get an HPV vaccination
• Avoid tobacco
• Moderate your alcohol intake
• Practice safe sex
• Limit oral sex partners

Because many suspicious growths are discovered by the patient, it’s also a good idea to perform self-checks at home. Be aware of any new or unusual lumps or bumps in the neck. Use a mirror to look inside your mouth and keep an eye out for any new masses or sores. Report these and any other symptoms to your health care provider.

In fact, seeing your family physician on a routine basis is important, as well as seeing your dentist for regular exams every six months. Poor oral hygiene is a known risk factor, and dentists are experienced at early detection.

Experience and Expertise

MedStar Washington Hospital Center is one of the largest treatment centers for cancers of the head and neck, with particular expertise in HPV-related cancers and salivary gland tumors. Because throat cancer treatments can sometimes have dramatic impacts on a patient’s appearance and lifestyle, the team is skilled and experienced in reconstructive surgery and microsurgery.

We deliver personalized care combined with the most advanced expertise and technology.

Our team is also involved in research; my areas of interest, for example, include head and neck cancer in the elderly. We will soon embark on a national study to assess and quantify quality-of-life outcomes for head and neck cancer patients.

Navigating head and neck cancer can present many challenges. But our mission is to be readily available to every patient, no matter the diagnosis.