Dr
Nick McIvor.....Throat cancer / Laryngeal cancer
"Throat" is the layman's term for the voicebox (larynx), and the gullet (pharynx and upper oesophagus). Cancers here are not common as far as all malignancies go, but we see about 70 new cases each year in Auckland.
The following is a set of characteristics that we tend to see with these cancers but they can occur at any age from teen-ager to centurian, in either gender, and in those with no obvious risk factors. Patients with the symptoms or signs listed below should be investigated.
Age
Cancer of the throat is most common in those older than 40 years. However it can present in any adult age group.
Risk factors
There is an asociation with smoking and excessive alcohol intake although many patients appear to have no such risk.
Symptoms
Throat cancer usually presents because of a lump or non-healing ulcer in the throat. This can be perceived in various ways according to its location:
Visible swelling or ulcer
Those high in the throat, eg the tonsil, may be seen when the mouth is
open.
Pain or discomfort
A non-healing ulcer may be felt as an irritation, discomfort or pain in
the throat, usually to one side. It may also be felt in the ear
of the same side due to irritation of a throat nerve that also supplies
sensation to the ear.
Difficulty swallowing
A throat tumour may progressively interfere with swallowing, initially
with solids and then progressively with liquids and saliva. At
the start, there may be a discomfort on swallowing and then some foods
may catch or stick. After a while, some solids may have to be regurgitated
and the person moves onto a pureed diet. Progressively fluids become
a problem and there is weight loss.
The above scenario is different from a common problem called “globus” which is the feeling of something in the throat when swallowing saliva. With globus, there is no discomfort or hold-up when swallowing solids or drinking. It occurs only when the person is performing a dry swallow i.e nothing but a bit of saliva in the throat. Globus is clearly different from the scenario of a throat tumour pictured above.
Change in voice or hoarseness
Tumours on the vocal cords will give a progressive alteration in voice
as distinct from a change that is there some days and not on others and
with no progression. Hoarseness is the sole symptom of an early
vocal cord cancer – therefore any persisting change in voice for
3 weeks or longer must be investigated.
Difficulty breathing and airway noise (stertor/stridor)
Tumours will gradually grow and occupy space that is important for breathing. As
they do so, sound is created as air passes through the narrowed channel. In
the upper throat e.g. the tonsil, this may sound like breathing with a
potato in one’s mouth or throat and the voice quality may seem like
one is talking with a "hot-potato" in the mouth. Typically
there is a slightly harsh breathing sound called “stertor”
In the voice box, there is already a normal narrowing in the airway at the level of the vocal cords which are very fine structures designed to vibrate voluntarily as one expels air. This is how voice is produced. With tumours in the voice-box or larynx, progressive airway narrowing causes involuntary noise during breathing that can have a tonal quality called “stridor”. This sound can be on breathing in, or breathing in and out. Airway noise occurring only when breathing out generally comes from the lower airway (in the chest) e.g. asthma.
Bleeding
Often there will be some blood tinging of saliva or sputum but not necessarily.
Neck lump
An enlarged lymph node is frequently the only thing noticed by a person
who has developed a throat cancer. This may be because the tumour
has not ulcerated enough to hurt, is not big enough to interfere with
swallowing or breathing, and is not affecting the vocal cords. Many
tumours are in this category and first bring attention to themselves
by spreading to a lymph node in the neck.