Throat Cancer: Hypopharyngeal, Laryngeal, Nasopharyngeal, Oropharyngeal

Throat cancer usually causes pain in the throat that increases with swallowing, difficulty swallowing and speaking, and pain in the ear. Sometimes a lump in the neck is the first sign of throat cancer. Throat cancer is a general term for any cancerous tumor present in the throat, scientifically the Hypopharyngeal, Laryngeal, Nasopharyngeal, Oropharyngeal.

Location of throat cancer

Not all throat cancers are located at the same level and can develop from:

The hypopharynx, which is the part of the throat just above the esophagus and trachea.
The glottis corresponding to the vocal cords.
The epiglottis which is the area of the larynx located above the vocal cords. It is shaped like a movable tab designed to prevent food from entering the airways.
The subglottis, part of the larynx located under the vocal cords.

What is hypopharyngeal cancer?

Hypopharyngeal cancer starts in the cells of the hypopharynx, which is part of the throat (pharynx). Cancerous (malignant) tumor is a group of cancerous cells that can invade and destroy nearby tissue. It can also spread (metastasize) to other parts of the body. Hypopharyngeal cancer is not common.

The hypopharynx is part of the pharynx (throat). The pharynx is part of the digestive and respiratory systems. It is divided into 3 parts. The nasopharynx forms the top of the pharynx. The oropharynx is the central part of the pharynx. The hypopharynx forms the bottom of the pharynx. It connects the pharynx to the esophagus.

In some cases, cells in the hypopharynx that have undergone changes can become cancerous. Hypopharyngeal cancer most often starts in squamous (squamous) cells that line the inside of the hypopharynx. This type of cancer is called squamous cell carcinoma of the hypopharynx.

Rare types of hypopharyngeal cancer can also occur. Accessory salivary gland carcinoma and sarcoma are examples.

The pharynx

The pharynx is commonly referred to as the throat. It is a passageway that is found in the head and neck and is part of the digestive system and the respiratory system. The pharynx connects the nose to the mouth and throat.

Structure of the pharynx

The pharynx is a hollow muscular tube that is approximately 13 cm (5 inches) long. It starts behind the nose and runs down the back of the mouth, then it travels down the neck to behind the larynx (the organ of speech). The lower part of the pharynx joins the tube that connects the pharynx to the stomach, called the esophagus.

The pharynx is made up of 3 parts called nasopharynx, oropharynx, and hypopharynx.

Nasopharynx

The nasopharynx is the upper part of the pharynx. It is connected to the nose and is separated from the mouth by the soft part at the back of the ceiling of the mouth called the soft palate. The base of the skull forms the top of the nasopharynx. The upper part of the pharyngeal wall forms the sides and back of the nasopharynx. The nasopharynx is lined with a thin layer of epithelial cells, called the respiratory epithelium or ciliated columnar epithelium.

The nasopharynx is connected to the central part of each ear by the eustachian tubes. These ducts have openings on either side of the nasopharynx.

Adenoids, or pharyngeal tonsils, are masses of lymphatic tissue located on the back wall of the nasopharynx.

Oropharynx

The oropharynx is the central part of the pharynx. It extends from the soft palate to the lower back (base) of the tongue. The oropharynx ends at the epiglottis, the end of mobile cartilage that folds over the larynx, and therefore closes it, when we swallow. The oropharynx consists of the base of the tongue, the tonsils, the soft palate and the central part of the pharyngeal wall. It also includes the small piece of tissue that hangs down the back of the mouth (uvula). The oropharynx is lined with thin, flat cells called squamous cells.

Hypopharynx

The hypopharynx is the lower part of the pharynx. It is also called the laryngopharynx. It starts in the epiglottis and travels down to the upper end of the esophagus. The hypopharynx occupies the back and each side of the larynx.

The hypopharynx consists of the 2 small grooves in the pharyngeal wall on either side of the opening that leads to the larynx called the piriform sinuses. It also includes the lower part of the pharyngeal wall as well as the postcricoid region, which is located just behind the cartilage of the larynx (cricoid cartilage). The hypopharynx is lined with squamous cells.

Function of the pharynx

The pharynx allows you to swallow, breathe, and speak.

