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What is throat cancer?
Cancer is the uncontrolled growth of cells within the body. Usually, all of our cells have a specific lifespan of days to years that is genetically programmed in our DNA. When our DNA becomes damaged, either through the aging process, exposure to toxins such as radiation or chemicals or through inherited genes, some cells do not die a natural death but continue to grow. As they do, they form new cells with the same genetic misinformation. These extra cells may form masses or tumours that can be either malignant or benign. A benign tumour is a tumour that does not invade the surrounding tissue or spread around the body and stays in one place. A malignant tumour can invade the surrounding tissue or spread via the blood or lymph networks and affects other cells and organs.
Throat cancer is not one of the most common types of cancer. The average general practitioner will diagnose between 1 and 4 cases during an entire career. Yet due to the proximity of this type of cancer to lymph nodes, the airway and the digestive tract, early detection and prompt treatment is important. Thyroid cancer – included in the wider group of head and neck cancers - is the most common with high remission rates after treatment.
There are many types of throat cancer as this area of the body contains a range of structures. This article will discuss mouth (oropharynx), voice box (larynx), upper gullet (oesophagus) and thyroid gland cancers. Cancer of the trachea is pharmacologically treated in the same way as lung cancer, although its surgical treatment is included here. For easier understanding, we will group pharynx, larynx, thyroid, upper oesophageal and tracheal cancers within the throat cancer group.
Surgeries are performed by head and neck specialists, otherwise known as ENT surgeons or otolaryngologists. Remedazo works together with a broad group of specialist consultants and surgeons with proven knowledge, experience, skills and excellent work ethics. We can arrange up to three free Second Opinion sessions with different ENT specialists to ensure you have the necessary information to make an informed decision as to your choice of hospital, doctor and treatment pathway.
Are there different types of throat cancer?
There are various forms of throat cancer and your medical notes may be difficult to understand. Most specific types are based upon the location and type of abnormal cells.
The throat is split into sections, beginning at the pharynx. The pharynx is located behind the mouth and nasal cavity and is part of the digestive system; however, it also separates the entrance of the airway from that of the oesophagus by way of a flap called an epiglottis. Your medical notes might mention supraglottic cancer (above the epiglottis) or subglottic cancer (below the epiglottis).
The pharynx is itself divided into three regions: the nasopharynx or upper portion of the throat that includes the soft palate, a connection to the inner ear (auditory tube) and the adenoids, the oropharynx that extends from the uvula (the hanging, single tonsil at the back of the throat) to the tongue base, and the laryngopharynx which lies under the epiglottis and continues to the divergence of the respiratory and digestive tracts at the larynx and oesophagus. Cancer in any of these structures is referred to as pharyngeal cancer.
The laryngopharynx helps us to speak and protects the airways from food particles. The thyroid lies extremely close to the larynx. This part of the body starts at the epiglottis, continues past the vocal cords (one of the reasons why hoarseness is a symptom of neck cancer) and ends at the top of the trachea. It is therefore more a part of the respiratory system than of the digestive system.
The thyroid gland, located just under the Adam’s apple, produces thyroid hormone that plays a role in the regulation of heart rate, blood pressure, body temperature and body weight. Cancer of the thyroid usually increases thyroid hormone production (hyperthyroidism) and, unlike most throat cancers, is more likely to affect women. Symptoms of hyperthyroidism include excessive sweating and heat intolerance, anxiety, rapid heart rate or palpitations, weight loss and observable shaking. Hypothyroidism (an underactive thyroid) and non-cancerous hyperthyroidism (overactive) without benign polyps do not increase the risk of developing thyroid cancer. Lumps felt in the thyroid are usually benign but should always be assessed by a specialist.
Pharyngeal cancer and laryngeal cancer cell types
The majority of pharyngeal and laryngeal throat cancers are nearly always squamous cell carcinomas that begin in the cells of the inner lining of the throat. Verrucous carcinoma is a rare form of squamous cell carcinoma that looks very much like polyps. If these polyps are thought to be benign and left untreated, they can quickly grow. Early diagnosis by an experienced ENT specialist means this cancer type can be completely cured.
Where salivary glands containing mucus-producing cells are involved, adenocarcinoma is also possible. This is the second most common type of throat cancer cell but is still relatively rare, especially in comparison with the prevalence of squamous cell carcinoma (SCC).
Rare throat cancer cell types are lymphomas that begin in one or more of the many lymph nodes that are found throughout the throat region and sarcomas that begin to form in the muscle fibres or connective tissues of this part of the anatomy. When spindle cells of the connective tissues of the throat mutate and multiply they can produce spindle cell sarcomas; spindle cells are part of the body’s natural healing process.
Thyroid cancer cell types
There are four main cancer types of thyroid cancer but they are all adenocarcinomas as the term ‘adeno’ refers to a gland. The most common of these is papillary carcinoma or papillary adenocarcinoma that is most often seen in women under the age of 40 years. The second most common type is follicular carcinoma that affects older populations. As these two types are the primary sources of thyroid cancer, they are grouped together as differentiated thyroid cancers and both begin in follicular cells which are the cells that produce thyroid hormones. They are therefore treated in the same way.
A rarer thyroid cancer type is medullary thyroid carcinoma that begins in thyroid C cells responsible for producing a calcium-regulating hormone. This type is often detected in very early stages through simple blood tests and can be hereditary. Anaplastic thyroid carcinoma is also rare and a particularly aggressive thyroid cancer that primarily affects women (but also men) of over 60 years of age and neck masses can grow very quickly causing significant symptoms. Finally, thyroid lymphoma, one of the rarest thyroid cancer types, starts in the thyroid immune cells of older populations and grows quickly.
