Throat cancer is a growth of cells that starts in the throat. The throat is a muscular tube that begins behind the nose and ends in the neck. Throat cancer also includes cancer that starts in the voice box, which sits next to the lower part of the throat.

Throat cancer symptoms include sore throat, ear pain and trouble swallowing. Symptoms may vary depending on the part of the throat that's affected.

Treatment for throat cancer also may vary depending on the cancer's location. Treatments may include surgery and radiation therapy. Medicines, such as chemotherapy, targeted therapy and immunotherapy, also may be used.

Where throat cancer happens

Throat cancer is a broad term for cancer that starts in the throat. Different subtypes of throat cancer are named for the part of the throat where they start.

• Behind the nose. The part of the throat that's behind the nose is called the nasopharynx. The most common type of cancer that happens in this part is called nasopharyngeal carcinoma.
• Behind the mouth. The part of the throat that's behind the mouth is called the oropharynx. Cancer that happens here is called oropharyngeal cancer. It includes soft palate cancer, tonsil cancer and cancer that affects the back of the tongue.
• The lower part of the throat. The lower part of the throat, just above the esophagus and windpipe, is called the hypopharynx. It also may be called the laryngopharynx. Cancer that happens here may be called hypopharyngeal cancer or laryngopharyngeal cancer.
• The voice box. The voice box, also called the larynx, sits next to the lower part of the throat. It holds the vocal cords that vibrate to make sound when talking. Cancer that starts in the larynx is called laryngeal cancer. It includes cancer that starts in the vocal cords, called glottic cancer.

Some throat cancer symptoms are common to many types of throat cancer. Other symptoms may depend on where the cancer starts in the throat.

Common throat cancer symptoms

Signs and symptoms of throat cancer in general may include:

• A sore throat.
• Ear pain.
• Pain with swallowing.
• Swollen lymph nodes in the neck.
• Trouble swallowing.
• Weight loss.

Nasopharyngeal cancer symptoms

Nasopharyngeal cancer starts in the part of the throat behind the nose. Symptoms include:

• Bleeding from the nose.
• Facial numbness.
• Hearing loss.
• Nasal stuffiness.
• Ringing in the ears, called tinnitus.

Oropharyngeal cancer symptoms

Oropharyngeal cancer starts in the part of the throat behind the mouth. Symptoms include:

• A lump under the skin on the neck.
• Pain with swallowing.
• Swollen lymph nodes in the neck.
• Throat pain.
• Trouble swallowing.

Hypopharyngeal cancer symptoms

Hypopharyngeal cancer starts in the lower part of the throat. Symptoms include:

• A lump under the skin on the neck.
• Coughing up blood.
• Ear pain.
• Indigestion.
• Swollen lymph nodes in the neck.
• Pain with swallowing.

Laryngeal cancer symptoms

Laryngeal cancer starts in the voice box. Symptoms include:

• Changes in your voice, such as hoarseness.
• Cough that doesn't go away.
• Coughing up blood.
• High-pitched sound when breathing in.

When to see a doctor

Make an appointment with a doctor or other healthcare professional if you have any symptoms that worry you.

Throat cancer is caused by DNA changes inside cells in the throat. Exactly what causes the changes isn't always known. Healthcare professionals know that smoking, drinking alcohol and human papillomavirus (HPV) infection can cause these changes. But not everyone who has these risk factors gets cancer. And some people who get cancer have no risk factors for the disease. More research is needed to understand exactly what causes cancer in different parts of the throat.

Throat cancer starts when something changes the DNA in throat cells. A cell's DNA holds the instructions that tell the cell what to do. In healthy cells, the DNA tells the cells to grow and multiply at a set rate. The DNA also tells the cells to die at a set time.

In cancer cells, the DNA changes give different instructions. The changes tell the cancer cells to grow and multiply quickly. Cancer cells can keep living when healthy cells would die. This causes too many cells.

The cancer cells might form a mass called a tumor. The tumor can grow to invade and destroy healthy body tissue. In time, cancer cells can break away and spread to other parts of the body. Throat cancer most often spreads to the lymph nodes in the neck. Less commonly, the cancer can spread outside of the head and neck area. When this happens, the cancer most often goes to the lungs. When cancer spreads, it's called metastatic cancer.

HPV: A common cause of oropharyngeal cancer

HPV can cause the DNA changes that lead to throat cancer. More specifically, HPV is linked to many cancers that happen in the part of the throat that's behind the mouth, called the oropharynx.

HPV is a very common virus. It spreads through close contact, most often during sex. In most people, the immune system clears the virus on its own without treatment.

