Early Stage Cancer of the Throat
Early stage cancers of the throat are small, localized, and highly curable when treated with surgery and/or radiation therapy. Early stage disease includes stage I, II, and some stage III cancers. Stage III cancer can be considered “early” if it is small and involves only a single lymph node, which can be surgically removed or treated with radiation with a high probability of cure.
Patients with throat cancers should consider being evaluated in a medical center that treats many patients with these cancers because cancers of the head and neck often require a multidisciplinary team approach comprised of a head and neck surgeon, a radiation oncologist, a medical oncologist, a plastic surgeon, a dentist, and social services personnel. Evaluation and treatment by an experienced team is essential for determining optimal treatment and support.
Treatment of Early Stage Throat Cancer
Treatment of throat cancer is multi-modality in nature. Because the throat is involved in talking, swallowing, and breathing, the type of treatment is selected to minimized impact on these important functions. Furthermore, treatment may be dictated by how it affects a patient’s appearance, and thus, quality of life.
Surgery: The most common treatment of early stage cancer of the throat is surgery, which results in cure for the majority of patients. In some cases, patients are unable to tolerate surgery or surgery results in significant functional defects, including difficulty in talking or swallowing.1 In these situations radiation treatment may be a viable alternative to surgery.
Radiation therapy: Radiation therapy has been shown to produce similar results to that of surgery for the treatment of early stage cancers of the throat. Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. Radiation therapy works by damaging the DNA in the cancer cell, thereby disabling the cancer cells from reproducing and growing. The National Cancer Institute recommends that patients undergoing radiation therapy be seen by a radiation oncologist experienced in managing head and neck cancer. The choice of treatment is dictated by the anticipated functional and cosmetic outcome of the treatment options and by the available expertise of the surgeon or radiation therapist. Treatment is individualized for each patient and will take advantage of the latest advances in the delivery of radiation therapy.1
Radiation and Surgery: Combined radiation and surgery is standard treatment for stage III throat cancer although not always necessary for stage I, or II disease because it produces superior outcomes to treatment with surgery or radiation alone. Combined therapy is usually reserved for larger cancers of the throat. However, this approach may also be used to treat patients who have cancer detected in the margins of the removed tissue or who have only a narrow margin of normal tissue remaining after surgical removal of the cancer.2
Treatment of the Lymph Nodes in the Neck
One of the controversies in treatment of early stage cancers of the throat has been whether or not to routinely treat the lymph nodes in the neck with surgery and radiation therapy. If left untreated, cancers of the throat can ultimately spread throughout the lymph system in the neck. Untreated cancer that has spread to lymph nodes is responsible for cancer recurrence. Thus, identifying whether cancer is present in the lymph nodes in the neck is important for preventing recurrence.
Currently, surgical removal of the lymph nodes in the neck by performing a “lymph node dissection” is the best way to determine whether cancer is present, and may represent effective treatment.3 Experts have debated the benefit of neck dissection in early stage squamous cancers before the disease spreads to the lymph nodes. Neck dissection performed in these circumstances is known as elective neck dissection. The alternative is an approach called therapeutic neck dissection, which involves waiting until cancer in the lymph nodes is detected by biopsy and removing them at that time.
To determine which approach might have the best outcomes, researchers compared survival between 596 patients with early stage cancer who had undergone elective neck dissection and those who had undergone therapeutic neck dissection. Patients in the elective surgery group appear to have better outcomes. These patients experienced improved survival and a delay until cancer recurrence. Patients with early-stage squamous-cell cancer may have better outcomes if they undergo elective surgery to remove lymph nodes in the neck than if they wait for disease to spread to the lymph nodes before removing them.
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