Tracheal cancer cell types
While the majority of tracheal cancers are, as with the pharynx and larynx, squamous cell carcinomas, a very slow-growing type that is not connected to risk factors is also possible. This is adenoid cyst carcinoma (ACC) that begins in secretory glands and rarely metastasizes but is difficult to treat in later stages. Adenoid cyst carcinoma is also possible in the larynx and pharynx but on the rare occasions that it is found is more likely to be located in the trachea.
As the trachea is part of the airway, cell types such as those found in lung cancer are also possible. You can find out more about these respiratory cancer cell types here.
Throat cancer stages
Your medical notes may have listed a number of codes concerning your diagnosis. Or perhaps you are waiting for further testing and prefer to be well-informed before receiving your results.
The majority of ENT specialists adhere to the universal TNM staging system. In short, this system uses a scoring system for tumour, (lymph) nodes and metastasis according to biopsy and imaging results.
T stands for tumour. T plus a letter or number describes the size (in centimetres) and location of a tumour. Where more than one tumour is present, the letter ‘m’ (multiple) is added. T letter and number systems for pharyngeal and laryngeal tumours are:
TX: It is not possible to evaluate the tumour due to a lack of data
T0: No evidence of a primary tumour
Tis: Tumour ‘in situ’ with cells only found on the mucosal surface
T1: The tumour is local to the pharynx and larynx (vocal cords move normally)
T2: The tumour is local to the pharynx and larynx but has spread to other areas of the same anatomy (to subglottal or supraglottal regions)
T3: The tumour has grown into other tissue types such as cartilage or connective tissue OR one or both vocal cords do not move
T4: The tumour has spread to areas beyond the larynx and pharynx and surrounding tissues and has extended into the thyroid gland, trachea or oesophagus
N stands for nodes or lymph nodes and the following codes apply:
NX: Regional (nearby) lymph nodes cannot be evaluated due to lack of data
N0: No spread to regional lymph nodes
N1: Tumour has spread to 1 regional lymph node on the same side of the neck as the cancer and this tumour is less than 3 cm
N2: Tumour has spread to more than one regional lymph nodes on the same side of the neck as the tumour of no more than 6 cm
N2a: Spread to one lymph node on the same side of the neck as the tumour and is between 3 cm and 6 cm
N2b: Spread to more than one lymph node on the same side of the neck as the tumour and these are less than 6 cm
N2c: Spread to lymph nodes on the other side of the neck and these are less than 6 cm
N3: At least one lymph node is greater than 6 cm
Finally, M stands for metastasis. The following codes apply:
M0: There is no spread to distant lymph nodes or other organs
M1: Distant metastasis is present in distant lymph nodes and/or to other organs.
Throat cancer metastasis is most likely to affect the lungs and bones.
Throat cancer is then further grouped according to TNM results in 4 stages. Stage I is relatively early non-metastasized throat cancer with no lymph node spread. Stage II indicates a larger tumour that has not spread to the lymph nodes. Stage III indicates larger tumour or has spread to one lymph node on the same side of the neck. Stage IV indicates spread to lymph nodes on the other side of the neck and/or other tissues or organs (metastasis).
Thyroid cancer stages
Thyroid cancer staging is not the same as pharyngeal and laryngeal cancer due to structural and functional differences:
TX: It is not possible to evaluate the tumour due to a lack of data
T0: No evidence of a primary tumour
T1: The tumour is local to the thyroid and less than 2 cm
T1a: Tumour is less than 1 cm and limited to the thyroid
T1b: Tumour is less than 2 cm and limited to the thyroid
T2: The tumour is local to the thyroid and between 2 and 4 cm
T3: The tumour is larger than 4 cm and local to the thyroid or has, at maximum, penetrated surrounding local (strap) muscles
T3a: Tumour is greater than 4 cm and local to the thyroid
T3b: Tumour is of any size and has penetrated the surrounding local (strap) muscles
T4: The tumour (any size) has spread to areas beyond the thyroid and has extended into surrounding soft tissues, larynx, trachea, oesophagus, nerve, fascia, carotid artery or mediastinal vessels
NX: Regional (nearby) lymph nodes cannot be evaluated due to lack of data
N0: No spread to regional lymph nodes
N0a: One or more benign lymph nodes
N0b: No evidence of regional lymph node metastasis
N1: Regional lymph node metastasis
N1a: Metastasis to pretracheal, paratracheal, prelaryngeal or upper mediastinal lymph nodes
N1b: Metastasis to neck (either or both sides) or retropharyngeal lymph nodes
M0: There is no spread to distant lymph nodes or other organs
M1: Distant metastasis is present
Thyroid cancer metastasis is most likely to affect the lungs and bones.
Throat cancer is then further grouped according to TNM results in 4 stages. Stage I is early non-metastasized thyroid cancer with no lymph node spread and a tumour under 4 cm in size. Stage II indicates a larger tumour that has spread to regional lymph nodes. Stage III indicates spread to surrounding tissues with or without lymph node metastasis. Stage IV indicates thyroid cancer spread to distant sites; anaplastic thyroid cancer is always categorised as a stage IV cancer.
Tracheal cancer stages
Previously, tracheal cancer was defined as stage IV lung cancer. However, primary tracheal cancer (cancer that begins in the trachea) is not the result of lung metastasis. Research into specific staging for primary tracheal cancer has still not agreed upon a global TNM classification but current drafts include the following:
T1: Primary tumour of less than 2 cm and local to the to trachea
T2: Primary tumour greater than 2 cm and local to the trachea
T3: Spread outside the trachea but not to adjacent organs or structures
T4: Spread to adjacent organs or structures
N0: No evidence of regional lymph node metastasis
N1: Regional lymph node metastasis
M0: There is no spread to distant lymph nodes or other organs
M1: Distant metastasis is present
H2 What are throat cancer symptoms?
If you are reading this page, you may have been diagnosed with throat cancer due to the presence of one or more symptoms.