Sometimes, the immune system does not clear HPV, and the virus stays in the lining of the throat. Over many years, it can cause changes to cells in the throat that may lead to oropharyngeal cancer.

HPV is mostly linked to oropharyngeal cancer, which includes soft palate cancer, tonsil cancer and tongue cancer that affects the back part of the tongue. HPV has many types, but the one that causes oropharyngeal cancer is called HPV 16. Cancers that test positive for HPV tend to have a better prognosis than cancers that are negative for HPV.

Cancers that happen in other parts of the throat also can test positive for HPV, but this is less common.

Factors that can increase the risk of throat cancer include:

• Tobacco use, including smoking and chewing tobacco.
• Excessive alcohol use.
• Viral infections, including human papillomavirus (HPV) and Epstein-Barr virus.
• A diet lacking in fruits and vegetables.
• Exposure to toxic substances at work.

There's no sure way to prevent throat cancer. But you can take steps to lower your risk.

• Don't use tobacco. If you don't use tobacco, don't start. If you use tobacco of any kind, talk with your healthcare team about strategies to help you quit.
• Limit alcohol intake. If you choose to drink alcohol, limit how often you drink, and keep the amount small. For overall health, drink one or fewer drinks a day. Do not drink every day. The less you drink, the better.
• Consider the HPV vaccine. Receiving a vaccination to prevent human papillomavirus (HPV) infection may reduce the risk of HPV-related cancers, such as throat cancer. Ask your healthcare team whether the HPV vaccine is appropriate for you.
• Choose a healthy diet full of fruits and vegetables. The vitamins and antioxidants in fruits and vegetables may help lower the risk of throat cancer. Eat a variety of colorful fruits and vegetables.

Throat cancer diagnosis often begins with an exam and a discussion of your symptoms. A healthcare professional may look at your throat with a scope and take a sample of tissue for testing. Imaging tests also may be used.

Head and neck exam

A healthcare professional may do an exam of the head and neck. This often involves feeling your neck for swollen lymph nodes. It also may involve looking inside your ears, nose and mouth. To see the throat, the health professional might use a bright light and mirror. This exam isn't enough to diagnose throat cancer, but it may give the healthcare professional clues about what tests to do next.

Endoscopy

A healthcare professional may use a lighted scope, called an endoscope, to get a close look at your throat. This procedure is called an endoscopy. The healthcare professional may put the endoscope through your nose or through your mouth to view the throat.

An endoscopy procedure may be done in a healthcare professional's office. Sometimes this exam is done in a hospital procedure room while you're in a sleeplike state.

Biopsy

A biopsy is a procedure to remove a sample of tissue for testing in a lab. If areas of concern are found during an endoscopy, surgical tools can be passed through the scope to collect a tissue sample. The sample is sent to a lab for testing.

Sometimes a biopsy for throat cancer takes a sample of tissue from a swollen lymph node in the neck. To get the sample, a healthcare professional may insert a needle through the skin and into the lymph node. The healthcare professional may use ultrasound images to help guide the needle to the right spot.

In the lab, specially trained doctors called pathologists look for cancer cells in the tissue sample. The pathologists also look to see what kind of cells are involved in the cancer. For most throat cancers, the cancer starts in the thin, flat cells that line the inside of the throat. These cells are called squamous cells. Cancer that starts in these cells is called squamous cell carcinoma.

The tissue sample also may be tested for human papillomavirus (HPV). This common virus is thought to cause most cancers that start in the part of the throat that's behind the mouth. Cancers that start in this part are called oropharyngeal cancers. Cancers that happen in other parts of the throat also can be caused by HPV, but this is less common.

HPV testing looks for signs of one type, called HPV 16. Having cancer that is HPV-positive may affect the treatment options. Cancers that test positive for HPV tend to have a better prognosis than cancers that test negative.

Imaging tests

Imaging tests make pictures of the body. They can show the location and size of a throat cancer. If there's concern that the cancer has spread, some imaging tests can help look for cancer in other parts of the body.

Types of imaging used for throat cancer include:

• Bone scan.
• Computerized tomography (CT).
• Magnetic resonance imaging (MRI).
• Positron emission tomography (PET).

Staging

Throat cancer staging is a way to describe the size of the cancer and whether it has spread. Staging helps your healthcare team understand your prognosis. It also helps your team create a treatment plan that fits your cancer.

Your healthcare team uses the results of diagnostic tests to assign your cancer a stage. The stages of throat cancer range from 0 to 4. In general, the lower numbers mean the cancer is small and more likely to be cured. As the cancer grows or spreads to the lymph nodes, the stage gets higher. A stage 4 throat cancer generally means the cancer has grown large or spread to other parts of the body, such as the lungs. It may be more difficult to cure.

