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Throat Cancer In Children: Symptoms, Diagnosis, And Treatment

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Throat cancer refers to cancerous growths that develop in the pharynx (throat), tonsil, epiglottis (cartilage over the windpipe), and larynx (voice box). This type of cancer is rare in young children, and more common among adults over the age of 50 years
(1). However, parents may worry if they notice inexplicable changes in their child’s voice, or the child has difficulty swallowing.

Read this MomJunction post to know more about the signs, symptoms, causes, diagnosis, treatment, and survival rate of throat cancer in children.

IN THIS ARTICLE

Signs And Symptoms Of Throat Cancer In Children

The following signs and symptoms can be seen in throat cancer
(1). They are similar to the symptoms of other less serious conditions.

  1. Cough
  2. Hoarseness of voice or other changes in the voice
  3. Swallowing difficulties
  4. Sore throat
  5. Unexplained weight loss
  6. Earache or ear pain
  7. Throat pain
  8. Lump in the neck or throat

If the symptoms don’t subside even after a week or recur frequently, then make an appointment with a healthcare provider. Early diagnosis and treatment can give better outcomes than delayed interventions.

Causes Of Throat Cancer In Children

The exact cause of cancer formation in the throat in children is not known. Genetic mutations (certain gene changes) of cells in the throat can be a reason for the uncontrolled growth of the cells. An increase in the number of cells and a decrease in cellular death can cause the accumulation of harmful cancerous cells (2).

Risk Factors For Throat Cancer In Children

The following factors can increase the risk of throat cancer (3).

  • Human papillomavirus (HPV)
  • Gastroesophageal reflux disease (GERD)
  • Family history of throat cancer, and head and neck cancers
  • Smoking or chewing tobacco
  • Heavy alcohol consumption

HPV infection may lead to the development of papillomatosis of the larynx. These are wart-like, benign tumor growth on the larynx, and often become cancerous (malignant) (4).

Types Of Throat Cancer In Children

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Throat cancer can be divided depending on the location of cancer within the throat (5).

  1. Nasopharyngeal cancer: This cancer is located in a part of the throat behind the nose.
  1. Oropharyngeal cancer: The cancer is on the part of the throat behind the mouth, including the base of the tongue and tonsils. Cancer of the tonsils is also located in the oropharynx.
  1. Hypopharyngeal cancer or laryngopharyngeal cancer: This includes cancers in the lower part of the throat above the trachea (windpipe) and esophagus (food tube).
  1. Laryngeal cancer:  Childhood laryngeal cancers involve the cancer of the larynx or voice box. Laryngeal cancer can be of three types depending on the part of the larynx affected. They include (4):
    • Glottic cancer — cancer of the vocal cord.
    • Supraglottic cancer — the upper part of the larynx, including the epiglottis, which is the cartilage that blocks the entry of food into the airways.
    • Subglottic cancer — cancer affecting the lower part of the voice box.

Rhabdomyosarcoma is the most common type of laryngeal cancer (soft tissue cancer) in children, whereas adults are more prone to squamous cell carcinoma. Congenital subglottic hemangioma is a common type of benign (non-malignant) laryngeal tumor in children (3).

Upper respiratory tract, including throat, may also develop a type of tumor called extramedullary plasmacytoma, which is a tumor that contains plasma cells originating from bone marrow. This tumor could occur with or without the involvement of bone marrow. Extramedullary plasmacytoma cases are referred to radiation oncologists since they are treated using radiation therapy (6).

Although throat cancers are of different types, the risk factors and symptoms can be similar in many cases. Younger children require treatment with oncology and surgery experts who specialize in the treatment of pediatric cancers.

Diagnosing Throat Cancer In Children

The following test can be done for diagnosis (7).

  • Looking at the throat and larynx using an endoscope or laryngoscope: Endoscopy gives a visualization of the throat using a thin, lighted tube with a camera on one end. It allows the transmission of the video on a screen. Laryngoscopy permits direct visualization through a lens.
  • Biopsy: Endoscopic or laryngoscopic guided biopsies are done to collect internal tissue samples from the throat if any abnormalities are detected. These tissue samples are analyzed in laboratories to find cancer cells.
  • Fine needle biopsy: It is a method to collect samples for biopsy from swollen lymph nodes.

If throat cancer has spread beyond the surface of the throat, then imaging tests are ordered to identify the spread of cancer and metastasis. These tests may include a chest x-ray, CT scan, MRI scan, or PET scan.

Stages Of Throat Cancer In children

After the diagnosis, throat cancer is staged based on the extent of cancer invasion to nearby tissues, lymph nodes, and spread to distant organs or tissues. Staging helps determine the treatment options.

All types of throat cancers have their own staging criteria. The stages usually include stage I, where the cancer is limited to the surface of the throat and can go up to stage IV, which involves the metastasis of other parts of the body. Stage IV cancers may require computed tomography, magnetic resonance imaging, or positron emission tomography to detect distant metastasis (8).