The most common symptoms of throat cancer (including tracheal cancer) are:
Swelling or sore that does not heal
Hoarseness
A persistent cough
A lump in the upper neck with or without pain
Red or white patch in the mouth
Bad breath
Difficulty breathing
Jaw pain
Loosening teeth
Loss of appetite and weight loss
Fatigue
If you smoke or used to smoke and/or regularly drink alcohol, suffer from GERD or present with any of the risk factors mentioned in this article, you should arrange general health screening with your general practitioner. Remedazo can arrange full annual health checks with diagnostic specialists for your peace of mind.
What are thyroid cancer symptoms?
If detected in early stages, thyroid cancer is completely curable. Most symptoms are similar to those of throat cancer; however, due to excess thyroid hormone production the following, more specific symptoms may occur:
Heat intolerance and excess sweating
Red face
Anxiety and/or irritability
Rapid heart rate, even when at rest
Increased appetite (and weight loss)
Frequent bowel movements
Tremors
Redness on the shins (Grave’s disease)
Thin skin and changes in nail and hair growth
Insomnia
Vision changes
Hyperthyroidism can be detected at early stages with a simple blood test; this means most thyroid cancer types can be diagnosed and treated during their early stages.
Can I prevent throat cancer?
Most throat cancer is first diagnosed when patients report hoarseness, unexplained weight loss and fatigue, a persistent cough or pain or difficulty swallowing. We are all aware that smoking increases risk and 85% of all head and neck cancers are linked to tobacco use or the effects of second-hand smoke. High alcohol consumption also increases one’s chance of developing the disease. The combination of heavy alcohol consumption and smoking should therefore always be avoided.
However, many other factors also exist. These range from viral infections (HPV and EBV), the male gender, poor oral and dental hygiene, chronic disorders such as Grave’s disease, low vitamin A and B consumption, acid reflux, low immunity and environmental pollution. It has also been noticed that Asian and African-American ancestry increases the risk of pharyngeal cancer.
Throat cancer types rarely run in families; however, if you live in the home of someone who smokes this can be detrimental to your overall health, affecting your immunity and increasing risk of multiple illnesses. One’s ancestry and gender in combination with other factors should encourage annual or biannual health checks for diseases that may be more common in specific groups.
Another way to lower the risk of pharyngeal, laryngeal, tracheal and upper oesophageal cancers is to avoid eating very hot food or drinks as these damage the inner linings of the throat. Very importantly for the prevention of both types of cancer but especially in the prevention of throat and oesophageal cancer is the treatment of chronic acid reflux and gastro-oesophageal reflux disease (GERD). This can be done using prescription or over-the-counter medications, avoiding certain foods (green peppers, onions, chocolate, alcohol, caffeine, fatty foods), sleeping in a partially upright position and refraining from eating at least four hours before going to sleep. Furthermore, surgery can reduce chronic acid reflux if other methods fail. A nissen fundoplication is a safe, laparoscopic procedure that wraps the top portion of the stomach around the bottom of the oesophagus. This means that whenever the stomach contracts, it also seals off the end of the oesophagus and so prevents stomach acids from rising. Even ten years after this type of surgery, most former sufferers remain free of the symptoms of GERD.
Certain types of work with continuous exposure to chemicals such as benzene, solvents, herbicides and asbestos can also increase risk. When inhaled through the nose and mouth and swallowed, these hazardous chemicals attack throat cells and cause mutations in their DNA. Safety equipment such as breathing apparatus and protective clothing should always be used.
Lack of dental and oral hygiene is an important risk factor for throat cancer as this makes you more susceptible to viruses that cause cell mutation. In fact, poor oral health increases the risk of human papilloma virus infections by well over 50%. As already mentioned, two types of virus can cause throat cancer. These are human papilloma virus (HPV) and Epstein-Barr virus (EBV); the former can be vaccinated against but is usually only offered to teenage girls. As the most common sexually transmitted disease, you can protect your children and help to eradicate this disease by vaccinating your daughters and sons (two or three times) from the age of 10. For those with existing HPV, long-term antibiotics taken over the course of 1 year can completely clear an infection.
Epstein-Barr virus is one of the most common herpes viruses and spreads through our saliva. An active infection is known as mononucleosis or glandular fever and people with a history of ‘mono’ have a higher risk of developing cancer. This virus, unlike HPV, does not respond well to antibiotics and currently, no vaccine is available. Prevention means avoiding contact with the saliva or other bodily fluids of infected individuals but most of us are infected during infancy and early childhood. Studies into bone marrow transplants for the treatment of chronic Epstein-Barr infections are currently being researched.
Grave’s disease is an autoimmune disease that affects how the thyroid gland functions. The most visible sign of Grave’s disease is a goitre or enlarged thyroid gland. This produces the symptoms of hyperthyroidism. Grave’s disease is more common in women aged between 30 and 50 years of age and may have genetic causes. Where one or more nodules (abnormal benign tissue growths) are present, thyroid cancer risk is increased by up to 15%. Treatment requires life-long pharmaceutical drugs that lower thyroid hormone production and require some time to take effect. If you have been diagnosed with Grave’s disease, your general practitioner should refer you to an ENT specialist for screening.
To prevent all types of cancer, you should enjoy regular exercise and get a good night’s sleep to increase your body’s resistance to illness and disease. You should also avoid highly salted foods, smoked foods and pickled foods as these also can damage the throat linings. Diets should include daily portions of fresh fruit and vegetables, whole grains, vitamins and minerals. It is suggested that supplementation of vitamins A and B in those who do not consume enough fresh produce can play a protective role against throat cancer.
How is throat cancer diagnosed?
If you arrive at your general practitioner’s office complaining of persistent coughing, difficulty swallowing, weight loss and fatigue, he or she will probably refer you to an ENT specialist. This physician will ask questions about your lifestyle and family history, take blood and clinically examining your mouth and neck.