Swallowing

The oropharynx is the passageway for the food you swallow (swallowing). The walls of the oropharynx and hypopharynx have muscles that help move food from the mouth to the esophagus.

Breathing

The nasopharynx allows air to pass from the nose to the rest of the pharynx then to the larynx and trachea and then to the lungs.

Word

When you speak, the muscles and walls of the pharynx vibrate as air is forcefully expelled from the larynx. These vibrations are transformed into sounds by the mouth, lips and tongue.

Other parts of the head and neck

Many important structures are found in the head and neck. Since the pharynx is located near these structures, cancers of the pharynx and its treatments can affect them.

Cervical lymph nodes

Lymph nodes are small, bean-shaped masses of lymphatic tissue that rest on lymphatic vessels. Lymph is a clear fluid that contains lymphocytes (a type of white blood cell that fights germs, foreign substances and cancer cells). Lymph vessels circulate lymph to lymph nodes throughout the body. Lymph nodes store lymphocytes and filter bacteria and foreign substances, including cancer cells, from the lymph.

Lymph nodes in the neck are called cervical lymph nodes. There are many of them and there are a few around the pharynx. These lymph nodes are classified into different groups called levels depending on their location in the neck. There are 6 levels of cervical lymph nodes on either side of the neck.

Cranial nerves

The cranial nerves control many functions of the head and neck, such as swallowing, vision, hearing, and eye movement. Some cranial nerves are found in the tissues that surround the pharynx.

Sometimes a tumor in the pharynx spreads to the cranial nerves. If these nerves are in the area to be treated, your healthcare team will try to protect them as much as possible. But a pharyngeal tumor or its treatments can damage cranial nerves and cause temporary or permanent side effects.

Cancerous tumors of the hypopharynx

A cancerous tumor of the hypopharynx can invade and destroy nearby tissue. It can also spread (metastasize) to other parts of the body. Cancerous tumor is also called a malignant tumor. The most common type of hypopharyngeal cancer is squamous cell carcinoma. It accounts for over 90% of hypopharyngeal cancers.

Squamous cell carcinoma

Squamous cell carcinoma starts in flat, thin cells called squamous cells. A layer of squamous cells, called the squamous epithelium, lines the hypopharynx. Squamous cell carcinoma most commonly begins in the piriform sinus but sometimes in the posterior pharyngeal wall or postcricoid region.

Verrucous carcinoma is a type of squamous cell carcinoma. It is low grade and rarely spreads to other parts of the body, but it can invade nearby tissues in depth.

Rare cancerous tumors of the hypopharynx

The following cancerous tumors of the hypopharynx are rare:

• The accessory salivary gland tumor begins in the cells of the accessory salivary glands. They are tiny glands in the lining of the hypopharynx. Adenocarcinoma, adenoid cystic carcinoma, and mucoepidermoid carcinoma are types of accessory salivary gland tumors. Find out more about cancerous salivary gland tumors.
• Sarcoma starts in connective tissue cells (cartilage). Types of hypopharyngeal sarcoma include chondrosarcoma and synovial sarcoma. Find out more about the types of soft tissue sarcoma.
• Melanoma usually starts in the skin, but it can also start on mucous membranes that line the inner surface of different parts of the body, including the hypopharynx. Find out more about melanoma.
• Non-Hodgkin lymphoma starts in lymphocytes. Lymphocytes are a type of white blood cell. Find out more about non-Hodgkin lymphoma.

What is laryngeal cancer?

Laryngeal cancer starts in cells of the larynx (also called the organ of speech). A cancerous (malignant) tumor is a group of cancer cells that can invade and destroy nearby tissue. It can also spread (metastasize) to other parts of the body.

The larynx is part of the respiratory system. This is the conduit that connects the throat to the windpipe. The vocal cords are 2 bands of muscles located in the middle of the larynx, which produce sounds and help us speak. The larynx helps prevent food and fluids from entering the trachea. It plays an important role when we breathe, swallow and speak.

Cells in the larynx sometimes undergo changes that make the way they grow or behave abnormally. These changes can lead to the development of non-cancerous (benign) conditions, such as chronic laryngitis and vocal cord nodules. They can also cause non-cancerous tumors such as vocal cord polyps and laryngeal papillomatosis.

