Throat cancer symptoms are often mild and similar to those of common conditions. Signs of throat cancer depend on the tumor’s location and can include:

• Sore throat, difficulty swallowing, or voice changes that won’t go away
• Neck lump
• Blurry or double vision
• Coughing up blood
• Headaches and facial pain or numbness
• Ear pain, fullness, or hearing changes, such as ringing in the ears
• Nasal congestion or nose bleeds

Most persons with throat cancer are older males. Additional factors may increase your risk, including:

• Smoking and heavy alcohol use
• Exposure to the Epstein-Barr virus (linked with nasopharyngeal cancer)
• Prior human papillomavirus (HPV) infection (linked with oropharyngeal cancer)
• Family history of head and neck cancers

Pharyngeal cancer types are named for where they start in the throat—the nasopharynx, oropharynx, or hypopharynx. Most pharyngeal cancers are squamous cell carcinomas, cancer that begins in thin, flat cells lining the throat. Types of pharyngeal cancer include:

• Nasopharyngeal cancer
• Oropharyngeal cancer, often used interchangeably with pharyngeal cancer
• Hypopharyngeal cancer

Throat cancer can also include laryngeal cancer, which starts in the larynx (voice box). In addition, benign (noncancerous) tumors can develop in the throat. They may require minimal or no treatment.

Doctors use a process called staging to determine how far the cancer has spread. This information helps doctors understand your prognosis (probable outcome based on others’ experiences) and develop your treatment plan.

When determining the cancer stage, doctors look at many factors, including:

• Size of the main tumor and whether it has spread to other parts of the throat or mouth
• Whether cancer has spread to nearby lymph nodes, and if so, which ones
• Whether cancer has spread to other parts of the body or distant organs

Stage 0 describes the early signs of disease and Stage 4 indicates an advanced case. Staging for pharyngeal cancer can be complicated. It may differ based upon the part of the throat affected or whether HPV is the cause of cancer. There are many variables involved in staging throat cancers, so talk with your doctor to understand your situation.

In general terms, pharyngeal cancer stages are:

Stage 0: Abnormal cells are in one layer of the pharynx’s tissue and haven’t spread elsewhere. This stage is also called carcinoma in situ, which means “in its original place.”

Stage 1: A cancerous tumor of 2 cm or smaller is in the pharynx. It hasn’t grown into nearby tissues, lymph nodes, or distant parts of the body.

Stage 2: The tumor is larger than 2 cm but no larger than 4 cm. It has not spread to lymph nodes or other body areas.

Stage 3: The tumor is larger than 4 cm and may have entered nearby lymph nodes and tissues. Cancer has not spread to distant body parts.

Stage 4: This stage is divided into several substages, each describing how the cancer has spread to nearby or distant parts of the body.

With an endoscopy, your doctor inserts an endoscope (a thin, lighted tube) through the nose or mouth to check the throat for abnormal cells. They may also take tissue samples for a biopsy. Types of endoscopy procedures that check for pharyngeal cancer include:

• Nasopharyngolaryngoscopy, evaluating the nasopharynx
• Nasoscopy, checking the nasal passages
• Esophagoscopy, examining the esophagus
• Bronchoscopy, viewing the bronchi (main airways of the lungs)

A neurological exam is a series of questions and tests to check brain, spinal cord, and nerve function. The exam checks an individual's mental status, coordination, walking ability, and function of the muscles, senses, and reflexes. This may be done to check for no obvious spread of cancer.

If imaging tests indicate that you might have pharyngeal cancer, your doctor may request a biopsy. A biopsy checks for cancer by removing and studying a tiny sample of cells from abnormal areas.

In addition to endoscopy, our doctors perform several types of biopsies, including:

• Needle biopsy: Your doctor inserts a thin needle (fine needle aspiration) or a wider needle (core biopsy) into a tumor to pull out cells.
• Image-guided biopsy: A radiologist uses an imaging technique such as ultrasound or MRI to guide the needle for the biopsy.
• Surgical (or excisional) biopsy: Your surgeon may remove all or part of a tumor to be tested.

Before and during your treatment, we take small samples of your blood to test in the lab. Blood tests provide information about your health and help us monitor any potential side effects of pharyngeal cancer treatment.

We may also test your urine to see if it contains blood, certain chemicals, or bacteria.