Let's Talk About Throat Cancer Causes
This challenging disease is almost entirely preventable, once you know what's behind it. Here's what experts say are the major risk factors.
There are two very different faces of throat cancer: One is older, with a pretty poor prognosis. The other is younger, with every reason to believe the condition can be cured. These contrasting profiles come down to one thing: The cause of the disease. As it turns out, throat cancer responds differently to treatment depending on the factors that contributed to its development. We’ll take a deeper look at what those variables may be, and how you can reduce your risk—or eliminate it entirely.
Our Pro Panel
We went to some of the nation's top experts on head and neck cancers to bring you the most up-to-date information possible.
Salvatore M. Caruana, M.D.
Director of the Division of Head and Neck Surgery
New York-Presbyterian Hospital Columbia University Medical Center
New York, NY
Nadia Mohyuddin, M.D.
Head and Neck Surgical Oncologist, Associate Professor of Clinical Otolaryngology
Houston Methodist Hospital
J. Kenneth Byrd, M.D.
Chief of Head and Neck Surgery, Medical Director and Research Director
Georgia Cancer Center at Augusta University
Technically, yes. Once approved for ages 9 to 26, the FDA has raised the age limit to 45. But it’s not likely to be effective unless you’ve never had an HPV infection before, and most people contract HPV almost as soon as they start having sex. If you’re in a monogamous relationship, there’s little reason to get the HPV vaccine past your late 20s. However, if you’re older, single, and dating, you may get some benefit, since the vaccine could protect you against a viral strain you haven’t encountered.
Electronic cigarettes haven’t been around long enough for experts to know for sure, but evidence is mounting that vaping—once touted as a healthier alternative to help people quit tobacco—may be dangerous. These battery-powered devices heat liquids that contain various chemicals to produce vapors, including nicotine and other potential carcinogens. So while it may not cause throat cancer, some people are developing serious lung disease as a result, and we have no idea what kind of damage long term use may do.
They can vary depending on which part of the throat the cancer occurs in, but some of the most common early signs are a persistent sore throat, pain or burning when swallowing, the sensation that food is stuck in your throat, voice changes such as hoarseness or sounding like you have a cold all the time, and a lump in your neck.
The oropharynx, where HPV cancer occurs, is not an easy surface to get to or examine, whether manually or with imaging tests. And even if your doc detected the presence of HPV in the oropharynx, that doesn’t mean you’ll get cancer. Most of the time the HPV infection will just clear on its own without any symptoms.
What Is Throat Cancer, Again?
Throat cancer is an umbrella term for four different types of tumors that are named based on the area where they occur. It's part of the head and neck cancer family and, fortunately, not that common. Head and neck cancers make up only about 4% of all cancers diagnosed in the U.S., and most are on the decline, with one exception. (More on that in a sec.)
Throat cancers have different causes, symptoms, and prognoses (outcomes) depending on which area they’re located in. One thing that most throat cancers do have in common, however, is that 90% to 95% of them are what’s known as squamous cell carcinomas, meaning they begin in the flat squamous cells that make up the thin layer of tissue that lines the inside of your head and neck.
Let’s take a closer look at the parts of your throat that can develop cancer. Your throat is made up of the pharynx and the larynx. The pharynx is the part you know best because you see it in the mirror when you open wide: It's a hollow tube about five inches long that begins behind your nose and extends until it reaches the esophagus (another tube that moves food and drink into your stomach).
Meanwhile, the larynx is a short passageway between the base of the tongue and the trachea. The larynx is also referred to as your voice box since it contains your vocal cords, which vibrate and make sound when air hits them. When you swallow, the larynx is covered by a small piece of tissue called the epiglottis, which prevents food from entering your air passages.
Let’s quickly review the different types of throat cancer you can get.
Throat Cancer Types
Each area of your throat can develop tumors, and while there are some similarities in these cancers, they also have different risk factors and survival rates.
