Throat Cancer

Many people get confused about what throat cancer really means.

“Throat cancer” is not a very exact medical term so doctors generally don’t use it. Many patients and relatives may use throat cancer to mean cancer that develops in any of the 3 parts of the pharynx. Or even other structures near the pharynx, such as the thyroid gland or the voice box (larynx). Some people also use it to mean cancer of the gullet (oesophagus).
Pharynx is the medical name for the throat.

To avoid confusion, it is important to know the exact medical name of the cancer you or your relative has so that you can find the right information. Cancers are treated according to where they started. The treatment for thyroid cancer is completely different to treatment for nasopharyngeal cancer, for example. If you are not sure of the medical name of your cancer, ask your doctor or nurse to write it down for you.

Parts of the pharynx

Pharynx is the medical name for the throat.

The pharynx is in 3 parts and the nasopharynx is one of these parts. The nasopharynx connects the back of the nose to the back of the mouth.

Cancer that develops in the nasopharynx is called nasopharyngeal cancer.

Nasopharynx is pronounced ‘nas-o-fah-rinks’. Nasopharyngeal is pronounced ‘nas-o-fah-rin-gee-al’. You can’t see your own nasopharynx directly, but if you look inside your mouth in the mirror, it lies above your soft palate (the soft area at the back of the roof of your mouth) and uvula (the dangly bit) at the back of the mouth.

The other two parts of the pharynx are

  • The oropharynx – the part of the throat just behind the mouth that connects the mouth to the top of the throat. Doctors call cancers that start in this area, oropharyngeal cancers. Oropharynx is pronounced ‘oar-o-fah-rinks’. Oropharyngeal is pronounced ‘oar-o-fah-rin-gee-al’
  • The hypopharynx (sometimes called the laryngopharynx) – sits behind and on either side of the larynx (voice box). Cancer can also start in the hypopharynx, pronounced ‘high-po-fah-rinks’.

The lymph nodes in your neck
Like other parts of the body, the neck contains lymph nodes (also called lymph glands). These small, bean shaped glands are part of the lymphatic system. Lymph nodes are often the first place cancer cells spread to when they break away from a tumour.

There are major groups of lymph nodes in the neck. If you have this type of It may spread to these lymph nodes. You may need radiotherapy with or without chemotherapy to treat the cancer in these lymph nodes.

Cancer that begins in the lymph nodes (rather than spreading to them) is called lymphoma.

The information provided through CancerHelp UK is not a substitute for professional care and should not be used for diagnosing or treating a health problem or a disease. If you have, or suspect you may have, a health problem you should consult your doctor.

RISKS

It is important to remember that

  • Nasopharyngeal cancers are rare – there are about 200 cases diagnosed each year in the UK.
  • We don’t know exactly what causes most nasopharyngeal cancers, but we do know that several things affect your risk.

Unlike most other types of head and neck cancer, alcohol is not a known risk factor for nasopharyngeal cancer.

Diet
A poor diet may increase your risk of nasopharyngeal cancer. This may be because of a lack of some vitamins and minerals. People who eat more green vegetables, fresh fruit and other sources of vitamin C have a lower risk of nasopharyngeal cancer. This is important throughout life, including in childhood.

Nasopharyngeal cancer is more common in parts of Asia, Northern Africa, and the Arctic than it is in Europe. Diets very high in salt cured meats and fish or pickled foods are more common in some of these places. These foods can be very high in nitrates and nitrites, which react with protein to form nitrosamines. These chemicals can damage DNA. Studies in America, where nasopharyngeal risk is generally low, have found increased risk in people who eat a lot of preserved meat – ham, sausages and bacon. People eating the highest amounts had about 5 times the risk as those eating low amounts.

Studies in China and Hong Kong have shown that babies and young children who eat Chinese cured and salted fish are at an especially high risk of nasopharyngeal cancer later in life. People from China, or with Chinese ancestry living in the UK, have higher rates of nasopharyngeal cancer than other ethnic groups, and it may be that this is due to their diet. Some studies have shown an increased risk of nasopharyngeal cancer among people who drink tea made from Chinese medicinal herbs.
Viruses
Viruses can help cause some cancers. But this does not mean that you can ‘catch’ these cancers like an infection. The virus can cause genetic changes in cells that make them more likely to become cancerous in the future. Many people are affected with a cancer causing virus but never get cancer. The virus only causes cancer in certain situations.

Nasopharyngeal cancers have been linked to the Epstein Barr virus (EBV). Most people carry EBV and it does them no harm. This virus is linked to a number of cancers, including Hodgkin’s disease and Burkitt’s lymphoma as well as nasopharyngeal cancer.

Inherited risk
The risk of nasopharyngeal cancer is higher in people who have a relative with this disease. The risk to other family members appears higher if the relative was diagnosed before the age of 40 and is a first degree relative. A first degree relative is a parent, brother, sister, son or daughter.

Some chemicals
People exposed to wood dust through their work have an increased risk of nasopharyngeal cancer. Treated wood contains several chemicals, and we don’t know which of these causes the increased risk.

Smoking
Studies show that smoking causes a slight increase in risk of nasopharyngeal cancer. Heavy smoking and smoking for a long time increases your risk more than light smoking. The risk is higher in current smokers than in ex-smokers. We need more research before we’ll know whether passive smoking increases the risk of nasopharyngeal cancer.

History of ear, nose and throat disease
People who have had chronic ear nose and throat diseases at some point in the past are at an increased risk of nasopharyngeal cancer. This includes chronic blocked and runny nose (rhinitis), middle ear infections (otitis media) and polyps.

Referrals

It can be very difficult for GPs to decide who to refer to a specialist. With many symptoms, it is perfectly right that your GP should ask you to wait to see if your symptoms go away on their own, or respond to treatment such as antibiotics. If GPs referred everyone with any symptom to a specialist immediately, the system would get jammed and those needing urgent appointments wouldn’t be able to get them.

According to Department of Health guidelines, you should ideally get an appointment within 2 weeks for an urgent referral.

The symptoms that need urgent referral for possible nasopharyngeal cancer are

  • An unexplained lump in your neck that is new or has changed in the previous 3-6 weeks
  • Unexplained swelling in the glands under your ear, or around your lower jaw, that does not go away
  • Unexplained pain on one side of your head and neck for more than 4 weeks, with earache, for no apparent reason
  • An unexplained sore or painful throat that has lasted longer than it should

Your doctor may also want to refer you to a dentist urgently if you have a loose tooth for more than 3 weeks, for no apparent reason.

The guidelines also say the GP should send you for an urgent chest X-ray if you have had a hoarse, husky or quieter than normal voice for more than 3 weeks, particularly if you are a smoker over the age of 50 or a heavy drinker. The reason for the X-ray is to try and rule out a lung cancer or head and neck cancer.

Do bear in mind that some of these symptoms can be caused by other less serious medical conditions and do not always mean that you have cancer of the nasopharynx.