How to spot the signs and symptoms of throat cancer
A lack of public awareness around throat cancer means only 13 per cent of head and neck cancers are currently diagnosed at an early stage. A fact that Chris Curtis, the founder of The Swallows Head and Neck Cancer Support Group, knows all too well after ignoring his symptoms for weeks. In 2011, the then 51-year-old was diagnosed with stage four oropharyngeal cancer.
“I’d never been a smoker or a drinker, let alone heard of throat cancer,” says Curtis. “I had a very small lump on the side of my neck, which had grown very quickly. I went to my GP thinking it was a swollen gland. I realise now I had other symptoms: I was incredibly tired and in bed by 9pm most days; my voice had become very husky. Within two weeks of my first GP appointment, I was diagnosed with stage four cancer at the base of my tongue.”
Head and neck cancer is the more common term used to describe more than 30 areas within the head and neck where cancer can develop, which include in or around the throat and larynx.
According to Cancer Research UK, head and neck cancer is the eighth most common form of cancer in the UK, and it’s two to three times more common in men. About 12,500 new cases are diagnosed each year, with experts warning incidences are on the rise.
Like many serious health conditions, the sooner it is caught, the better it responds to treatment. Here’s everything you need to know about throat cancer.
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What is throat cancer?
This refers to all types of cancer that can develop in the throat, known as the pharynx, and also the voice box (larynx). Throat cancer most often begins in the flat cells that line the inside of the throat. The pharynx is a tube that is divided into these main parts:
Nasopharynx – the upper part connecting the back of the nose to the back of the mouth
Oropharynx – the middle part at the back of the mouth (including the base of the tongue, the tonsils and the sides of the throat)
Hypopharynx – the lower part connecting the oropharynx to the gullet and windpipe
The larynx (voice box) sits in front of the lower pharynx (hypopharynx), containing vocal cords, and is also susceptible to throat cancer.
What are the types of throat cancer?
There are several different types of throat cancer, listed in order of prevalence:
Oropharyngeal cancer – originates in the oropharynx. The most common places for this cancer to develop are on the tonsils and the base of the tongue
Laryngeal cancer – originates in the larynx
Nasopharyngeal cancer – this begins in the nasopharynx and is a rare cancer
Hypopharyngeal cancer – begins in the hypopharynx behind the voice box. This is a rare cancer with an incidence rate of 0.63 per 100,000 people
What are the symptoms of throat cancer?
“The telltale signs are not generally silent but can take a while to be noticed,” warns Dr Naomi Vaughan, a GP with a practice in Harrow, north-west London.
Vaughan says these include:
Any new lump or swelling in the neck or throat, which can present as pain-free
Bad breath
A persistent cough or sore throat
Unexplained hoarseness or other changes to your voice which should not be ignored
Mouth ulcers that are not healing
Earache
Sudden difficulties with swallowing
Noisy breathing
Shortness of breath and fatigue
When to see a doctor
Dr Vaughan advises anyone living with any, or a combination, of these symptoms for more than three weeks to see a GP, especially if they are a smoker or a drinker.
“If you feel something is not as it should be, speak to your doctor,” says Vaughan, who has been practising for over 20 years. “Working in a medium-sized practice of around 11,500 patients, we refer about eight people a month as suspected head and neck cancers. I can’t give exact figures, but in general about 8-10 per cent of cancer referrals turn out to have cancer.”
Curtis went through radiotherapy, chemotherapy and two surgeries. Now, alongside his wife Sharon, he works tirelessly as the chief executive of The Swallows, the Blackpool-based charity he founded in 2012, raising awareness and offering support to thousands across the world.
How serious is throat cancer?
Curtis survived his stage four cancer diagnosis, but every year 4,100 people die from head and neck cancer. That’s 11 every day.
The prognosis is good if diagnosis comes early. “If caught early – stage one or stage two – the five-year survival rate is upwards of 80 per cent,” says Chris Elkington, the chairman of Head and Neck Cancer UK. “If caught at a later stage, this drops to around 50 per cent.”
However, Claire Barber, the chairman of the British Association of Head and Neck Oncology Nurses, and clinical nurse specialist in head, neck and thyroid cancers at the Royal Devon University Healthcare NHS Foundation Trust, has seen great progress in survival rates during her 30-year career.
“When I first started, if anybody had a throat cancer which had spread to another part of the body, such as the lungs, the average length of life was something between nine and 15 months, whereas now patients are living years down the line.”
What are the causes and risk factors?
