Throat Cancer

Cancers in the oropharynx (where the back of the mouth meets the throat) often begin in the tonsil, soft palate or base of the tongue. Risk factors for throat cancer include tobacco and alcohol abuse, as well as human papillomavirus (HPV).

Symptoms can include development of asymmetrical tonsils, pain such as a persistent sore throat or pain that shoots to one ear, difficulty swallowing, a muffled sound to the voice or a lump in the neck. Occasionally a neck lump or mass may be an initial sign.

Diagnosis

Doctors can often detect tumors in this area without special instruments, but they may need to use special mirrors or fiber optic telescopes, or to feel the back of the throat with a gloved finger. They may then take a biopsy to confirm a cancer diagnosis. In some cases biopsies can be formed in the office with local anesthetic. Radiologic imaging (CT scan, MRI or PET scan) maybe used to assess the tumor extent and stage of the cancer.

Treatment

Treatment of oropharyngeal cancer often consists of surgery or radiation therapy, with or without chemotherapy. Small tumors may be removed surgically without the loss of throat function. Larger tumors can be surgically removed, if necessary, but these surgeries require throat reconstruction and may harm the ability to swallow.

Laser Microsurgery

A new option that is available for some patients who have excellent swallowing function is minimally invasive laser surgery. With this type of surgery, reconstruction is usually not needed, particularly for the areas around the tonsils and base of the tongue. Some patients with soft palate tumors may need reconstruction that can be completed by transfer tissue from an adjacent area of the mouth instead of a major reconstructive procedure. Larger resections, however, may require major reconstruction.

When tumors are found in the early stages, surgical treatment may be all that is needed. A major advantage of minimally invasive surgery is that it can help preserve organs and salivary function when used to treat cancerous tumors. That makes it easier to maintain oral and dental hygiene and function and helps prevent dental decay often associated with radiotherapy.

Radiation therapy typically subjects a significant amount of normal tissue, including major salivary glands as well as minor salivary glands, to the side effects of radiation. Advanced radiation therapy planning followed by delivery using intensity modulated radiation therapy (IMRT) allows maximum protection of the salivary glands for those who require head and neck radiation therapy.

It also may be possible for a patient to have a submandibular (salivary) gland transfer procedure, in which a surgeon moves the gland out of the field of radiation to protect them and preserve salivary flow, which is critical for swallowing and speaking.

For some tumors, when organ and function-preserving surgery is not feasible, chemotherapy with radiotherapy is given as an alternative.