Symptoms and Diagnosis of Pharyngeal Cancer

The symptoms of pharyngeal (throat) cancer vary according to the part of the throat in which the tumour is located and its size. Mild complaints that at first resemble an ordinary throat infection may become persistent over time. This page explains which symptoms need attention and the steps by which a diagnosis is made.

Symptoms that need attention

In pharyngeal cancer, symptoms usually begin insidiously and progress slowly. The following complaints need to be assessed if they last more than a few weeks:

• Sore throat: Particularly pain that is on one side, does not go away and increases over time.
• Difficulty swallowing (dysphagia): A feeling of something stuck in the throat, pain on swallowing or difficulty swallowing solid food.
• Earache: Constant pain felt on the same side even though there is nothing wrong with the ear; this is referred pain caused by the nerve pathways shared by the throat and the ear.
• Lump in the neck: A painless, firm and gradually enlarging mass; sometimes it is the first and only sign.
• Change in the voice: A muffled or hoarse voice, or a thick quality to the speech.
• Other symptoms: Blood in the saliva, bad breath, unexplained weight loss, nasal blockage or reduced hearing on one side.

Examination

Assessment begins with the history of your complaints and questions about your habits. The inside of the mouth, the tonsils and the neck are examined by hand and by eye. Because the lower parts of the throat cannot be seen directly, they are inspected with a thin, flexible camera passed through the nose (flexible endoscope). This is done in the consulting room with the help of a local anaesthetic spray, takes a few minutes and usually causes no significant discomfort.

Biopsy

If a suspicious area is seen at endoscopy, a tissue sample (biopsy) must be taken to confirm the diagnosis. In accessible areas the sample is taken during the examination; in deeper areas it is taken in the operating theatre under a brief anaesthetic. The pathology examination determines the type of tumour; in oropharyngeal tumours, markers indicating a link with the human papillomavirus (HPV) are also assessed. If there is a lump in the neck, a sample of cells can be obtained by fine-needle aspiration under ultrasound guidance.

Imaging

Imaging is used to determine the depth of the tumour, its spread into neighbouring structures and the state of the lymph nodes in the neck:

• Computed tomography (CT): Shows involvement of bone and cartilage, and the lymph nodes.
• Magnetic resonance imaging (MRI): Shows spread within soft tissue in detail.
• PET/CT: Used to look for spread to other parts of the body.
• Ultrasound: Useful for assessing the lymph nodes in the neck and for guiding a needle biopsy.

Staging

All the findings are brought together to determine the stage of the disease. The stage describes the size of the tumour, whether it has spread to the lymph nodes and whether distant organs are involved. Stages I and II indicate early disease, and stages III and IV advanced disease. Staging is the fundamental basis for planning treatment and predicting the course of the disease.

When should you see a doctor?

If any of the complaints above lasts more than a few weeks, and especially if you use tobacco or alcohol, you are advised to see an ear, nose and throat specialist. Early assessment allows a possible tumour to be detected while it is still small.