While scientists and clinicians don’t know exactly what triggers the mutation causing throat cancer, there are common risk factors that can increase chances of developing it. Some major factors are:
Regularly smoking or chewing tobacco
Excessive alcohol use
A diet lacking in fruit and vegetables
Common viruses – human papillomavirus (HPV) and Epstein-Barr virus (EBV). Most people exposed to these viruses will not develop cancer, but there are links to certain types of throat cancer
Epstein-Barr virus, which causes glandular fever, is linked in a small number of cases to nasopharyngeal cancer
Human papillomavirus is linked to a rise in oropharyngeal cancers
“HPV infection is the leading driver in the growing number of diagnoses,” warns Tamara Kahn, the chief executive of Oracle Cancer Trust. “These cancers are presenting in younger people and although historically it has been more men, there are also increasing rates of women also being diagnosed with throat cancers.”
“Twenty years ago we recognised an uptick in oropharyngeal cancer caused by the HPV virus,” explains Prof Vinidh Paleri, a consultant head and neck surgeon at The Royal Marsden Hospitals and director of the International Centre for Recurrent Head and Neck Cancer.
“Studies across America, UK, Europe and other places have shown that between 50 per cent and 90 per cent of cancers in the oropharynx can be caused by the HPV virus. It’s 70 per cent in the UK. Interestingly, this cancer, compared to all other head and neck cancers, seems to arise in the younger, male population. That’s something we didn’t see before.”
Historically, a typical patient was a male smoker or heavy drinker in their 60s or 70s. On the upside, HPV-linked cases generally respond much better to treatment than those that are not HPV-related.
Is throat cancer preventable?
At 43, Jamie Rae was a globetrotting businessman when in May 2010 he was diagnosed with oropharyngeal cancer caused by HPV. After finishing his treatment, Rae launched the Throat Cancer Foundation, campaigning for the HPV vaccine – which has been available to Year 8 girls since 2008 – to be rolled out to schoolboys.
“I never wanted other men to suffer the way I did, so that was my number one objective, to get boys vaccinated,” says Rae.
“It took the best part of six years to convince the Government to do it.”
From September 2019, the vaccine has been offered to Year 8 boys. However, in 2022 only 52 per cent of boys and 56 per cent of girls were fully vaccinated in the UK. A higher awareness of the HPV vaccine will go a long way to eradicating HPV-related cancers and, as Prof Paleri hopes, “eventually getting rid of these tumours by 2060”.
Also, while it’s not always possible to prevent throat cancer, informed lifestyle choices such as quitting smoking, drinking sparingly, eating a healthy diet and taking regular exercise will help.
Diagnosis and tests
To check for throat cancer, you may have a:
Laryngoscopy to look at the larynx, or an endoscope may be inserted to get a clear view of the throat.
If cancer is suspected, a biopsy and blood tests will help the assessment.
Head and neck specialists will also arrange for a series of scans, such as X-rays, CT scan, MRI scan, an ultrasound or 3D imaging PET scan, to get a correct diagnosis.
What is the treatment for throat cancer?
“This is determined by factors such as staging, location of tumour and a patient’s overall health,” says Barber.
Options include:
Surgery
Chemotherapy
Radiotherapy
In some cases, immunotherapy
Depending on the cancer’s severity, some radical surgeries may be performed, such as:
Cordectomy (removal of all or part of the vocal cords)
Laryngectomy (removal of all or a portion of the voice box)
Pharyngectomy (removing part of the throat)
Neck dissection (removal of lymph nodes)
Prof Paleri is spearheading transoral robotic surgery across the UK, a less invasive treatment of head and neck cancers. “The treatments are quite toxic, quite brutal,” he explains. “Any progress we can make to reduce their toxicity is so important and that’s where robotic surgery comes in.”
Coping and support
“Patients often have a very challenging post-treatment quality of life,” says Barber. “Each treatment brings its own set of potential problems and side effects. Some are short-lived, but some never go away. It’s unlike any other cancer because it affects the ability to eat and drink, swallow, talk and communicate.”
Side effects include:
Dry mouth (damage to salivary glands makes it very difficult to swallow and chew)
Changes in taste and smell
Infections and mouth sores
Dental problems
Breathing and speaking
Coming to terms with changes in the appearance of the neck or face
Speech and language therapists help patients relearn how to speak, and swallow safely again. Anxiety and depression commonly extend beyond treatment, and counselling with a dedicated head and neck counsellor or clinical psychologist is advised.
“Some people endure significant weight loss,” Barber explains, “and require tube feeding for many months after treatment.”
“Throat cancer is one of the worst treatment pathways for cancer,” says Curtis. “The only good thing is the majority survive, but we survive with side effects.”
For more help and support, visit Cancer Research UK, Macmillan Cancer Support, the Swallows support group, the Throat Cancer Foundation, HANCUK or the British Association of Head & Neck Oncologists