Blood tests can determine viral infections, thyroid dysfunction and auto-immune disorders but will not indicate whether cancer is present. Visible signs of cancer such as white or red patches in the mouth and throat or palpable lumps are detected using an endoscope or laryngoscope. You will be sent for imaging tests that include X-ray, computerized tomography (CT), magnetic resonance imaging (MRI) and positron emission tomography (PET).
Where suspicion of cancer is found, the next step is to test the cells for the presence of cancer by way of a biopsy. This can be done via endoscopy or laryngoscopy procedures, the latter of which may require a local anaesthetic spray. For upper oesophageal lesions, a gastroscopy is performed, and for tracheal lesions a bronchoscopy. Tracheobronchial procedures usually require a general anaesthetic as the ENT doctor needs to pass through the vocal cords. Thyroid cancer required an ultrasound-guided fine needle aspiration technique that removes small quantities of cells from the thyroid via the skin of the neck and is most often performed by a radiologist. The needle is extremely fine and you will not require sedation. For difficult to reach areas of the throat, surgery may be necessary; because bleeding in the throat can cause complications after surgery, you will usually be required to spend the night in the hospital. Any cancerous cells from non-invasive or invasive biopsy samples can then be tested on a molecular level to determine the most successful treatment pathway.
Depending on the type of cancer that is diagnosed, other tests may be planned. These include blood tests together with CT, PET, MRI or bone density scans that can indicate whether cancer cells have spread into other areas of the body.
How are pharyngeal and laryngeal cancers treated?
The most common and recommended treatment for non-metastasized cancer is surgery.
For early stage throat cancer, non-surgical removal via endoscopy or laryngoscopy without a general anaesthetic is possible. Removal of early stage tumours can be done using lasers or incisions. This procedure requires an overnight stay in the hospital.
Your ENT surgeon may opt to remove 1 or more lymph nodes either for biopsy or because he or she suspects the cancer may have spread. Depending on the size of the operation site, hospital stays may increase by a further 24 hours.
Pharyngectomy describes the removal of part or all of the pharynx and can be a minor procedure or an extremely complex one. Laryngopharyngectomy is the removal of the larynx and hypopharynx (lower pharynx). Laryngectomy refers to the removal of the larynx but also often removes a narrow portion of the lower pharynx and will permanently affect your ability to speak. All of these procedures require a general anaesthetic and hospital stays ranging from 1 to 8 days depending on the amount of tissue removed. In addition, radiotherapy, chemotherapy, targeted therapy and perhaps immunotherapy will be prescribed. These treatments are discussed further on.
How is thyroid cancer treated?
Most thyroid cancers are first treated with surgery (thyroidectomy). Total and partial thyroidectomy procedures are possible, as is the removal of lymph nodes during a central compartiment neck dissection. Cure rates are high. Surgically-removed small, local tumours rarely require additional treatment.
Once a cancerous thyroid gland has been removed, further therapy is recommended by way of radioactive iodine or RAI treatment in all stages of thyroid cancer except in those types that do not spread and in anaplastic thyroid cancer. As the thyroid is the only organ that absorbs iodine in the human body, radioactive iodine (RAI or I-131) can destroy thyroid cells without affecting other areas. Anaplastic cancers do not absorb iodine and do not benefit from this treatment.
Before RAI therapy you will be asked to follow a low-iodine diet. This means that your thyroid will have plenty of space to absorb the radioactive iodine. You will also need to stop taking any thyroid hormones. This is because normal levels of thyroid hormones halt production by reducing the amount of thyroid stimulating hormone (TSH) produced in another gland known as the pituitary gland. By lowering the amount of thyroid hormones in the body, the pituitary gland is stimulated to produce more TSH. This effect is also possible by way of an injection given over a period of 2 days. Your RAI treatment will then begin on the 3rd day.
RAI means you will become slightly radioactive until there is no more radioactive iodine contained in your thyroid gland. You will need to remain in isolation for a number of days and avoid contact with others, especially pregnant women and children. Your Remedazo oncologist will discuss all aspects of radioactive iodine therapy with you well before treatment commences.
Total thyroidectomies require life-long replacement of thyroid hormones; partial thyroidectomies may or may not, depending on the amount of tissue that is removed.
How is tracheal cancer treated?
Most treatments for tracheal cancer include both surgery and radiotherapy. Occasionally, chemotherapy is prescribed. As tracheal cancer is usually the result of lung metastasis, surgery will not be discussed in detail and non-surgical treatments should be referred to in the article dedicated to lung cancer.
Removal of a small section of the trachea (partial tracheotomy or tracheal resection) is an extremely specialized operation and is not offered in all hospitals. Remedazo works together with experienced thoracic surgeons in multiple clinics who are confidently able to offer this complex procedure. Even the removal of a small section of the trachea requires a stay in intensive care and postoperative physiotherapy. For some time after a partial tracheotomy, you will need to be careful when moving your head or neck as this already short tube will be even shorter. To make sure you do not accidently move your head and perhaps separate the two ends of the operated windpipe, the surgeon places a stitch that keeps your head in a slightly downward position. Hospital stays of 7 to 12 days are common.
Complete removal of the trachea is not possible.
How is upper oesophageal cancer treated?
For the treatment of lower oesophageal cancer, please look here.
Upper oesophageal cancer is often treated with laser or radiofrequency ablation endoscopy, endoscopic mucosal resection (EMR) and radiotherapy. All of these treatments are discussed in detail further on. Surgery is not always the first choice but a partial oesophagectomy is certainly an option in combination with chemotherapy and radiation therapy. As the upper oesophagus is so close to fragile and heavily innervated structures such as the larynx, the side effects and potential complications of this type of surgery are not always justified.
Why do I need throat cancer treatment?
