Figure: example of throat cancer.
From the site: cancer.uvahealth.com
The precise causes of this tumor have not yet been recognized; however, doctors and scientists believe that tobacco use and alcohol abuse are on the list of major risk factors.
The main pathological manifestations of throat cancer are: hoarseness, difficulty in swallowing and sore throat.
For a correct diagnosis, doctors resort to several tests, including a local biopsy.
Treatment depends on the location and severity of the tumor. For stage I (mild) throat cancers, radiotherapy combined with chemotherapy may be sufficient. For more serious tumors, however, surgery becomes necessary.
Brief review of what a tumor is
In medicine, the term tumor identifies a mass of very active cells, capable of dividing and growing in an uncontrolled way.
- We speak of a benign tumor when the growth of the cell mass is not infiltrative (that is, it does not invade the surrounding tissues) and not even metastasizing.
- We speak of a malignant tumor when the abnormal mass of cells has the ability to grow very quickly and spread to surrounding tissues and the rest of the body.
The terms malignant tumor, cancer and malignant neoplasm are to be considered synonymous.
, larynx or palatine tonsils.
Figure: sections that make up the pharynx (highlighted in red) and anatomical parts adjacent to them (in black). From the site: memorize.com
But what exactly are the pharynx, larynx and palatine tonsils?
PHARYNX
The pharynx is a musculo-membranous duct about 13 centimeters long, covered by a mucous membrane and located between the nasal cavity and the esophagus. To be more precise, it resides:
- Postero-inferior to the nasal cavity (i.e. behind and lower than the nasal cavity)
- Posterior to the mouth
- Superior to the esophagus and larynx
The pharynx constitutes a fundamental tract of the upper digestive airways, which are so called because they allow both the progression of food towards the esophagus and the passage of air destined for the lungs for breathing.
Starting from the nasal cavity and going down towards the esophagus, three compartments can be recognized in the pharynx: the nasopharynx (or nasopharynx), the oropharynx and the hypopharynx (or laryngopharynx).
LARYNX
The larynx is an uneven tubular duct, located at the level of the neck, before the beginning of the trachea. cartilage, muscle and ligament structures.
Figure: the larynx and the main cartilage structures that make it up are highlighted in red. From the site: ponsuke2.s98.xrea.com
Seat of the vocal cords, the larynx performs three fundamental functions:
- It channels the air towards the trachea, then towards the lungs.
- It allows phonation, through the vibration of the vocal cords.
- Thanks to a cartilage valve called the epiglottis, it prevents food, which is about to be swallowed, from entering the trachea and obstructing the airways.
Externally, the larynx can be placed in correspondence with the so-called Adam's apple (anterior protrusion of the neck more evident in men than in women).
PALATINE TONSILS
The palatine tonsils - which are commonly referred to by the single term (albeit imprecise) of tonsils - are two symmetrical lymphoglandular organs, with an anti-infective and immune function.
Located at the bottom of the oral cavity (in a position known as the isthmus of the jaws), they have the task of defending the organism from bacterial and viral infections typical of the buccal and nasal cavities.
THROAT CANCER IS ALMOST ALWAYS A SPINOCELLULAR CANCER
Squamous cell carcinomas are malignant skin tumors other than melanoma, which originate in so-called squamous cells.
In 9 out of 10 cases, throat cancer is squamous cell carcinoma (or squamous cell carcinoma).
If it remains, it may have the same characteristics as Kaposi's sarcoma or mucinous adenocarcinoma (i.e. a neoplasm that develops from mucus-producing cells).
N.B: unlike the cells present in the skin, the squamous cells present in the mouth and throat are devoid of a protein called keratin.
EPIDEMIOLOGY
Throat cancer is generally a less widespread cancer, which mainly affects people aged 60-70 and over.
According to a recent statistical study referring to 2014, in the USA, the new cases of cancer of the larynx and pharynx would have been, respectively, 12,630 and 14,410.
Throat cancer is more common among men: for example, for laryngeal cancer we speak of a male: female ratio of 4: 1.
