Let's Talk About Throat Cancer Symptoms
Throat cancer can mimic lots of other everyday ailments, so don't get fooled. We've got the doctor-approved scoop on the red flags that signal real trouble.by Stephanie Wood Health Writer
From garden variety colds to strep to allergy-inspired postnasal drip, your pharynx (that's doctor-speak for throat) can feel like the epicenter of life's everyday health nuisances. So when does throat discomfort signal something more serious? When should you worry about…cancer? No need to start Googling: We’ve got all the answers you need right here. Because when it comes to the body part you rely on for eating, breathing, and speaking, you can’t catch trouble soon enough.
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
From what we can tell, it all comes down to lifestyle. Two of the main risk factors—smoking and alcohol overuse—are more common in men. Historically, men have also been more likely to work in professions with occupational exposure risks like wood dust, paint fumes, and asbestos. When it comes to HPV-caused throat cancer, research suggests that women develop protective antibodies to HPV after only a few sexual partners, but for men it can take 10 or more partners.
The ear, nose, and throat are intricately connected and love to share, which is why so many upper respiratory ailments involve symptoms in all three areas. This connection includes several sensory nerves in the ear that also run through the head, neck, and chest. For people with throat malignancies, the pain actually occurs at the site of the cancer but the sensation travels through the nerves to the ear—this is what doctors call “referred” pain.
A burning sensation in your chest, difficulty swallowing, feeling like there’s a lump in your throat: The symptoms of heartburn and cancers of the throat are similar to be sure, but don’t just pop an antacid and forget about it. Research shows that people who experience heavy heartburn are at a 78% increased risk of cancers of the pharynx and larynx, regardless of whether they smoke, drink, or have HPV.
It’s unlikely. While visible lumps and bumps, described as “cobblestone throat,” can look scary, they are caused by inflamed and enlarged tissue, not cancer. Most likely, they are due to post-nasal drip that can occur with seasonal allergies, upper respiratory infections, cold dry air, and some meds, including birth control pills. Cobblestone throat is usually harmless and easy to treat with decongestants or antihistamines.
What Is Throat Cancer, Again?
Actually “throat cancer” is an umbrella term for several kinds of cancer that can occur in your pharynx and larynx, the two main parts of the throat. Depending on the type, throat cancers are two to five times more likely to affect men than women, and they usually occur in people age 50 and older. The vast majority of these cancers—90% to 95%—are squamous cell carcinomas, meaning they begin in the flat squamous cells that make up the thin layer of tissue on the surface of the throat.
A few more facts: There are multiple types of cancers of the throat, part of a category known as head and neck cancers, and they are not that common (whew!). According to the National Cancer Institute, throat cancers make up about 4% of all cancer cases, and most of them are on the decline in the U.S. (with the exception of one type). That’s because fewer people are smoking or using chewing tobacco—a major culprit. At least 75% of all head and neck cancers are caused by tobacco or alcohol use, and engaging in both habits at once increases your risk even more. The reason: Alcohol may act as an irritant, helping the carcinogens in tobacco enter the cells more easily, and it may also slow the body’s ability to break down and get rid of those chemicals.
The other common cause of head and neck cancers is infection from certain types of the human papillomavirus (HPV), a group of more than 200 viruses which spread through vaginal, anal, and oral sex. HPV-related throat cancer is the only category of head and neck cancers on the rise, and it’s one of the fastest growing types of cancer being diagnosed today. Fortunately, it’s also proving to be one of the most treatable.
Fun fact: Because there are so many types, doctors don’t even use the expression “throat cancer.” Instead, the malignancies that occur here are named after the part of the throat they’re located in. They also have some different symptoms and prognoses (outcomes). Here’s a guided tour of this often overlooked but all-important body part.
Get to Know Your Throat: Anatomy 101
Your throat is made up of—in medical lingo—the pharynx and the larynx (your voice box). Let’s look at them one by one.
The pharynx is a hollow tube that’s about five inches long. It begins behind your nose and travels down to the esophagus, another hollow tube that helps food and drink journey on to your stomach. The pharynx has three parts:
The nasopharynx is the upper part behind your nose. Malignancies that begin here are known as nasopharyngeal cancer or NPC.
The oropharynx is in the middle of your throat, starting where the oral cavity (mouth) ends and including the soft palate at the back of your mouth, the base of your tongue, and your tonsils. Malignancies that begin here are known as oropharyngeal cancer.
The hypopharynx refers to the lower part of the throat. Malignancies that begin here are known as hypopharyngeal cancer.
The larynx, more commonly known as your voice box, is a short passageway formed by cartilage between the base of the tongue and the trachea (windpipe). Malignancies that begin here are known as laryngeal cancer. The larynx contains your vocal cords which vibrate and make sound when air hits them. That sound then echoes through the pharynx, mouth, and nose to create your unique voice. The larynx also includes a small piece of tissue, called the epiglottis, which shifts to cover the opening when you swallow so food won’t accidentally enter the air passages. Like the pharynx, the larynx also has three parts:
The supraglottis is the upper part above the vocal cords. The epiglottis is also located here.
The glottis is the middle part where the vocal cords are located.
The subglottis is the lower part between the vocal cords and trachea.
