Throat Cancer

Treatment

The standard treatment for most cases of throat cancers includes surgery and radiation therapy, either alone or in combination, depending on the size and location of the tumor. Sometimes physicians use chemotherapy when tumors have spread too far for surgery or radiation therapy to be effective. Chemotherapy is also used to enhance the effectiveness of radiation therapy, to improve survival and to help preserve the larynx. Physicians base treatment recommendations on the type and stage of the cancer, the patient's overall health, the patient's preferences, the probability of curing the disease and the side effects of treatment.

Surgery

Otorhinolaryngologists at Mayo Clinic surgically treat approximately 700 throat and other head and neck cancer patients each year. At Mayo Clinic, physicians carefully evaluate patients case by case to determine the optimal surgical approach to manage cancer. The type of surgery required depends on the cancer's size and location. Small tumors found relatively early may be removed through an endoscope (tube) passed through the mouth to the cancer. Most medium to large tumors require the removal of all or part of the voice box. When the entire voice box must be removed (total laryngectomy), physicians connect the windpipe to the neck as a stoma (hole) through which the person breathes (tracheostomy). Smaller cancers can often be removed by removing only part of the voice box in a partial laryngectomy.

Mayo's surgical techniques include multiple new surgical procedures that remove the cancer and maintain function and appearance as much as possible. One approach, transoral laser microsurgery, involves less tissue invasion than normal surgery and typically requires fewer days for recovery.

Laser Microsurgery

Skilled head and neck surgeons at Mayo Clinic perform transoral laser microsurgery for patients with cancers of the larynx, oral cavity and pharynx. More than 100 patients a year at Mayo Clinics in Arizona and Florida are treated with laser microsurgery. The procedure is typically used for small and medium tumors in the throat, but sometimes can be used for large tumors. Transoral laser microsurgery has many advantages over conventional surgery, including:

• Preservation of normal tissue
• A shorter hospital stay than typically required for conventional surgery
• Swallowing and speech may be less impaired
• A tracheostomy (insertion of a tube into the throat) may not be necessary

Transoral laser microsurgery involves use of an instrument (endoscope) to view the larynx and pharynx through the mouth and nose. The surgeon directs the laser toward the tumor with the help of a micromanipulator fixed to a surgical microscope. Looking through the microscope, the surgeon divides the tumor into managable sections that can be removed through the endoscope. During the operation a surgical pathologist examines the cells at the edge of the tumor to detect how much tissue must be removed.

Reconstructive Surgery

Depending on the location and spread of the tumor, reconstructive surgery may be necessary. Otolaryngologists perform microvascular reconstructive surgery with a focus on improving a patient's appearance and restoring their function as close as possible to normal. Additionally, a tracheostomy (a hole in the neck) or gastrostomy (a hole in the abdomen) may be necessary in cases where breathing and swallowing abilities have been significantly altered because of extensive spread of the tumor.

Radiation

At Mayo Clinic, patients receive state-of-the-art radiation therapy alone or combined with chemotherapy or surgery. Highly skilled radiation oncologists use radiation therapy for throat cancers of all stages, providing several types of radiation therapy, including intensity-modulated radiation therapy (IMRT), three-dimensional conformal radiation therapy, radiosurgery and brachytherapy. A multidisciplinary team of oncologists evaluates patients with throat cancer and tailors treatments to each patient.

IMRT allows the radiation oncologist to treat the cancer effectively while limiting radiation to healthy tissues such as the eyes, optic nerves, brain, brain stem, salivary glands and spinal cord. This skill is particularly critical for cancers located in the head and neck. IMRT also makes it possible to deliver high doses of radiation to inoperable tumors. Radiation therapy can be used alone or combined with chemotherapy in some cases to avoid surgery that would require removal of the voice box.

Radiation therapy may be used as the main treatment for throat cancer when the cancer is small or when the patient cannot undergo surgery because of poor general health. Radiation therapy can be used as adjuvant or additional treatment after surgery to kill small cancer deposits in the neck that cannot be seen and removed during the operation. Radiation therapy may be given in combination with chemotherapy instead of surgery in selected cases. It can also be used to ease the symptoms of advanced cancers, such as pain, bleeding and difficulty swallowing (palliative treatment).

Chemotherapy

Chemotherapy may be used alone or combined with radiation treatments to control advanced throat cancer that is either inoperable or has metastasized (spread to other parts of the body). Chemotherapy may be used with radiation therapy after surgery in selected patient to improve control of the cancer locally. Medical oncologists administer chemotherapy either through a vein or by mouth. Physicians prescribe chemotherapy to treat cancer that has spread extensively (metastasized) to organs beyond the throat.

Rehabilitative Services

Expert speech therapists at Mayo Clinic can help throat cancer patients overcome problems with speech and swallowing that may accompany treatment. Dietitians help patients choose foods that will reduce problems associated with chewing and swallowing. In addition, physical and occupational therapists can help patients make the adjustments needed for returning to work and private life.