Nasopharyngeal cancer forms in the upper part of the throat behind the nose. This type of cancer is not common: Fewer than one person per 100,000 is diagnosed with NPC annually in the U.S. It can occur at any age, including childhood, and men are two times more likely than women to be affected by NPC. The overall five-year survival rate is 61%.
Oropharyngeal cancer forms in the middle of the throat, which includes the soft palate at the back of your mouth, the base of the tongue, and the tonsils. This type of cancer is on the rise, and 70% of cases are caused by the sexually transmitted human papillomavirus virus (HPV), which is spread to the throat during oral sex. The good news is that HPV-related oropharyngeal cancers are considered one of the more curable types of head and neck cancers.
Men are four times as likely as women to develop oropharyngeal cancers, and experts have begun to see them in men in their 40s, compared to the average age of diagnosis for most head and neck cancers, which is 62. The overall the five-year survival rate is about 65%.
Hypopharyngeal cancer forms in the tissues at the bottom part of the throat (your hypopharynx) where cancer can grow for a long time before symptoms develop. About 3,000 people are diagnosed annually in the U.S. with hypopharyngeal cancer, and it affects men four to five times more often than women. Because this cancer is usually not diagnosed until a later stage, it has a worse prognosis: The overall five-year survival rate is only 32% (but if it’s discovered at an earlier stage, it improves to 59%).
Laryngeal cancer forms in the tissues of the larynx and is the second most common type of head and neck cancer. It significantly effects quality of life, including the ability to speak and eat. It’s not uncommon for someone with laryngeal cancer to need a tracheostomy, a procedure in which the windpipe is surgically moved toward a hole in the neck for breathing. About 12,370 adults in the U.S. diagnosed with laryngeal cancer each year, and men are four to five times more likely to get it than women. The overall five-year survival rate is 60%.
What Causes Throat Cancer?
The majority of throat cancers can be traced back to three things: Tobacco use, heavy alcohol consumption, and the HPV virus. Let’s zoom in on why, exactly, your cancer risk rises when you come in contact with these things.
You already know that tobacco spews cancer-causing chemicals known as carcinogens into your lungs, making it the leading cause of lung cancer. So it kind of makes sense that other parts of your body that come in contact with tobacco are vulnerable to cancer as well.
That means the cells in your mouth, throat, and nasal area are all at risk, as the chemicals in tobacco (including cigarettes, pipe tobacco, cigars, and chewing or “smokeless” tobacco) beat up your DNA, causing the damaged cells to mutate and grow into tumors.
If tobacco hikes your throat cancer risk, alcohol makes it worse. Research show that drinking alcohol while smoking or using other forms of tobacco increases the risk of head and neck cancers even more than just smoking or just drinking alone. It’s believed that alcohol acts as an irritant in the mouth and throat, helping the chemicals in tobacco enter the cells more easily. Alcohol may also slow the body’s ability to break down and get rid of toxic chemicals. At any rate, these two vices can add up to a lethal combo.
A generation ago, smoking was by far and away the leading cause of throat cancer. Not anymore. In recent years, certain types of the human papillomavirus (HPV) have taken over as the most common cause of the disease.
In a nutshell, HPV is a group of more than 200 viruses spread through vaginal, anal, and oral sex. A handful of these viruses can cause cancer and two of them—HPV16 and HPV18—cause the most cases. Experts believe, bluntly, that an increase in oral sex has led to a rise in HPV-related throat cancer.
HPV-caused head and neck cancers usually develop in oropharynx part of the throat, which includes the tonsils, the back of the mouth, and the base of the tongue. Oropharyngeal cancer is now the most common form of HPV-related cancer.
The biggest risk factors for HPV-related throat cancer are the number of oral sex partners you’ve had, your gender, and ethnicity.
The odds of HPV-positive throat cancer doubles in individuals who reported between one and five lifetime oral sex partners and quintuples (that’s a five-fold increase) for people with six or more oral sex partners.
Men appear slower to develop antibodies to the virus, and thus may be affected from four to eight times more often than women with HPV-related cancer.