These mutations - which usually affect a single cell, from which other mutated cells originate by mitosis - are responsible for the uncontrolled process of cell division and growth, typical of a neoplasm.
The precise causes of these genetic changes are often unclear; however, in the case of throat cancers, doctors believe that a key role is played by some risk factors:
- Tobacco, in any way it is used: therefore cigarettes, cigars, pipes, chewing tobacco, etc.
- Alcohol abuse.
- Human papilloma virus infections (or HPV from English Human Papilloma Virus).
- A diet low in vegetables and fruit.
- Old age. According to various statistical studies, throat cancer is much more common among individuals over the age of 60.
- Exposure to dust, fumes and toxic substances that can spread in the air and be inhaled. The people most exposed to these substances are those who work in factories or industrial plants.
TYPES OF THROAT CANCER
Depending on where the tumor is formed, throat cancer takes on different names. In fact, there are:
- Nasopharyngeal cancer. It is a pharyngeal tumor that develops from the nasopharynx (or nasopharynx).
- Oropharyngeal cancer. It is a tumor of the pharynx which has the oropharynx as its starting point.
- Hypopharyngeal cancer. It is a pharyngeal tumor that develops from the hypopharynx (or laryngopharynx).
- Glottic cancer. It is a tumor of the larynx that has the vocal cords as its starting point.
- Supraglottic cancer. It is a laryngeal tumor that begins at the supraglottis or epiglottis level.
- Subglottic cancer. It is a tumor of the larynx that begins to develop from the subglottis (or in any case from the area below the glottis).
- Tonsillar cancer. It is the tumor that starts from the palatine tonsils.
- Hoarseness. Hoarseness is the change in the tone (or timbre) of the voice. It is a common sign of all throat cancers but is particularly pronounced in laryngeal cancers.
- Cough
- Difficulty swallowing. Such difficulties usually manifest as pain while eating.
- Pain in the ears
- Feeling of having something, like a lump, in the throat
- Persistent sore throat
- Weight loss. It is due to swallowing problems, which prevent the patient from eating according to his own needs.
- Respiratory difficulties. They occur if the tumor mass somehow blocks the passage of air along the pharyngolaryngeal tract.
- Swollen lymph nodes on the neck
WHEN TO SEE THE DOCTOR?
If the aforementioned symptoms are particularly severe or persist for more than two weeks (without showing any improvement), you should immediately contact your doctor to investigate the situation.
For example, hoarseness should arouse suspicion when it has been going on for at least 2-4 weeks.
COMPLICATIONS
If not treated properly, throat cancer can spread some malignant cells to the rest of the body, affecting nearby lymph nodes and then also extending to some organs (such as the liver).
The process that leads a tumor to disseminate its malignant cells to the rest of the organism is called metastatic process or more simply metastasis.
OBJECTIVE EXAMINATION
During the physical examination, the doctor visits the patient and asks him or her to describe the symptoms felt and how long they have been with them.
Once this is done, investigate the possible causes of throat problems, asking the individual under test if he is a smoker, frequently abuses alcohol or works in some industrial plant.
In the presence of one or more of the above circumstances, the hypothesis is stronger that the complaints accused are linked to throat cancer.
ENDOSCOPY AND LARYNGOSCOPY
Endoscopy is a medical procedure that allows you to inspect the throat of an individual to identify any abnormalities. The instrument used for endoscopy is the "endoscope; the" endoscope is a kind of probe equipped with light and a camera connected to a monitor , for the projection of images.
Alternatively or in addition to endoscopy, doctors sometimes also resort to laryngoscopy. Laryngoscopy is the exploration of the larynx, performed with an instrument called a laryngoscope; the laryngoscope, like the endoscope, has a camera connected to a monitor, on which it reproduces what is being recorded.
TISSUE BIOPSY
Tissue biopsy consists of taking and analyzing a sample of cells from the tumor mass in the laboratory.
The sample is generally carried out during endoscopy (or laryngoscopy), especially if these show the presence of something abnormal in the pharynx, larynx or tonsils.