Early stages have a better prognosis, while later stages may indicate advanced cancer with poor prognosis.

Throat Cancer Treatment In Children

Treatment of throat cancer is based on its location, type of cancer, stage, and your child’s health status. The treatment may include the following (9).

  1. Radiation therapy

This treatment uses high energy sources, such as X-rays or protons, to destroy cancer cells. It can be done with machines from outside the body with external beam radiation or directly to cancer using wires through a process known as brachytherapy.

Radiation therapy alone is given in the early stages, and combined radiation therapy with chemotherapy or surgery is appropriate for advanced cancers.

  1. Laser surgery

It is the method of destroying cancer cells using narrow beams of intense light. Laryngeal cancers and papillomatosis are treated with laser surgeries.

  1. Surgery

Doctors may choose any of the following types of surgery, depending on the location and stage of throat cancer.

    • Endoscopic surgery: This is the removal or scraping of cancer tissue from the surface of the throat using an endoscope with a special tool. Endoscopic surgeries are appropriate for the early stages of cancer, which are confined to the throat surface.
    • Laryngectomy: This is the surgical removal of the larynx (voice box). Affected part of the voice box is often removed, and the ability to breathe and speak is preserved. However, in some cases, if entire voice box removal is required, then the child may require tracheostomy that is the surgical creation of a hole in the throat to breathe. Speech therapies are given by a speech pathologist who trains the child to speak without a voice box.
    • Pharyngotomy: This is the surgical removal of the pharynx and reconstructing the part of the throat to allow swallowing of food.
    • Removal of affected lymph nodes: Surgical removal of lymph nodes in the neck is recommended if they contain cancer cells.

Surgeries can often impact swallowing and speaking. There may also be a risk of bleeding and infection.

4. Chemotherapy

Chemotherapy is the destruction of cancer cells using drugs. Systemic chemotherapy can be given in combination with radiation therapy.

5. Targeted drug therapy

These are drugs that specifically target proteins or other components of cancer cells and destroy them. Cetuximab or Erbitux is a monoclonal antibody used for target therapy in throat cancer. This can also be given in combination with radiotherapy or chemotherapy.

Supportive (palliative) care is the medical care that aims to provide relief from pain and other symptoms. Palliative care specialists can provide supportive care before, during, and after other treatments. This type of care may help to improve the quality of life of patients and their families.

Rehabilitation After Treatment

Post-treatment recovery processes may be different based on the type of treatment given. Your child may require special treatments to deal with problems such as (10).

  • Tracheostomy care
  • Swallowing
  • Speech
  • Pain and stiffness of the neck

These problems can be well-managed with rehabilitation treatments based on doctors’ recommendations.

Preventing Throat Cancer In Children

There is no approved way to prevent throat cancers. HPV vaccination may reduce the risk of squamous cell carcinoma (oropharyngeal cancer) of the base of tongue and tonsils in children with oral HPV infections (11).

Prevention of Epstein-Barr virus infection could reduce the risk of nasopharyngeal cancer, such as Burkitt’s lymphoma and Hodgkin’s lymphoma (12). Avoiding tobacco and alcohol may reduce the risk of throat cancer.

Survival Rate For Children With Throat Cancer

The five-year survival rate for throat cancer may vary depending on the location and the stage of cancer. Early diagnosis and treatment could improve the survival rate. Glottic cancers have better survival rates, which is about 83% in the early stages (13).

Hypopharynx cancers may have fewer survival rates of about 59% in the early stages. The survival rate is lower in the advanced stages of all types of throat cancers (13).

If your child is being diagnosed with throat cancer, then you will have to be strong and support them during treatments. Speech and swallowing problems can be difficult for children to manage, and they may require positive encouragement from parents and caregivers.

References:

1. Childhood Laryngeal Tumors Treatment (PDQ®); The United States National Library of Medicine (NLM)
2. Risk Factors for Laryngeal and Hypopharyngeal Cancers; The American Cancer Society
3. Throat Cancer; The United States National Library of Medicine (NLM)
4. Childhood Laryngeal Tumors Treatment (PDQ®)–Patient Version; The National Cancer Institute (NCI)
5. Head and Neck Cancers; The National Cancer Institute (NCI)
6. Multiple myeloma; The Canadian Cancer Society
7. Childhood Laryngeal Tumors Treatment (PDQ®)–Health Professional Version; The National Cancer Institute (NCI)
8. Throat Cancer Stages; Memorial Sloan Kettering Cancer Center
9. Treatment; laryngeal (larynx) cancer; The National Health Service
10. Rehabilitation; The Sidney Kimmel Comprehensive Cancer Center; Johns Hopkins Medicine
11. Oropharyngeal Cancer (OPC) and HPV Prevention in Children; The American Academy of Pediatrics
12. Viruses that can lead to cancer;The American Cancer Society
13. Survival Rates for Laryngeal and Hypopharyngeal Cancers; The American Cancer Society

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