Changes in the cells of the larynx can also cause a precancerous condition. This means that the abnormal cells are not yet cancerous, but are at an increased risk of becoming cancerous. The most common precancerous condition of the larynx is dysplasia.

In some cases, however, changes in the cells of the larynx can cause cancer. Laryngeal cancer most often starts in thin, flattened cells called squamous cells. These cells line the inner part of the larynx. This type of cancer is called squamous cell carcinoma of the larynx. Laryngeal cancer can start anywhere in the larynx. It often starts in the central part of it, near the vocal cords. Most squamous cell carcinomas start off as dysplasia.

There are also rare types of laryngeal cancer, which include cancers of the accessory salivary glands, sarcomas, melanomas, and lymphomas.

What the larynx does
The larynx has 3 main functions.

Breathing
The epiglottis and vocal cords naturally open during breathing to allow air to enter and exit the lungs through the trachea. A cough reflex is triggered if food or liquid enters the larynx.

Swallowing
The muscles and ligaments around the larynx prevent food or fluids from entering the trachea and lungs when swallowing. When you swallow, these muscles move the larynx upward, causing the epiglottis to close over the upper part of the larynx. It also helps move food from the mouth to the esophagus.

Phonation
The larynx makes the sound that allows us to speak by pushing air out of our lungs. Sound is produced when air passes through the larynx and vibrates the vocal cords. The muscles of the vocal cords expand and contract, causing the volume and tone of the voice to vary. When you push air out, pushing it up the larynx and out through the mouth, you create the different sounds of speech by moving your teeth, tongue, and lips.

Cancerous tumors of the larynx

A cancerous tumor of the larynx can invade and destroy nearby tissue. It can also spread (metastasize) to other parts of the body. The most common type of laryngeal cancer is squamous cell carcinoma. It accounts for 95% of all cancers of the larynx.

Squamous cell carcinoma

Squamous cell carcinoma of the larynx starts in the thin, flattened cells found in the epithelium, or inner lining of the larynx.

Squamous cell carcinoma is classified according to the part of the larynx where the cancer starts:

• Glottic carcinoma starts in the area that contains the vocal cords.
• Subglottic carcinoma starts in the area below the vocal cords.
• Supraglottic carcinoma starts in the area above the vocal cords.

Rare tumors of the larynx

The following cancerous tumors of the larynx are rare:

• Accessory salivary gland tumors start in the cells of the accessory salivary glands. These are small glands located under the lining of certain areas of the larynx. Types of tumors include adenocarcinoma, adenoid cystic carcinoma, and mucoepidermoid carcinoma. Find out more about cancerous salivary gland tumors.
• Sarcoma starts in connective tissue cells (cartilage). Types of laryngeal sarcomas include chondrosarcoma and synovial sarcoma. Find out more about the types of soft tissue sarcomas.
• Melanoma usually starts in the skin, but it can appear on mucous membranes that line the inner surface of different parts of the body, including the larynx. Find out more about melanoma.
• Non-Hodgkin lymphoma starts in lymphocytes. Lymphocytes are a type of white blood cell. Find out more about non-Hodgkin lymphoma.
• Extramedullary plasmacytoma is a type of multiple myeloma that starts in plasma cells. Find out more about the types of multiple myeloma.

What is nasopharyngeal cancer?

Nasopharyngeal cancer starts in the cells of the nasopharynx, which is part of the throat (pharynx). Cancerous (malignant) tumor is a group of cancerous cells that can invade and destroy nearby tissue. It can also spread (metastasize) to other parts of the body.

The pharynx is part of the digestive and respiratory systems. It is divided into 3 parts. The nasopharynx forms the top of the pharynx, behind the nose. The oropharynx is the central part of the pharynx. The hypopharynx forms the bottom of the pharynx.

Sometimes cells in the nasopharynx undergo changes that make the way they grow or behave abnormally. These changes can lead to non-cancerous (benign) tumors such as angiofibroma and hemangioma.

But in some cases, the altered cells in the nasopharynx can become cancerous. Nasopharyngeal cancer most often starts in epithelial cells that line the inside of the nasopharynx. This type of cancer is called nasopharyngeal carcinoma (CNP).