Ethnicity also plays a role: White men have the highest rates, Asian and Pacific Islanders the lowest, and blacks and Hispanics fall somewhere in the middle.
Additional Throat Cancer Causes
Beyond the three main causes of tobacco, alcohol, and HPV, there are a few additional risk factors, including:
Ancestry: Although researchers are still exploring why, it appears people of Asian descent, and especially Chinese ancestry, are at greater risk for nasopharyngeal cancer. Black and white people are more likely to develop hypopharyngeal and laryngeal cancer.
Epstein-Barr virus: Contracting this virus, which causes mononucleosis or “mono” for short, is a risk factor for nasopharyngeal cancer.
Nutrition: A diet low in vitamins A and E may raise a person’s risk of laryngeal and hypopharyngeal cancer, although more research is needed as to the reasons for this.
Occupation: Certain workplace inhalants can increase the odds of developing throat cancer. Exposure to wood dust is a risk factor for nasopharyngeal cancer, while exposure to asbestos, wood dust, paint fumes, and certain chemicals may increase a person’s risk of developing hypopharyngeal cancer. Both asbestos and synthetic fibers have been associated with cancer of the larynx (voice box). People who work in construction, metal, textile, ceramic, logging, and food industries may also have an increased risk of cancer of the larynx.
Paan (betel quid): This chewable combo of betal leaf and areca nut is popular among Southeast Asians for its stimulant and psychoactive effects (similar to cocaine) and its use has been strongly associated with an increased risk of oropharyngeal cancer.
Plummer-Vinson syndrome: This rare condition, which involves iron deficiency and causes difficulty swallowing, increases the risk of hypopharyngeal cancer.
Preserved or salted fish: Also popular in Asia, these foods were previously linked to nasopharyngeal cancer when consumed in childhood (but not adulthood), but it’s now believed they play a smaller role than originally thought.
Your Next Steps With Throat Cancer
If you’ve already been diagnosed with the disease, knowing what caused it may help you and your doctor decide on the most effective course of treatment. If your throat cancer is caused by HPV, for instance, treatment may be less intense and shorter than someone who got throat cancer due to smoking. Either way, the sooner you get started on treatment, the better your outcome, so don’t delay.
And if you don’t have throat cancer but are curious or concerned about what causes the disease, it’s especially important to hear this message: This condition is almost entirely preventable. Don’t smoke and don’t drink excessively. And lower the odds of contracting or spreading HPV by getting tested for the virus before having sex with a new partner if you’re a woman. There is currently no test for men, but wearing a condom (and dental dam for women) can greatly reduce the chances of getting or spreading HPV. When you eliminate these variables, the odds of getting throat cancer drop substantially.
- Head and Neck Overview: Thyroid, Head and Neck Cancer Foundation. (n.d.). “Head and Neck Cancer Guide.” headandneckcancerguide.org/
- Oral Cancer and Alcohol: The Oral Cancer Foundation. (n.d.). “The Alcohol Connection.” oralcancerfoundation.org/understanding/alcohol-connection/
- HPV Cancer in Men: Centers for Disease Control and Prevention. (2019). “HPV-Associated Cancer Statistics.” cdc.gov/cancer/hpv/statistics/?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fcancer%2Fhpv%2Fstatistics%2Ftrends%2Findex.htm
- HPV Cancer and Prognosis: Oral Oncology. (2016). “Prognostic Significance of Non-HPV16 Genotypes in Oropharyngeal Squamous Cell Carcinoma.” sciencedirect.com/science/article/abs/pii/S1368837516301476?via%3Dihub
- Tracheostomy and Laryngeal Cancer: International Archives of Otorhinolaryngology. (2017). “Persistent Tracheostomy After Organ Preservation Protocol in Patients Treated for Larynx and Hypopharynx Cancer.” ncbi.nlm.nih.gov/pmc/articles/PMC5629076/
- HPV Vaccination: American Society of Clinical Oncology. (2017). “Impact of HPV Vaccination on Oral HPV Infections Among Young Adults in the U.S.” meetinglibrary.asco.org/record/153036/abstract