What Are the Signs and Symptoms of Throat Cancer?
Each of the four types of throat cancer has its own—as well as shared—signs and symptoms. Unfortunately, many of these indicators could also be symptoms of garden variety upper respiratory illnesses. That’s why you need to pay close attention to two things:
How long symptoms last. Two weeks is the time frame you need to keep in mind. Most everyday illnesses don’t hang around much more than that, so if your symptoms are still lingering 14 days later, it’s good to get it checked out.
Symptom symmetry. Pay attention to whether the symptom is occurring on one or both sides of your head or neck. Here’s why: The head and neck are what’s known as paired systems—their construction is symmetrical, or the same on both the left and the right. Physical abnormalities tend to occur in balance, so a lump or pain that is only on one side is a big concern. You can start by seeing your primary care physician, who may then refer you to an otolaryngologist, a doctor who specializes in disorders of the ear, nose, and throat (ENT).
Different types of throat cancers have unique calling cards, but all share these symptoms in common:
A lump in the neck
Persistent sore throat
Trouble breathing or feeling like something is caught in your throat
These are a few more things to watch out for, broken down by cancer type:
These cancers, which form in the air passageway of the upper part of the throat, are diagnosed in fewer than one person per 100,000 annually in the U.S. About half the people with NPC are under age 55 and men are two times more likely than women to be affected. The overall five-year survival rate is 61%. There are often no symptoms in the early stages of NPC, but if you do experience them, here’s what might occur:
Blurred or double vision
Difficulty opening your mouth
Nasal obstruction or stuffiness
Pain, numbness or paralysis
Middle-of-the-throat cancers are the one type of head and neck cancer that’s on the rise, largely due to the fact that 70% are caused by the sexually transmitted HPV virus. Fortunately, they’re also considered one of the more curable types. The five-year survival rate is about 65% and men are four times as likely as women to develop oropharyngeal cancers. The average age of diagnosis is 62, but doctors are now seeing cases related to HPV in men as young as 40. Be aware of these red flags:
A red or white patch on the tongue, tonsils, or lining of the mouth that does not go away
Changes in speech
Chronic bad breath
Coughing up blood
Hoarseness or change in voice
Loosening of teeth, tooth pain, or dentures that no longer fit
Trouble opening the mouth fully
Trouble moving the tongue
Weight loss for no known reason
This cancer that forms in the bottom part of the throat is diagnosed in about 3,000 people annually in the U.S. and affects men four to five times more often than women. Because of its deeper location, these cancers can grow for a while before symptoms develop, giving it a five-year survival rate of only 32%. Watch for and act on these clues:
Enlarged lymph nodes
Chronic bad breath
Hoarseness or a change in voice
Cancer that forms in the tissues of the larynx is diagnosed in about 12,370 U.S. adults annually. It affects men four to five times more often than women and the five-year survival rate is 60%, but that varies depending on whether the cancer is located in the glottis (76% five-year survival rate), supraglottis (46%), or subglottis (52%).
The glottis is the most common area for laryngeal cancer to occur, and the subglottis, the least. Watch for:
Hoarseness or voice changes (often an early symptom)
What to Do Next
As you can see, many of the symptoms for various types of throat cancer could apply to any number of situations, including catching a cold or developing a case of bronchitis. And given the low percent of people who actually get throat cancer, the odds that you have it are not terribly high.
Nevertheless, any type of cancer is infinitely easier to treat and has a much more optimistic outlook if you catch it and deal with it in its earlier stages. So if you are experiencing any of the symptoms here, and they last for more than two weeks—especially if the occur asymmetrically in your head, neck, or throat, and extra-especially if you use tobacco and drink—see your doctor. It’s worth the peace of mind.
- Cancer Statistics 4%: CA: Cancer Journal for Clinicians. (2017). “Cancer Statistics: 2017.” ncbi.nlm.nih.gov/pubmed/28055103
- Cancer Statistics 75%: Cancer Research. (1988). “Smoking and Drinking in Relation to Oral and Pharyngeal Cancer.” ncbi.nlm.nih.gov/pubmed/3365707
- Nasopharyngeal Cancer: American Society of Clinical Oncologists. (2019). “Nasopharyngeal Cancer Guide.” cancer.net/cancer-types/nasopharyngeal-cancer/introduction
- Oropharyngeal Cancer: American Society of Clinical Oncologists. (2019). “Oral and Oropharyngeal Cancer Guide.” cancer.net/cancer-types/oral-and-oropharyngeal-cancer/introduction
- Laryngeal and Hypopharyngeal Cancer: American Society of Clinical Oncologists. (2019). “Laryngeal and Hypopharyngeal Cancer Guide.” cancer.net/cancer-types/laryngeal-and-hypopharyngeal-cancer/introduction
- Men and HPV Risk: Journal of Clinical Oncology. (2015). “Epidemiology of Human Papillomavirus-Positive Head and Neck Squamous Cell Carcinoma.” ncbi.nlm.nih.gov/pubmed/26351338
- Gastric Reflux: Cancer Epidemiology Biomarkers. (2013). “Gastric reflux is an independent risk factor for laryngopharyngeal carcinoma.” ncbi.nlm.nih.gov/pmc/articles/PMC3681904/