Throat Cancer and Transoral Robotic Surgery

Your throat consists of the pharynx (commonly called the throat), the larynx (voice box), the top part of the esophagus (food pipe) and the trachea (wind pipe). The throat is lined with cells called squamous cells. The thyroid gland lies on either side of the trachea (wind pipe) 

Throat cancer can originate in several places within the throat and may spread to other structures. If you are experiencing any of the symptoms listed below, we advise checking in with your local GP. Your GP may then refer you to a Head and Neck specialist like Dr. Francis Hall. 

What causes Throat Cancer?

There are several causes of throat cancer including: 

  • Smoking-cancer of larynx (voice box), tonsils, base of tongue, hypopharynx (bottom of the throat behind the larynx) 
  • Regular or heavy consumption of alcohol-cancer of tonsils, base of tongue, larynx, hypopharynx 
  • Human papilloma virus (HPV)-cancer of tonsil and base of tongue, a common cause of throat cancer 
  • Epstein Barr virus (EBV)-cancer of the nasopharynx (top of the throat behind the nose) NPC 

What are Throat Cancer symptoms?

Throat cancer symptoms can easily go undetected as they are often very mild, and quite common. Some symptoms of throat cancer include:  

  • A lump in the neck-very common with throat cancer 
  • Hoarseness for 2 weeks or more-cancer of the larynx  
  • Earache, especially when swallowing.  
  • Pain in the throat while eating and drinking 
  • Difficulty swallowing 
  • Trouble hearing in one ear and a blocked feeling in that ear-middle ear fluid on one side (unilateral otitis media), NPC 
  • Blood-stained phlegm  
  • The sensation of something stuck in the throat.  
  • Breathing difficulties and noisy breathing-cancer of the larynx  

It’s important to note that 95% of head, neck, and throat cancer develops in the cell lining –squamous cell carcinoma (SCC) and can be seen on flexible endoscopy. SCC occurs most often in middle-aged to elderly people who smoke, drink alcohol or have been exposed to human papilloma virus (HPV). It can also occur in patients with no risk factors. Worldwide there is an increase in the number of people developing cancer of the tonsil and the base of the tongue (back of the tongue) and this increase is due to HPV. Dr. Hall commonly sees men, aged 45-70 who do not smoke or drink a lot of alcohol, with a lump in the upper neck and discover that they have HPV cancer (scc p16+ve) of either the tonsil or the base of the tongue.  

How is Throat Cancer diagnosed?

If you are experiencing any of the above-mentioned symptoms, Dr. Hall can help you. He will: 

  • Take a careful history 
  • Perform a thorough physical examination, which will include flexible endoscopy 
  • Perform ultrasound and ultrasound guided biopsy, fine needle aspiration (FNA)of any neck lumps – a sample of neck lump is sent to the laboratory for examination under a microscope.   

Dr. Hall may request CT, MRI and PET CT scans.  

Throat Cancer treatment options

Treatment of cancer of the throat depends on the site of the cancer (nasopharynx,  tonsil, base of tongue, larynx, hypopharynx), how big the cancer is (stage), where the cancer has spread to (stage) and the patient. Dr. Hall presents the patient to a head and neck multidisciplinary meeting (MDM). The history, examination findings, scans (ultrasound, CT, MRI, PET/CT) and pathology are reviewed by a team of experts (surgeons, radiologists, pathologists, medical oncologists (treat cancer with drugs (chemotherapy)), radiation oncologists (treat cancer with radiation (xrays)) are reviewed and recommendations for treatment are made. Treatment options are discussed with the patient.  

Many patients with cancer of the tonsil or base of tongue are suitable for Trans Oral Robotic Surgery (TORS). Dr. Hall is the New Zealand pioneer of TORS. He worked in America for five years as a head and neck cancer surgery and brought TORS back to New Zealand in 2016.  

What are the benefits of Robotic Head and Neck surgery?

Transoral robotic surgery involves 3D magnified vision of the throat and uses specialised flexible instruments to remove cancer from the throat.   Each and every movement of the robot is controlled by the surgeon. This allows Dr. Hall to access difficult to reach areas. TORS surgery is vastly better to traditional surgery with shorter operating times, shorter hospital stay, faster return to work and vastly better speech and swallowing function. TORS is usually combined with a neck dissection-an operation to remove lymph nodes from the neck. For more information on TORS, you might like to download Dr. Hall’s booklet on TORS.  

Dr. Hall and TransOral Robotic Surgery for Throat Cancer

Dr. Hall has completed many TORS procedures for cancer of the tonsil, base of tongue, larynx and unknown primaries. He has also performed TORS for patients with obstructive sleep apnoea that has not responded to other treatments and surgery. His patient-centred approach ensures that his treatment plans are comprehensive and based on the latest treatment modalities.   
He spent five years at Henry Ford Hospital in Detroit, USA where he gained his expertise in TORS. He brought this experience back with him to New Zealand in 2016. In 2016, Dr. Hall and a colleague became the first surgeons in New Zealand to perform transoral robotic surgery.   

If you are experiencing symptoms related to throat cancer, please ask your GP for a referral and call our team (09) 281 2963 today on or book a consultation with Dr. Hall online.