Assessment and Treatment of Throat Cancer

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Assessment and Treatment of Throat Cancer


INTRODUCTION                                                SIGNS AND SYMPTOMS
Throat cancer refers to a malignant tumour that             Signs and     symptoms     of   throat   cancer   may
develops in the throat. In common usage the                 include:
throat refers to either the pharynx or the larynx
(voice box).                                                •   Cough
                                                            •   Change in voice such as hoarseness or
The larynx is a 5 inch long muscular tube that                  raspiness
begins behind your nose and ends at the base of             •   Difficulty swallowing
your neck at the top of your swallowing tube or             •   Ear pain
oesophagus. The voice box or larynx is just below           •   Lump or sore in the neck that does not heal
your Adam ’s apple and the thyroid cartilage.               •   Breathing difficulties
                                                            •   Blood stained phlegm
TYPES OF THROAT CANCER                                      •   Weight loss
                                                            •   Sensation of something permanently stuck in
Throat cancers are usually subdivided into those                the throat
that develop in the throat (pharyngeal cancers) or
those that develop in the voice box (laryngeal              If you have any of these symptoms for more than
cancers). The throat and voice box are closely              2 weeks you should see your doctor and if there is
connected with the voice box (or larynx) sitting            any doubt you should be referred to a specialist
just below the throat (pharynx). More specific              Otolaryngologist Head and Neck Surgeon.
terms to describe the types of throat cancer
include:
                                                            RISK FACTORS
•   Nasopharyngeal cancers - beginning in the               Although the exact cause of throat cancer is
    nasopharynx, that part of your throat that sits         unknown tobacco products are thought to play a
    just behind your nose.                                  significant role in about 80% of cases. Risk
•   Oropharyngeal cancers – tumours beginning               factors include:
    in the oropharynx, that part of your throat that        •   Tobacco use including smoking or chewing of
    is right behind the opening of your mouth and               tobacco
    the back of your tongue.                                •   Regular and heavy consumption of alcohol
•   Hypopharyngeal cancers – a tumour                       •   Poor dental hygiene
    beginning in the hypopharynx, the lower part            •   Sexually transmitted virus called human
    of your throat just above the top of the                    papilloma virus or HPV
    oesophagus and the trachea.                             •   A diet lacking in fruit and vegetables
                                                            •   Exposure to asbestos or irradiation
•   Laryngeal cancers – laryngeal cancers are               •   Family history of cancer, that is to say genetic
    divided into glottic cancers - supra and sub                predisposition
    glottic which are those that begin on the vocal fold.
•   Supraglottic cancers – those cancers that               DIAGNOSIS
    begin in the upper part of the larynx and               The diagnosis of throat cancer is usually made by
    include the laryngeal ventricles, the false vocal
                                                            a specialist Otolaryngologist Head and Neck
    cords and the epiglottis.
                                                            Surgeon. If you have any of the symptoms
•   Subglottic cancers - those that begin in the            alluded   to    above    and    you    see   your
    lower part of your voice box, that part below           generalactitioner they will, if they have any
    the level of the true vocal folds and the top of        concerns or suspect the presence of throat
    your trachea.                                           cancer, refer you to a specialist urgently. The
 




                                   Assessment and Treatment of Throat Cancer



specialist will undertake a number of procedures       Stage IV – any of the following may be true –
including:                                             the cancer is very large and involves several
                                                       structures extensively, the cancer has spread to
•   Complete medical history                           more than one lymph node on the same side of
•   Physical examination which may include using       the neck as the cancer, the lymph nodes on one
    a mirror to examine the voice box                  or both sides of the neck or to any lymph node
                                                       that measures more than 6 cm (over 2 inches), or
•   Flexible Fiberoptic Endoscopy where a small        the cancer has spread to distal parts of the body.
    camera tip is passed through the nose to have
    a look at the pharynx, the larynx and the
    upper oesophagus                                   TREATMENT
                                                       The standard treatment for most cases of throat
•   Video stroboscopy – the use of high speed light
                                                       cancer involves surgery and radiation therapy,
    attached to the camera to look for subtle
                                                       either alone or in combination. The exact
    changes in movement of the vocal folds
                                                       treatment for an individual case depends on the
•   Biopsy, taking a small sample of suspected         size and site of the tumour, the general health of
    malignant tissue for laboratory examination        the patient, and the patient’s informed decision
•   Imaging tests which may include x-ray,             making after appropriate consultation with
    ultrasound, computerised tomography (CT            specialist surgeons and radiotherapists preferably
    scan), Magnetic Resonance Imaging (MRI             in a combined Clinic setting.
    scan), position emission tomography (PET)
                                                       Each case is assessed individually. A specialist
    scan, plus or minus specific blood tests
                                                       Otolaryngologist Head and Neck Surgeon carefully
Once throat cancer is diagnosed the next step is       evaluates every case to determine the optimal
to determine the extent or stage of the disease.       surgical approach to manage the cancer if that is
Knowing the stage accurately is important in           the modality chosen. The type of surgery
determining   treatment    options  and    likely      appropriately used depends on the cancer’s size
outcomes.                                              and location. Small tumours found relatively early
                                                       may be removed through an endoscope passed
                                                       through the mouth to the cancer. Medium to large
STAGING                                                tumours may require removal of all or part of the
The staging of throat cancer is characterised by       voice box. When the entire voice box must be
Roman Numerals from I – IV. Each sub-type              removed (total Laryngectomy), Surgeons will
throat cancer has its own criteria for each stage.     connect the wind pipe to the neck via a stoma or
In general, Stage I throat cancer indicates a          hole through which the person breathes and this
smaller tumour confined to one area of the throat.     is known as a Tracheotomy. Smaller cancers can
Later stage or larger tumour are indicated by          often be removed by removing only part of the
higher staging with IV being the most advanced.        voice box in an operation called a partial
                                                       Laryngectomy.
Stage I - the cancer is small and found only in
the area where it started. It has not spread to
lymph nodes or to other parts of the body.             LASER MICROSURGERY
                                                       Increasingly skilled Head and Neck Microsurgeons
Stage II – the cancer remains confined to the
                                                       perform trans-oral laser microsurgery for patients
larynx or pharynx and has not spread to nearby
                                                       with cancer of the larynx, oral cavity and
lymph nodes. The exact definition of this stage
                                                       pharynx. This procedure is typically used for small
depends on where the cancer started.
                                                       to medium sized tumours in the throat but
Stage III – one of these two conditions exist;         sometimes is the best approach even for large
                                                       tumours. Trans-oral laser microsurgery has many
1. The cancer is larger than Stage II and involves     advantages over conventional surgery including:
more structures. If the cancer is in the larynx and
the vocal cords cannot move normally, or the           •   Preservation of normal tissue
cancer has spread to tissues next to the larynx.       •   A shorter Hospital stay than typically required
                                                           for conventional surgery.
2. The cancer has spread to one lymph node on          •   Swallowing and speech may be less impaired
the same side of the neck as the cancer and the        •   A tracheotomy tube may not be necessary.
lymph node measures no more than 3 cm (just
over 1 inch).                                          Professor Havas has extensive experience in
                                                       Microlaryngeal Laser Surgery for throat cancer