Rare types of nasopharyngeal cancer can also occur. Papillary adenocarcinoma and accessory salivary gland carcinoma are examples.

Cancerous tumours of the nasopharynx

A cancerous tumour of the nasopharynx can grow into and destroy nearby tissue. It can also spread (metastasize) to other parts of the body. Cancerous tumours are also called malignant tumours.

Nasopharyngeal carcinoma

Nasopharyngeal carcinoma (NPC) is the most common type of nasopharyngeal cancer. There are 3 main types of NPC. They look different under the microscope but all start in the epithelial cells that line the surface of the nasopharynx.

• Non-keratinizing squamous cell carcinoma is linked with the Epstein-Barr virus (EBV). It accounts for 60% of NPC in adults. It is an aggressive cancer that tends to spread quickly to surrounding tissues and lymph nodes.
• Keratinizing squamous cell carcinoma is less common than non-keratinizing squamous cell carcinoma. It usually develops in people over the age of 40 and is associated with a history of smoking and drinking alcohol. It is not linked with EBV.
• Basaloid squamous cell carcinoma of the nasopharynx is a rare, aggressive type of NPC. It is similar to basaloid squamous cell carcinomas of other areas of the head and neck.

Rare nasopharyngeal tumours

Other types of nasopharyngeal tumour are uncommon.

Nasopharyngeal papillary adenocarcinoma is a low-grade cancer of the nasopharynx. This means that the cancer cells look and act like normal cells and the tumour grows slowly. It grows into the space in the nasopharynxand often blocks the nasal passages.

Minor salivary gland carcinoma is a cancer of the very small salivary glands in the lining of the nasopharynx.

Sarcoma is a cancer that starts in the connective tissues of the nasopharynx, such as bone, cartilage, fat, muscle or blood vessels.

Non-cancerous tumors of the nasopharynx

A non-cancerous (benign) tumor of the nasopharynx is a lump that does not spread to other parts of the body (not metastasize). The non-cancerous tumor is usually not life threatening and is rare. It is usually removed by surgery and usually does not come back (come back).

The following are some types of non-cancerous nasopharyngeal tumors:

• Angiofibroma is a lump filled with blood vessels that can bleed.
• Hemangioma is a mass made up of blood vessels that have swelled (dilated, or widened).
• Benign accessory salivary gland tumor is a mass that appears in the accessory salivary glands. These glands are found on the inner surface of the pharynx (throat).

What is oropharyngeal cancer?

Oropharyngeal cancer starts in the cells of the oropharynx, which is part of the throat (pharynx). Cancerous (malignant) tumor is a group of cancerous cells that can invade and destroy nearby tissue. It can also spread (metastasize) to other parts of the body.

The pharynx is part of the digestive and respiratory systems. It is divided into 3 parts. The nasopharynx forms the top of the pharynx. The oropharynx is the central part of the pharynx, at the back of the mouth. The hypopharynx forms the bottom of the pharynx.

Oropharyngeal cells sometimes go through changes that make the way they grow or behave abnormally. These changes can lead to non-cancerous (benign) conditions such as retention cysts. They can also cause non-cancerous tumors such as papilloma and hemangioma to form.

But in some cases, the modified cells in the oropharynx can become cancerous. Oropharyngeal cancer most often starts in squamous (squamous) cells that line the inside of the oropharynx. This type of cancer is called squamous cell carcinoma of the oropharynx.

Rare types of oropharyngeal cancer can also occur. Accessory salivary gland carcinoma and lymphoma are examples.

Cancerous tumors of the oropharynx

A cancerous tumor of the oropharynx can invade and destroy nearby tissue. It can also spread (metastasize) to other parts of the body. Cancerous tumor is also called a malignant tumor. The most common type of oropharyngeal cancer is squamous cell carcinoma. It accounts for over 90% of oropharyngeal cancers.

Squamous cell carcinoma

Squamous cell carcinoma starts in flat, thin cells called squamous cells. A layer of squamous cells, called the squamous epithelium, lines the oropharynx. Tonsil carcinoma is the most common type of squamous cell carcinoma of the oropharynx.