Treatment is always necessary for any type of throat cancer to try to prevent cancerous cells from travelling to other organs via the many surrounding blood and lymph vessels of these parts of the anatomy. Furthermore, when treated early to mid-stage, throat and thyroid cancer can be cured or kept under control for long periods of time. Even in more advanced stages, new therapies and procedures are continuously increasing longer-term survival.
How do I prepare for throat cancer treatment? What can I expect?
Approximately 3 to 4 weeks before surgical cancer treatment or other therapy pathways you will be asked to supply the results of your blood tests and copies of any diagnostic and imaging results (endoscopy, CT, MRI and/or PET). This means we can see how your throat cancer is progressing and will help us to advise the best treatment options. We will also need any information regarding medication use, other illnesses or disorders and your overall state of health.
You will need to undergo an MRI, PET or CT scan and possibly a bone scan – if these have not yet taken place - which will help us to see if cancer has spread to other organs. If throat cancer has spread or metastasised you will need to consider both surgical and nonsurgical treatments.
Approximately 2 weeks before your treatment you will need to ask your home doctor to take blood for a preoperative or pre-treatment blood test. Remedazo will inform you well beforehand which tests your doctor will need to take blood for. For some procedures, blood-thinning and other medications will need to be temporarily stopped, others do not. Our or your own doctor will advise you what to do.
Throat cancer surgery
Please scroll down to the appropriate section. The given information covers all available treatments for throat cancer, and later for thyroid cancer, at Remedazo. If you would like information on any treatment not covered in these sections, please do not hesitate to contact us.
Endoscopic laser surgery
Endoscopic laser surgery is minimally invasive, requiring no incisions to the skin. It is for an experienced ENT specialist to use a high-quality laser that offers excellent precision. Laser surgery is rapid, safe and is in no way inferior to invasive surgery.
This type of procedure can be used on all manner of throat cancers, from pharyngeal to laryngeal and also upper oesophageal cancers. The removal of benign polyps of the throat that may become malignant can also be performed using laser surgery.
This procedure is performed by an ENT specialist under sedation or a general anaesthetic depending on the location of the polyp or cancer and requires an overnight hospital stay.
Vocal cord stripping
The majority of vocal cord stripping procedures do not affect your voice long-term. Some hoarseness may be experienced but as only the outer layers of tissue are removed in very localised tumours, this is a short-term complication. Polyps and benign nodules can also be removed using this minimally invasive technique. A general anaesthetic is necessary and an overnight stay is not always necessary.
Partial glossectomy
Where the tongue shows signs of cancer cell growth, removal of part of the tongue may be enough to cure it. As with all throat surgeries, this procedure is carried out under general anaesthesia. Hospital stays range between 1 and 4 days, depending on the amount of tissue that is removed. Post operative care includes gargling with an antiseptic mouthwash to avoid infection. As the tongue is a particularly sensitive area, pain medication will be prescribed for the following 10 to 14 days. If larger areas of the tongue are removed, speech therapy to help with talking and swallowing is recommended. Remedazo’s holistic approach ensures all additional therapies are seamlessly arranged with highly-trained professionals.
Partial pharyngectomy and partial laryngopharyngectomy
Cancer of the nasopharynx, oropharynx or hypopharynx that is too large to be treated with laser, has returned or is in later stages but still local to the pharynx is usually removed with invasive surgery.
Any broad resection of the throat area is considered major surgery due to the proximity of the airways, major nerves and blood vessels. As postoperative bleeding is a common complication, patients remain in an intensive care unit the night after the operation but can move to a general surgical ward within 24 hours. Recovery time is quite long and some patients are fed via a feeding tube placed through the nose and into the stomach. This speeds up the healing process and also protects the airways. The average hospital stay after a partial pharyngectomy is 5 days.
The surgeon excises the affected area via the mouth (transoral) using a laryngoscope and can also perform this surgery as a robot-assisted procedure. A 12 to 15 cm incision to one side of the neck (transcervical) is an alternative method, as is the transmandibular approach across the bottom of the lower jaw with a similar-sized incision. Depending on the site of the cancer, the voice box may or may not need to be removed. Removal of part of the pharynx (partial pharyngectomy) with removal of part of the larynx (partial laryngectomy) is known as a partial laryngopharyngectomy.
To replace the excised area of pharynx, reconstructive surgery using a flap of muscle, skin or other tissue such as intestine must be carried out. This stage significantly lengthens the operating time. It is not uncommon for pharyngeal surgery to take 5 to 7 hours, sometimes longer. Reconstruction requires an ENT surgeon with significant experience and the use of a medical microscope. Remedazo partners with various highly trained and experienced ENT surgeons who have performed countless successful pharyngeal surgeries.
If the voice box must be removed, the surgeon will perform a tracheostomy. A tracheostomy requires a small incision at the front of the neck just below the vocal cords through which a hollow tube is inserted. This tube allows air to enter the lungs. A tracheostomy can be temporary or permanent. Without a voice box, it is impossible to speak. Furthermore, as we can increase abdominal pressure via this part of the anatomy, such as when having a bowel movement, lifestyle changes are necessary. At a later stage, a voice prosthesis can be placed using a simple procedure to enable speech.
Partial laryngectomy
With a partial laryngectomy it is possible to preserve speech and a normal swallowing function. This procedure is only carried out where cancer is localised to a specific area of the larynx. As swelling after surgery can cause problems, a temporary feeding tube and tracheotomy is necessary. Hospital stays of up to 6 days are required to ensure the swelling has receded and you are able to swallow; the feeding tube and tracheotomy can then be removed. Where a permanent tracheotomy is necessary, voice rehabilitation after your recovery can include the implantation of an electro larynx prosthetic that will allow you to speak. This is done by way of a tracheoesophageal puncture that takes place 3 to 6 months after a laryngectomy and is also performed under a general anaesthetic. A temporary prosthesis is inserted that is itself replaced with a voice prosthesis after 5 to 7 days.