The precise definition of each stage is different based on the part of the throat that's affected by the cancer. For oropharyngeal cancer, the stage also depends on whether the cells show signs of HPV infection.

Throat cancer treatments include surgery, radiation therapy and chemotherapy. Other treatments may include targeted therapy and immunotherapy. These treatments can be used in different combinations or orders depending on many factors.

When making your treatment plan, the healthcare team thinks about your overall health and the location, size and stage of your cancer. The care team also considers your preferences. For some kinds of throat cancer, the treatment options also might depend on whether the cancer cells show signs of human papillomavirus (HPV) infection.

In general, treatments for throat cancer include:

• Surgery. The goal of surgery is to remove all of the cancer. Depending on where the cancer is, the surgeon may remove it through the mouth or through cuts in the neck or face. Sometimes both approaches are used. The surgeon also may remove lymph nodes in the neck to see whether the cancer has spread there.
• Radiation therapy. Radiation therapy treats cancer with powerful energy beams. The energy can come from X-rays, protons or other sources. During radiation therapy, you lie on a table while a machine moves around you. The machine directs radiation to precise points on your body.
• Chemotherapy. Chemotherapy treats cancer with strong medicines. Chemotherapy is often used along with radiation therapy in treating throat cancers. Some chemotherapy medicines make cancer cells more sensitive to radiation therapy.
• Targeted therapy. Targeted therapy treats cancer with medicines that attack specific chemicals in the cancer cells. By blocking these chemicals, targeted treatments can cause cancer cells to die.
• Immunotherapy. Immunotherapy for cancer is a treatment with medicine that helps the body's immune system kill cancer cells. The immune system fights off diseases by attacking germs and other cells that shouldn't be in the body. Cancer cells survive by hiding from the immune system. Immunotherapy helps the immune system cells find and kill the cancer cells.

Treatment for nasopharyngeal cancer

Nasopharyngeal cancer happens in the part of the throat that's behind the nose, called the nasopharynx. For small cancers, treatment may involve radiation therapy alone. For larger cancers, treatment usually combines radiation with chemotherapy.

If nasopharyngeal cancer keeps growing despite treatment or comes back after treatment, the healthcare team might consider other options. These might include surgery and immunotherapy.

Treatment for oropharyngeal cancer

Oropharyngeal cancer happens in the part of the throat that's behind the mouth, called the oropharynx. Small cancers may be treated with surgery or radiation. For larger cancers, treatment sometimes starts with medicines, such as chemotherapy or immunotherapy. Then surgery or radiation can treat any cancer that remains.

When oropharyngeal cancer treatment starts with surgery, sometimes other treatments are used afterward. Radiation therapy, medicines or both are sometimes used to kill any remaining cancer cells. But if the cancer is HPV-positive, small and hasn't spread to lymph nodes in the neck, more treatment may not be needed. Researchers are studying whether treatment can be reduced after surgery for some HPV-positive oropharyngeal cancers.

For advanced oropharyngeal cancers, radiation with chemotherapy can help slow the growth of the cancer in the throat. Chemotherapy, targeted therapy and immunotherapy may help slow the growth of cancer that spreads to other parts of the body.

Treatment for hypopharyngeal cancer

Hypopharyngeal cancer happens in the lower part of the throat, called the hypopharynx. Small cancers are often treated with radiation therapy or surgery. Surgery for small cancers may involve removing part of the throat and part of the voice box.

For a larger cancer, surgery may involve removing part of the throat and all of the voice box. The surgeon repairs the throat so that you can swallow and reroutes the windpipe so that you can breathe. A speech pathologist can help you learn to speak without a voice box.

Sometimes treatment for larger cancers starts with chemotherapy to shrink the cancer. Then surgery or radiation can treat any cancer that remains.

For advanced hypopharyngeal cancers, radiation with chemotherapy can help slow the growth of the cancer in the throat. Chemotherapy, targeted therapy and immunotherapy may help slow the growth of cancer that spreads to other parts of the body.

Treatment for laryngeal cancer

Laryngeal cancer happens in the voice box, also called the larynx, which sits next to the lower part of the throat. Small cancers are often treated with radiation therapy or surgery. Surgery for small cancers involves removing part of the voice box. Sometimes radiation therapy or medicines are used after surgery.

Surgery for a larger cancer might involve removing all of the voice box. The surgeon repairs the throat so that you can swallow and reroutes the windpipe so that you can breathe. A speech pathologist can help you learn to speak without a voice box.

Sometimes treatment starts with medicines, such as chemotherapy or immunotherapy. Then radiation or surgery can treat any cancer that remains.