Verrucous carcinoma is a type of squamous cell carcinoma. It is low grade and rarely spreads to other parts of the body, but it can invade nearby tissues in depth.

Rare cancerous tumors of the oropharynx

The following cancerous tumors of the oropharynx are rare:

• The accessory salivary gland tumor begins in the cells of the accessory salivary glands. They are tiny glands in the lining of the oropharynx. Adenocarcinoma, adenoid cystic carcinoma, and mucoepidermoid carcinoma are types of accessory salivary gland tumors. Find out more about cancerous salivary gland tumors.
• Sarcoma starts in connective tissue cells (cartilage). Types of oropharyngeal sarcoma include, but are not limited to, chondrosarcoma and synovial sarcoma. Find out more about the types of soft tissue sarcoma.
• Melanoma usually starts in the skin, but it can also start on mucous membranes that line the inner surface of different parts of the body, including the oropharynx. Find out more about melanoma.
• Non-Hodgkin lymphoma starts in lymphocytes. Lymphocytes are a type of white blood cell. Lymphoma can appear in the lymphatic tissue of the oropharynx, such as the base of the tongue or the tonsils. Find out more about non-Hodgkin lymphoma.

Tumors and non-cancerous conditions of the oropharynx

A non-cancerous (benign) tumor of the oropharynx is a lump that does not spread to other parts of the body (not metastasize). The non-cancerous tumor is usually not life threatening. Usually it’s removed by surgery and it doesn’t usually come back (come back).

Non-cancerous tumors

Here are some types of non-cancerous oropharyngeal tumors:

• The papilloma is a smooth or wart-like mass.
• Benign accessory salivary gland tumor is a mass that appears in the accessory salivary glands. These glands are found on the inner surface of the pharynx (throat).
• Hemangioma is a mass made up of dilated (widened) blood vessels.
• Lymphangioma is a mass made up of dilated lymphatic vessels.
• Lipoma is a tumor made up of fat cells.
• A fibroid is a mass that originates in the tissue that surrounds and supports various organs, that is, fibrous connective tissue.
• The neuroma is a mass that starts in nerve cells (neurons).

Non-cancerous conditions

Non-cancerous oropharyngeal disease is a change in the cells of the oropharynx, but it is not cancer. The non-cancerous condition does not spread to other parts of the body (no metastases) and is usually not life threatening.

The retentional cyst is the most common type of non-cancerous disease of the oropharynx. It is a bag filled with a liquid or semi-solid substance. It can start in a mucous gland in the pharyngeal wall that is blocked. Sometimes a large retention cyst is treated with surgery.

Symptoms of throat cancer

Symptoms of throat cancer vary somewhat depending on where the cancer is located.

Oral cancer is usually painless for a long time, but ends up causing pain as it grows. When the pain begins, it usually occurs during swallowing, such as a sore throat. People may have difficulty speaking.

Throat cancer usually causes pain in the throat that increases with swallowing, difficulty swallowing and speaking, and pain in the ear. Sometimes a lump in the neck is the first sign of throat cancer.

In most types of throat cancer, the unique symptoms make it difficult to take food and people start to lose weight.

Diagnostic Throat Cancer

Since early detection greatly improves the likelihood of recovery, doctors and dentists should carefully examine the mouth and throat during every routine medical and dental examination. The exam should include the area under the tongue, where people usually don’t see or feel abnormal growth until it has grown very large.

Most common diagnostic for throat cancer:

• Endoscopy
• Biopsy
• Imaging tests for stage definition

To diagnose cancers of the mouth and throat, doctors take a biopsy (taking a sample of tissue to look at under a microscope) of any abnormal areas seen on the exam. Only a biopsy can determine if a suspicious area is cancerous. If doctors don’t see any abnormal growth in the mouths of people with symptoms, they examine the throat with a special mirror and / or a flexible viewing tube (endoscope). They take a biopsy of any abnormal areas seen during this exam.