Chemotherapy may be necessary if it is suspected that localized cancer has or may spread and is sometimes given before surgery to shrink the tumour. Radiation treatment may also be used to kill off potentially remaining cancer cells.
Total laryngopharyngectomy
The removal of the larynx and areas of the pharynx is a complex surgery and is either performed through the mouth as a robot-assisted operation or open, with incisions in the throat area. This procedure requires a general anaesthetic, a temporary feeding tube and a permanent tracheotomy with significant postoperative physiotherapy sessions that teach you how to swallow.
Any broad resection of the throat area is considered major surgery due to the proximity of the airways, major nerves and blood vessels. A total laryngopharyngectomy attaches the non-cancerous area of the trachea to the skin to form a breathing hole or tracheotomy. A new connection between the mouth and oesophagus must also be constructed using muscle or skin flaps (usually from the forearm or thigh) or part of the stomach or small intestine. Voice rehabilitation after your recovery can involve the implantation of an electro larynx prosthetic that allows you to speak. This is done by way of a tracheoesophageal puncture that takes place 3 to 6 months after a laryngopharyngectomy; this procedure is performed under a general anaesthetic. A temporary prosthesis is inserted that is itself replaced with a voice prosthesis after 5 to 7 days.
Where part or all of the thyroid gland is removed during a broader laryngopharyngectomy, usually referred to as a neck resection, lifelong medication may be required. Removal of one or more of the 4 parathyroid glands may mean you will need to take lifelong calcium supplements.
During a total laryngopharyngectomy, a large incision is made in the middle of the neck and across the jawline. Laparoscopy is required for reconstructive surgery using the small intestine or alternatively, open incisions in one forearm or thigh. A stay in intensive care for the first 2 to 3 days after surgery is necessary, as is a longer hospital stay on a general ward after discharge from intensive care where speech and swallow therapy will then take place. Your feeding tube will need to remain in place for up to 2 weeks. Because of this, your hospital stay will be of the same duration. Additional chemotherapy or radiation treatment is nearly always advised before or after this type of surgery.
A total laryngopharyngectomy requires a highly experienced ENT surgeon. Remedazo can arrange free Second Opinions with various ENT experts who will be able to answer all of your questions.
Thyroid cancer surgery
Thyroid cancer surgery has high cure rates, minimal pain and rapid recovery. Depending on the location and type of thyroid cancer cells, a part of the thyroid gland or the entire gland with or without surgical resection of the surrounding lymph nodes is removed. The proximity of the thyroid gland to the airway means you will need to be closely monitored for the first 24 hours after surgery but total hospital stays are rarely more than 3 days. For smaller amounts of tissue, an overnight stay is often enough. Both types of procedure require a general anaesthetic. The incision is small – between 4 and 6 cm – and is located across the front of the neck. Either 1 or 2 small drains to remove fluids associated with postoperative inflammation are placed during surgery; these will be removed within 48 hours. Where larger portions of the thyroid gland is removed, lifelong thyroid hormones must be taken to replace any deficiencies.
Occasionally, radioactive iodine treatment is advised after surgery.
Peri-operative throat cancer care
All throat cancer surgeries include the insertion of 1 or more drains to remove fluids from the operation site. Drains remain in place for 24 to 72 hours after surgery. Partial and total throat surgeries include the placement of a nasogastric tube to ensure correct nutrition until you are once again able to swallow. Many throat surgery types require a temporary or permanent tracheotomy.
For all of these procedures, you will be admitted to your chosen clinic on the day of the operation. Certain people such as those with a very high BMI, breathing difficulties, diabetes or other chronic illnesses usually benefit from spending the night before the operation in a hospital setting. This also applies to those requiring partial oesophagectomy who will need to drink an oral gastric preparation the night before.
From midnight of the day before your surgery, you will be asked to refrain from eating. Undigested stomach contents can create serious complications during general anaesthesia. Smokers should stop smoking at least one week before oesophageal surgeries as thoracic incisions will affect breathing quality; stopping smoking beforehand also improves oxygen levels throughout the body. Between midnight and six hours before anaesthesia you may only drink water or clear liquids. You are not permitted to eat, drink or smoke in the six hours preceding anaesthesia. Failure to comply may mean the anaesthesiologist and surgeon will be forced to postpone your procedure. This is purely for your own safety. It is possible to brush your teeth during this period but no water may be swallowed. In certain circumstances, medical staff will administer oral medications with a little water. These are administered under the advice of the anaesthesiologist and are therefore permitted.
Approximately sixty minutes before the planned procedure time you will be collected from your room and brought to the surgical department either in your bed, on a gurney, in a wheelchair or on foot.
Preoperative throat and thyroid cancer surgery preparation requires:
An intravenous line
A blood pressure cuff placed on the upper arm
The completely painless placement of electrodes to the chest to measure heart activity
A finger or ear sensor to measure oxygen levels in the blood
A general anaesthetic
Preoperative total laryngopharyngectomy and some partial procedures further require:
A urinary catheter (usually placed after you are anaesthetised)
An arterial catheter
A nasogastric tube placed through the nose
A tracheotomy
At the surgeon’s signal, you will be anaesthetised.
What happens after throat or thyroid cancer surgery? What can I expect?
You will be woken by the anaesthesiologist immediately after surgery and transported from the operating theatre to the recovery room. Here you will be carefully monitored. All patients remain in the recovery ward until they are fully responsive and any pain is well under control.
When the anaesthesiologist is satisfied you are fully awake and comfortable you will be brought to a surgical ward; throat surgery patients will be taken to the medium or intensive care unit where they will remain for 24 to 72 hours before being transferred to a general surgical ward. Pain medication is given as standard for the first 48 hours and then upon request and according to your personal doctor’s prescription.