 
 




                                    Assessment and Treatment of Throat Cancer



and in fact has recently designed a range of new        deformity, speech and swallowing problems
laryngoscopes and malleable instruments to              requiring expert speech therapy, problems with
facilitate performing these operations. He uses, as     diet and weight loss that require the regular input
is appropriate, not only a small spot carbon            of a dietician, social and psychological problems
dioxide laser but a new single fibre pulsed diode       pertaining to altered sense of body image
laser.                                                  including possible breakdown in relationships,
                                                        sometimes inability to work which require the
RECONSTRUCTIVE SURGERY                                  input of trained social workers, psychologists and
Depending on the location and spread of the             clinical nurse consultants.
tumour reconstructive surgery may be necessary.
                                                        The diagnosis of throat cancer is not a death
Microvascular reconstructive surgery with a focus
                                                        sentence. Overall treatment results for all stages
on improving the patient’s appearance and
                                                        of throat cancer are good and continue to
restoring their function is a gold star standard and
                                                        improve. Prevention is best achieved by not
is performed at the time of tumour removal
                                                        smoking. If you smoke – quit, if you don’t smoke,
usually by skilled Microvascular Plastic Surgeons.
                                                        don’t start. Drink alcohol only in moderation if at
Occasionally, for extensive tumours of the
                                                        all. For women and older adults this means no
pharynx a feeding gastrostomy may need to be
                                                        more than 1 drink a day. For men, moderate
performed to provide adequate nourishment while
                                                        drinking means no more than 2 drinks a day.
the healing process takes place.
                                                        Choose a healthy diet full of fruit and vegetables.
                                                        The vitamins and anti-oxidants in fruits and
RADIATION THERAPY                                       vegetables may reduce your risk of throat cancer.
                                                        Particularly eat a variety of colourful fruits and
Most throat cancers are sensitive to radiation          vegetables.
therapy so radiation certainly has a significant
part to play either as the sole (single modality)       Exercise caution around chemicals and avoid
form of treatment or as part of planned combined        breathing hazardous chemical fumes. If you have
therapy. Radiation therapy uses high energy             any symptoms or any concerns see your doctor
particles such as x-rays to deliver radiation to the    early and ensure that you get appropriate, urgent
cancer cells causing them to die. Even with a fine      referral to a Specialist Otolaryngologist/Head and
focus beam there is variable damage to                  Neck Surgeon.
surrounding tissues and this accounts for some of
the side effects of radiotherapy such as dryness of
mouth, hoarseness of voice, difficulty in
                                                        If further information is required,
swallowing, mucositis or skin redness and peeling.      please email us:
In addition to being used in combination with           enquires@earnosethroat.com.au
surgery radiation therapy can be used in terms of
Chemotherapy. This usually takes place for
advanced tumours which are either inoperable or
have metastasised widely (spread to other parts
of the body).
Chemotherapy alone at this stage has little role in
treating Head and Neck malignancies but is part
of planned combined therapy, in combination with
radiotherapy, in many cases of advanced or
metastatic disease.


THE TEAM APPROACH
It is important to note that throat cancers are
ideally managed by a team which looks after the
physical and psychological aspects of the patient,
to discuss treatment options and allow the patient
to partake in the decision making process. After
treatment there are certain side-effects which are
likely to occur and which are discussed
preoperatively to optimize the postoperative
outcome. These include nausea, scarring and

 

				
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Description: Assessment and Treatment of Throat Cancer