If the biopsy shows cancer, then doctors do imaging tests to determine the extent (stage) of the cancer, such as

• Computed tomography (CT)
• Magnetic resonance imaging (MRI)
• Combination of positron emission tomography (PET) and CT

These imaging tests are done to help doctors determine the size and location of the cancer, whether it has spread to nearby structures, and whether it has spread to lymph nodes in the neck. Doctors also use an endoscope to examine the inside of the mouth and throat to view cancer in nearby structures. Doctors do laryngoscopy (to look inside the larynx), bronchoscopy (to look inside the airways), and esophagoscopy (to look inside the esophagus).

Prognosis

The survival rate of people with throat cancer varies, depending on:

• The initial site of the tumor
• Whether the cancer has spread, and if so, to what extent (stage)
• The cause

The cure rate for squamous cell carcinoma of the mouth is important if all of the tumor and surrounding healthy tissue is removed before it spreads to the lymph nodes. On average, more than 75% of people with carcinoma of the tongue that has not reached the lymph nodes survive at least 5 years after diagnosis. About 75% of people with floor of the mouth cancer that has not spread survive for at least 5 years after diagnosis. However, if the cancer has spread to the lymph nodes, the 5-year survival rate decreases by about 50%. About 90% of people with lower lip cancer survive at least 5 years, and the carcinoma rarely spreads. Carcinoma of the upper lip tends to be more aggressive and spreads.

On average, 60% of people with throat cancer survive at least 5 years after diagnosis. The rates are greater than 75% if the cause is human papillomavirus (HPV) and less than 50% if the cause is different.

People with cancer caused by HPV have a better survival rate than people with similar cancer caused by other factors.

Prevention

Avoiding excessive consumption of alcohol and tobacco can significantly reduce the risk of oral and throat cancer. Smoothing out sharp edges of chipped teeth or fillings is an additional preventive measure. Staying out of the sun and using sunscreen helps reduce the risk of lip cancer. If the sun damage affects a large area of the lip, shaving the lips, which involves removing the outer surface with surgery or laser, can prevent cancerous growth.

Current HPV vaccines target certain strains of HPV that cause throat cancer. Therefore, vaccination can prevent the development of some of these cancers.

Treatment Throat Cancer

• Surgery
• Radiotherapy, sometimes combined with chemotherapy (chemoradiotherapy)
• The mainstays of treatment for oral and throat cancer are surgery and radiotherapy. Doctors choose treatment based on the size and location of the cancer.

For throat cancer, doctors more often use surgery as the initial treatment. New techniques allow doctors to operate through the mouth rather than through an incision in the neck. Some techniques use an endoscope to guide laser surgery. Another technique involves the use of a surgical robot. The surgeon controls the robot’s arms from a console and views the operation through a camera attached to an endoscope that has been inserted into people’s mouths.

Radiation therapy, or sometimes chemoradiation therapy, can be used after surgery or as an initial treatment. Doctors usually use radiation therapy for early stage cancers and add chemotherapy to it when the cancer is more advanced. A specific type of radiation therapy called intensity-modulated radiation therapy (IMRT) allows doctors to treat a very specific area with radiation, which can decrease side effects.

Find out more about chemotherapy.

List of all Cancers

The word “cancer” is a generic term for a large group of diseases that can affect any part of the body. We also speak of malignant tumors or neoplasms. One of the hallmarks of cancer is the rapid multiplication of abnormal growing cells, which can invade nearby parts of the body and then migrate to other organs. This is called metastasis, which is the main cause of death from cancer. Types of cancer (in alphabetical order of the area concerned):

Types of Cancer | List all of Cancers | Adult, Children, Head and neck, Digestive and Types of Blood Cancer

Information: Cleverly Smart is not a substitute for a doctor. Always consult a doctor to treat your health condition.

Sources: PinterPandai, American Cancer Society, Web MD, Cancer Center, Cleveland Clinic

Photo credit: Wikimedia Commons

Photo descriptions (main photo): Larynx Malignant vegetative tumor. Original diagnosis: Malignant vegetative tumor (squamous epithelioma stratified squamous cell). Updated diagnosis: Invasive squamous cell carcinoma. History: 52-year-old woman Macroscopic description. Bumpy tumor, not ulcerated, rather hard in consistency, the size of a bean located at the level of the anterior commissure and involving the anterior 2/3 of the right vocal cord. Microscopy description: Squamous cell carcinoma with rough horny globes and marked stromal and lympho-plasmocytic reaction.