Arterial lines are removed within 24-hours after surgery; those in medium or intensive care units retain the arterial line until transfer to a general surgical ward. A single intravenous catheter will continue to administer fluids for at least 24 hours in thyroid cancer patients and until successful swallow test results for throat surgeries. Surgical drains will be removed by a trained nurse or doctor within 2 - 3 days, depending on the complexity of your operation. Urinary catheters are usually removed after 24-hours.
Speech and swallow therapy under the guidance of a physical therapist are necessary for all but the most localised excisions (not for thyroid surgery). Remedazo ensures you are supported by a complete, multidisciplinary team during your hospital stay and will arrange all home visits and follow ups during your time at your chosen accommodation.
The majority of throat cancer patients are out of bed within 8 hours of exiting the recovery room. For total laryngopharyngectomy procedures this period of time may extend until you are taken to the general surgical ward. Upon discharge from hospital you will be transported to your accommodation and supported by your personal Remedazo team until you have safely and comfortably returned home or have completed further treatment. You will be able to travel within 2 to 4 days after discharge from hospital after thyroidectomy or partial glossectomy. For those who have undergone pharyngectomy, laryngectomy or laryngopharyngectomy, this time should be lengthened to 5 to 7 days. You will need to wear compression stockings and preferably split long flights into shorter journeys.
Long-term postoperative care includes the removal of stitches after 7 to 14 days. This can be done by your general practitioner at home if your hospital stay is shorter or if you are not attending further treatment sessions. Full recovery from thyroidectomy and minor glossectomy is rapid and you can go back to work or carry on with your usual daily activities within 10 to 14 days. Partial pharyngectomy requires 3 to 4 weeks or rest and rehabilitation; total pharyngectomy, partial laryngectomy and total laryngopharyngectomy surgeries may need up to 3 to 6 months for recovery and will require additional speech and swallow therapy.
Benefits of throat cancer surgery
Thyroid and throat cancer surgeries aim to remove a tumour in its entirety and so have the potential to be curative procedures. Surgery is nearly always recommended in cases of non-metastatic cancers; however, most treatment pathways integrate multiple therapies. In the case of throat cancer, these are most commonly chemotherapy and radiotherapy; for thyroid cancer, radioactive iodine therapy.
Where the voice box is removed, innovative technologies such as the Provox prosthetic are available to help you to speak once more.
Disadvantages of oesophageal and throat cancer surgery
Postoperative infection is always a risk with this type of surgery and patients are administered antibiotics as a preventive measure before surgery commences. Your chosen clinic’s doctors and nurses are trained to recognise the symptoms of infection very early on and various steps are taken to protect inner sutures and give internal incisions the opportunity to heal. Other short-term risks include bleeding, adverse reactions to the anaesthesia, blood clots, an urge to urinate in the presence of a urinary catheter, and breathing problems. Avoidance of cigarettes prior to and after throat surgery is obligatory.
Throat cancer aftercare involves sometimes significant dietary changes due to difficulties swallowing, speech therapy with or without a temporary or permanent tracheostomy, thyroid hormones where part or all of the thyroid gland has been removed and possible calcium supplementation where one or more of the parathyroid glands have been excised. Thyroid surgery requires close monitoring for thyroid hormone in the blood through simple blood test.
Other long-term complications include scar tissue formation that can narrow the trachea or upper oesophagus. We recommend you visit your local ENT specialist early on so he or she can keep an eye on your progress.
Nonsurgical treatments for throat and thyroid cancer
Nonsurgical treatments are offered to those unable to undergo surgery due to low overall levels of health or those who need to keep metastatic or potentially recurring cancer under control. These treatments include radiofrequency ablation of the tumour that destroys cancer cells using electrical current, and microwave ablation which uses needles that emit microwaves to produce localised heat. Target cells are accessed by way of needles and these procedures can be carried out under sedation and with a local anaesthetic together with medical imaging machines. Due to the proximity of the airway to throat and thyroid you will need to stay overnight. Another option is cryotherapy where, instead of electricity, low temperatures are applied directly to a tumour to freeze and kill the cancerous cells.
Non-surgical neo-adjunct and adjunct therapies for throat cancer
As already mentioned, additional therapies are often advised before or after surgery to either shrink a tumour before resection or to destroy potentially remaining cancer cells that may have been missed during a surgical procedure. The most common of these non-surgical treatments is radiotherapy or a combination of radiotherapy and chemotherapy, but there are a number of options you can consider, all of which contribute to cancer control in all stages of the disease.
Radioactive Iodine for thyroid cancer
Radioactive iodine treatment for thyroid cancer has been described in detail in the section above titled “How is thyroid cancer treated?”
Throat cancer radiation therapy
Radiotherapy is the most common neo-adjunct or adjunct therapy for throat cancer that is either given before surgery to shrink a larger tumour (neo-adjuvant radiotherapy), after surgery to reduce the risk of the cancer recurring (adjuvant radiotherapy) or as a palliative measure for advanced cancers to help control uncomfortable symptoms such as narrowing of the trachea or upper oesophagus.
Radiotherapy can be used as a stand-alone cancer therapy for inoperable tumours with varied success but newer radical chemo-radiotherapy combinations of approximately 30 daily radiotherapy treatments given over the course of 6 weeks in combination with 4 to 6 cycles of chemotherapy has been known to put throat cancer into complete remission, significantly shrink tumours or decelerate tumour growth.
Fractionated external beam radiation therapy (EBRT) may be given to prevent the growth of potentially remaining cancer cells after surgery. This therapy is given over the course of 3 to 7 weeks in low doses. More recently, stereotactic body radiation therapy (SBRT) has provided patients with a higher dose, shorter course of radiation therapy.
Radiotherapy for oesophageal and throat cancer is composed of two main types – external beam radiation therapy (EBRT) and stereotactic body radiation. If cancer has spread to the bone tissue (bone metastasis), patients may be offered radiopharmaceuticals. These are injected drugs that contain radioactive substances that settle in areas of damaged bone. Here, they emit radiation that kills cancer cells. These drugs also relieve bone pain caused by metastasis and can extend life.