IMAGE DIAGNOSTICS
Using CT (computed tomography), nuclear magnetic resonance, X-rays, or PET (positron emission tomography), doctors can tell if the cancer has spread to neighboring lymph nodes and other organs in the body.
CT, X-rays, and PET scans involve exposure to a minimal dose of harmful ionizing radiation.
GRAVITY OF CANCER: THE TUMOR STAGES
The severity of a tumor depends on the size of the tumor and the spreading capacity of the tumor cells. There are 4 stages of severity; these stages are distinguished from each other by the first four Roman numerals.
Stage I identifies less severe tumors, confined to a specific site; stage IV, on the other hand, identifies the most severe and extensive tumors, which are even widespread in the lymph nodes and other organs of the body (usually the liver). Stages II and III distinguish tumors of intermediate severity.
As anticipated, it represents the treatment of choice for less severe throat tumors (therefore not very extensive and confined to well-defined areas), but it can also represent a valid support for surgery in cases of severe or very severe neoplasms.
Unfortunately, radiation therapy is not free from side effects.
The X-ray source can be external or located in close contact with the tumor
The source that releases the ionizing radiation can be a machine designed specifically to emit X-rays and in which the patient is placed (external radiotherapy); or it can occur in the form of radioactive material of very small size, which can be placed near the tumor to be treated (brachytherapy).
Brachytherapy has the advantages of being highly specific and very rapid (N.B: for any additional information on this subject, we recommend that you consult the article on brachytherapy on the following page).
CHEMOTHERAPY
Chemotherapy is the administration of drugs capable of killing all rapidly growing cells, including cancer cells.
It is often combined with radiotherapy, to make the latter more effective. However, it must be remembered that, with the chemotherapy-radiotherapy combination, the side effects of each treatment are more likely to develop.
Nausea
He retched
Hair loss
Sense of fatigue
Infection vulnerability
Loss of teeth
Sense of fatigue
Mandibular stiffness
Inflammation of the mouth
Bleeding gums
Dry mouth
SURGERY
The type of surgery varies according to the location and stage of the tumor. In fact, it is possible to resort to:
- Endoscopic resection. Endoscopic resection is reserved for tumors of small size and confined to a limited "area. It is so called because the removal takes place using an endoscope, which is used by the surgeon operating as a guide tool for the removal of the tumor mass.
- Laryngectomy. Laryngectomy is the operation of removal of the larynx. Practiced on the occasion of tumors of the larynx, it can be partial or total, depending on the extent of the neoplasm.
In the case of total laryngectomy, the patient is no longer able to breathe properly; therefore, in these situations, the tracheotomy operation is also foreseen, with which the respiratory capacities are re-established. - Pharyngectomy. Pharigectomy is the partial removal and reconstruction of the pharynx. Practiced in the presence of a pharyngeal tumor, it can involve part or all of the pharyngeal tract.
- Neck dissection. It is the surgical procedure aimed at removing the lymph nodes present on the neck and contaminated by throat cancer cells. Therefore, it is generally practiced on the occasion of neoplasms at an advanced stage.
Interventions of the aforementioned type require particular preparation and, like any surgical operation, they are not completely free from risks / complications.
Among the possible complications, it should be noted:
- Difficulty speaking normally
- Problems with chewing
- Difficulty breathing properly
- Difficulty swallowing and eating enough
For each of these problems, there is the possibility of undergoing a specific rehabilitation therapy, which allows to recover, at least in part, the normal abilities.
OTHER ANTI-CANCER DRUGS
There are anticancer drugs, such as Cetuximab, which act specifically against cancer cells, as these have very specific characteristics, different from those of healthy cells.
Several scientific researches have shown that Cetuximab can be combined with chemotherapy and / or radiotherapy.
SOME IMPORTANT THERAPEUTIC RULES
Doctors strongly advise to stop smoking and drinking alcohol, as tobacco and alcohol (especially the former) slow down the healing of surgical wounds, negatively affect therapy (i.e. the effects are reduced), favor the appearance of other tumors ( or relapses) and, finally, make chemotherapy and other anticancer drugs less tolerable.
.Therefore, it is recommended to use condoms when the sexual partner could be a carrier of the virus.