Treatment for advanced laryngeal cancers may involve radiation with chemotherapy to slow the growth of the cancer in the throat. Chemotherapy, targeted therapy and immunotherapy may help slow the growth of cancer that spreads to other parts of the body.

Alternative medicine therapies can't cure throat cancer. But some integrative treatments can be combined with your healthcare team's care to help you cope with side effects of cancer and its treatment.

Many people with cancer experience fatigue. Fatigue feels like being very tired, but it often doesn't get better with rest. If fatigue interferes with your ability to go about your day, tell your healthcare team. Your care team may offer treatments that can help. You also might talk with your team about trying integrative therapies.

Integrative medicine treatments that can help with fatigue include:

• Acupuncture.
• Exercise.
• Massage therapy.
• Mindfulness activities.
• Yoga.

Talk with your healthcare team if you're interested in these treatment options.

Quit smoking

Throat cancers are closely linked to smoking. Not everyone with throat cancer smokes. But if you do smoke, now is the time to stop because:

• Smoking makes treatment less effective.
• Smoking makes it harder for your body to heal after surgery.
• Smoking increases your risk of getting another cancer in the future.

Stopping smoking can be very difficult. And it's that much harder when you're trying to cope with a stressful situation, such as a cancer diagnosis. Your healthcare team may suggest things that can help. Talk with your care team about your options, including medicines, nicotine replacement products and counseling.

Quit drinking alcohol

Alcohol, particularly when combined with smoking or chewing tobacco, greatly increases the risk of throat cancer. If you drink alcohol, stop now. This may help reduce your risk of a second cancer.

With time, you may find what helps you cope with the uncertainty and worry of a throat cancer diagnosis. Until then, here are some ideas that may help.

Learn enough about throat cancer to make decisions about your care

Ask your healthcare team about your cancer, including your test results, treatment options and, if you like, your prognosis. As you learn more about throat cancer, you may become more confident in making treatment decisions.

Keep friends and family close

Keeping your close relationships strong can help you deal with throat cancer. Friends and family can provide the practical support you may need, such as helping to take care of your home if you're in the hospital. And they can serve as emotional support when you feel overwhelmed by having cancer.

Find someone to talk with

Find someone who is willing to listen to you talk about your hopes and worries. This may be a friend or family member. The concern and understanding of a counselor, medical social worker, clergy member or cancer support group also may be helpful.

Ask your healthcare team about local support groups, or contact the American Cancer Society or another cancer organization in your area to find resources. Find support online through Mayo Clinic Connect, a community where you can connect with others for support, practical information and answers to everyday questions.

Make an appointment with a doctor or other healthcare professional if you have any symptoms that worry you.

If you have throat cancer, you may be referred to a doctor who specializes in diseases of the face, mouth, teeth, jaws, salivary glands and neck. This doctor is called an oral and maxillofacial surgeon. You also may be referred to a doctor who specializes in diseases that affect the ears, nose and throat. This doctor is called an ENT specialist or otolaryngologist.

Here's some information to help you get ready for your appointment.

What you can do

• Be aware of any restrictions before your appointment. At the time you make the appointment, be sure to ask if there's anything you need to do in advance, such as restrict your diet.
• Write down symptoms you have, including any that may not seem related to the reason you scheduled the appointment.
• Write down important personal information, including major stresses or recent life changes.
• Make a list of all medicines, vitamins or other supplements you take, including the doses.
• Take a family member or friend along. Sometimes it can be hard to remember all the information you're given during an appointment. Someone who goes with you may remember something that you missed or forgot.
• Write down questions to ask your healthcare team.

Your time with your healthcare team is limited, so preparing a list of questions can help you make the most of your time together. List your questions from most important to least important in case time runs out. For throat cancer, some basic questions to ask include:

• What is the likely cause of my symptoms or condition?
• Are there other possible causes for my symptoms or condition?
• What kinds of tests do I need?
• What is the best course of action?
• What are the alternatives to the approach that you're suggesting?
• I have these other health conditions. How can I best manage them together?
• Are there any restrictions that I need to follow?
• Should I see a specialist? What will that cost, and will my insurance cover it?
• Is there a generic option of the medicine you're prescribing me?
• Are there any brochures or other printed material that I can take with me? What websites do you recommend?
• What will decide whether I should plan for a follow-up visit?

Don't hesitate to ask other questions.

What to expect from your doctor

Be prepared to answer questions, such as:

• When did your symptoms begin?
• Have your symptoms ongoing or do they come and go?
• How severe are your symptoms?
• What, if anything, seems to improve your symptoms?
• What, if anything, appears to worsen your symptoms?