External beam radiation therapy focuses beams of radiation into the affected area and requires short (10 to 30 minute) visits to the hospital 5 times a week for several weeks. Long-term stays with all accommodation, home nursing care, catering, transportation and follow ups can be seamlessly arranged by your Remedazo team.
EBRT is a painless treatment and recent technology now enables oncologists to be even more precise with dosage and range. Additional options such as three-dimensional conformal radiation therapy or 3D-CRT use computers to map the area that requires treatment and shape the radiation beams to avoid damaging non-cancerous tissues. The even more advanced intensity modulated radiation therapy (IMRT) machine moves around the patient, shapes the beams and adjusts radiation intensities. This may be done with built-in scanners (image guided radiation therapy or IGRT) or using a more rapid but not necessarily more effective technique called volumetric modulated arc therapy or VMAT. You will be able to discuss all of these alternatives with a Remedazo oncology specialist.
The side effects of radiation therapy often depend on its effects upon healthy tissues that are found close to the throat, including the major blood vessels, airway, thyroid gland, heart, and certain nerves. In addition, radiation treatments can make you feel tired for weeks to months. At Remedazo, all associated information will be given upon or shortly after your consultation; you can then make an informed decision regarding the types of radiotherapy available to you.
Throat cancer chemotherapy
Throat cancer is most often treated with surgery in combination with radiotherapy, but chemotherapy may also be prescribed. Squamous cell carcinomas tend to respond less positively but are not completely resistant. Chemotherapy may be given to shrink tumours prior to surgery, to treat cancer types with the potential to return, and also to destroy any cancer cells that may have been left behind after surgery. Where surgery is not indicated, chemotherapy is given in combination with radiotherapy and is often supported by other non-surgical therapies, most of them listed within this section. Multiple cytotoxic (cell-toxic) combinations exist, all of which can be discussed with a Remedazo oncology specialist.
Chemotherapy drugs are administered intravenously via a portacath, PICC line or central venous catheter. Drug cycles usually last for 21 days and, depending on your type of cancer, may be repeated up to 6 times. This can mean 5 months of therapy with regular blood tests and follow ups of symptoms and side effects. Ask Remedazo for more information regarding longer-term stays where all of your physical, psychological and emotional needs are catered for during this stressful time. Alternatively, we can arrange similar accommodation and familiar, trusted team members for regular returns to your clinic of choice and cater for your accompanying family members or friends.
Throat cancer immunotherapy
Checkpoint inhibitors allow your immune system to respond to the presence of specific cancer cells and attack them. This response is often absent during tumour growth. It has been shown that some advanced throat and thyroid cancers respond well to immunotherapy treatment but this certainly does not apply to all. Ask about immunotherapy options during your free Second Opinion.
Drugs such as pembrolizumab block the activity of a protein that prevents your immune cells from recognizing and attacking inflamed tissues and cancer cells. Oncologists partnered with Remedazo are renowned for their knowledge of the most recent clinical studies and research pertaining to effective and new cancer-fighting drugs.
Each intravenous immunotherapy treatment requires at least a 2 hour stay in a clinical setting and should be repeated every 2 to 3 weeks. Immunotherapy has been shown to increase survival times in metastasised cancer; however, immunotherapy is rarely offered before other types of therapy. The usual first-line treatment for metastatic oesophageal or throat cancer without surgery is chemotherapy plus targeted therapy.
The side effects of immunotherapy are many and can be serious. Those offered this type of treatment are given in-depth information regarding side effects and the detection of their early signs. Remedazo can put you in touch with one of our specialist oncologists to discuss your eligibility for immunotherapy based upon your personal medical history.
Throat cancer pharmaceuticals
Targeted therapy drug cetuximab (Erbitux) is a tyrosine kinase inhibitor (TKI). In combination with checkpoint inhibitors (immunotherapy), cetuximab has been proven to be effective in the treatment of metastatic throat cancer; however, not every type of throat cancer responds in the same way to either inhibitory drugs or immunotherapy. Where radioactive iodine treatment in thyroid cancer is unsuccessful, tyrosine kinase inhibitors may help.
Tyrosine kinase inhibitors are drugs that prevent the growth of a tumour’s own blood supply network and are sometimes combined with early treatment modalities such as surgery. These drugs either alone or in combination with other treatments have achieved breakthrough advances in the management of a number of hard-to-treat malignancies, including advanced cases of throat cancer.
Throat cancer cryotherapy
Cryotherapy uses cold temperatures to freeze cancerous cells. This can be a first-line treatment with very small, localised tumours where a patient is unable to undergo surgery.
Multiple cryotherapy procedures may be required if cancer cells are left behind. Cryotherapy or cryoablation of the throat and/or upper oesophagus is performed under an endoscopic procedure that requires sedation and an overnight hospital stay. Using an endoscope with a camera, the ENT specialist locates the area where an earlier biopsy has shown that cancer is present and inserts hollow needles through which an extremely cold gas is passed. These extremely low temperatures freeze and kill the cancer cells.
Thyroid and throat cancer alternatives
It is possible that you have been given a choice of one or more alternative treatments or have not yet made an appointment for your free e-consult and are simply browsing the possibilities.
The accepted and current thyroid and throat cancer treatment alternatives have been described in detail above. Complementary throat cancer remedies are unproven and should not take the place of accepted treatment courses. Cancer stem cell therapies for thyroid and throat cancer are, as yet, insufficiently developed to be used as first-line treatment.
Of course, there is no alternative for professional medical advice. Please call us to arrange your e-consult and the opportunity to speak personally with specialist otolaryngologists and oncologists to determine the best treatment type for you. You can discuss all thyroid and throat cancer treatment alternatives with them, ask for second or third opinions, and take the first step towards your personalised Remedazo holistic care package.
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