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Throat and Oral Cancer

Definition:
Recently, you've noticed a pale lump inside your mouth that doesn't seem to be healing. It's not like anything you've seen before. What you may have encountered is an early sign of oral or throat (oropharyngeal) cancer.

The American Cancer Society estimates more than 30,000 new cases of oral and throat cancer occur annually in the United States. Oral cancer includes cancer of your lips, mouth, tongue, gums and salivary glands. Throat cancer involves cancer of the part of your throat just behind your mouth. It's estimated that more than 7,000 Americans die of oral and throat cancers annually.

Periodic self-examination of your mouth is the best way to detect the early signs of oral and throat cancer. And, when detected early, oral cancer is almost always successfully treated. Unfortunately, many oral and throat cancers are far advanced by the time a doctor is made aware of the situation. This is because oral and throat cancers are usually painless in their early stages or have minor symptoms similar to other health problems, such as a toothache.

Causes:
Recently, you've noticed a pale lump inside your mouth that doesn't seem to be healing. It's not like anything you've seen before. What you may have encountered is an early sign of oral or throat (oropharyngeal) cancer.

The American Cancer Society estimates more than 30,000 new cases of oral and throat cancer occur annually in the United States. Oral cancer includes cancer of your lips, mouth, tongue, gums and salivary glands. Throat cancer involves cancer of the part of your throat just behind your mouth. It's estimated that more than 7,000 Americans die of oral and throat cancers annually.

Periodic self-examination of your mouth is the best way to detect the early signs of oral and throat cancer. And, when detected early, oral cancer is almost always successfully treated. Unfortunately, many oral and throat cancers are far advanced by the time a doctor is made aware of the situation. This is because oral and throat cancers are usually painless in their early stages or have minor symptoms similar to other health problems, such as a toothache.

Risk Factor:
A variety of factors that you can control increase your risk of oral cancer. These include:
  • Use of tobacco. Tobacco can damage cells in the lining of the oral cavity and upper throat. Smokers are much more likely to develop oral or upper throat cancers than nonsmokers are. About 90 percent of people who develop these cancers use some form of tobacco. Tobacco use is more prevalent among men, so oral cancer is more common in men than in women.

    People who use smokeless or chewing tobacco are at even higher risk of cancers of the cheek and inner surface of the lips. Aside from oral and throat cancers, using smokeless tobacco can cause other serious health problems, including other cancers, gum disease and possibly cardiovascular disease.

  • Excessive alcohol consumption. Alcohol also can damage cells inside your mouth and upper throat. Roughly three-fourths of people with oral and upper throat cancers are frequent drinkers of alcohol. The combination of alcohol and tobacco use significantly increases your risk.
  • Chronic denture irritation. Irritation caused by dentures doesn't itself appear to be a factor in oral cancer. However, poorly fitting dentures can trap particles of tobacco and alcohol, and prolonged exposure to these known risk factors may further increase your risk of oral cancer.
  • Prolonged exposure to ultraviolet light. Too much ultraviolet light can damage the cells on your lips and increase your risk of lip cancer. Almost one in three people with lip cancer have jobs that keep them outdoors for long periods of time.
  • White patches on the tongue or inside of the cheek (leukoplakia). Most of the time leukoplakia isn't dangerous. But leukoplakia can be serious, as some of the patches may show early signs of cancer, and many cancers of the mouth occur in areas in which leukoplakia is adjacent. Leukoplakia may result from a variety of causes, including smoking or chewing tobacco products or ill-fitting dentures.
  • Red raised patches inside the mouth (erythroplakia). Erythroplakia is more likely than leukoplakia to indicate a developing cancer. The majority of these are eventually diagnosed as cancer. These areas often bleed easily if scraped.
  • Human papillomavirus (HPV). HPV is a group of sexually transmitted viruses that have been linked to most cases of cervical cancers. More recently, HPV has been found to be a factor in about one out of five oral cancers.

When to seek medical advice:
See your doctor if you:
  • Notice sores inside your mouth that don't heal
  • Have lumps or white, red or dark patches in your mouth
  • Feel persistent pain or have a loss of feeling inside your mouth
  • Have repeated bleeding in your mouth
  • Notice any change in the way the soft tissues of your mouth look and feel
Any of the above factors may indicate oral cancer. If you have any of these signs and symptoms that last more than two weeks, see your doctor. The earlier you seek medical advice, the better your chances of successful treatment.

Symptoms:
An early indication of oral and throat cancer is one or more changes in the way the soft tissues of your mouth usually look or feel. Signs and symptoms may include:
  • A sore in your mouth that doesn't heal or increases in size
  • Persistent pain in your mouth
  • Lumps or white, red or dark patches inside your mouth
  • Thickening of your cheek
  • Difficulty chewing or swallowing or moving your tongue
  • Difficulty moving your jaw, or swelling or pain in your jaw
  • Soreness in your throat or feeling that something is caught in your throat
  • Pain around your teeth, or loosening of your teeth
  • Numbness of your tongue or elsewhere in your mouth
  • Changes in your voice
  • A lump in your neck
  • Bad breath
Most oral cancers arise on the lips, tongue or on the floor of the mouth. They also may occur inside your cheeks, on your gums or on the roof of your mouth.

Dignosis:
Diagnosis initially involves you and your dentist or doctor discussing the history of your signs and symptoms and your doctor performing an examination of your mouth. To determine whether abnormal-appearing areas within your mouth are cancerous, your doctor will need to take a small tissue sample (biopsy) to be examined in the laboratory.

Almost all oral and throat cancers are of the squamous cell type (squamous cell cancer or carcinoma). Squamous cells are firm and flat, and they form the lining of the oral cavity and upper throat as well as the surface of your skin. Squamous cell cancer begins with abnormal cells located only on the surface. As it progresses, the malignant cells invade deeper layers of the oral cavity and upper throat and may spread to your lymph nodes as well as to other parts of your body.

For your doctor to determine if the oral or throat cancer has spread, and if so how far it has spread, you'll need to undergo imaging procedures, which may include:
  • X-ray. Your doctor may want to see dental X-rays as well as X-rays of your head and chest.
  • Computerized tomography (CT) or magnetic resonance imaging (MRI) scan. A CT scan allows your doctor to see your organs in two-dimensional slices. Split-second computer processing creates these images as a series of very thin X-ray beams are passed through your body. An MRI scanner uses no X-rays. Instead, a computer creates tissue-slice images from data generated by a powerful magnetic field and radio waves. These images can be viewed from any direction or plane. These images help determine the extent of the mass and whether the cancer has spread to nearby lymph nodes.
  • Ultrasound. This imaging technique uses no radiation. Instead, it combines high-frequency sound waves and computer processing. Ultrasound is especially good for providing information about the shape, texture and makeup of tumors and cysts. While you relax on a bed or examining table, a wand-like device (transducer) is placed next to your head. It emits inaudible sound waves that are reflected back to the transducer (similar to sonar). Those reflected sound waves are then translated into a moving image by a computer.
Many oral and throat cancers aren't detected until they're far advanced. When detected early, squamous cell cancer can often be successfully treated.

Treatment:
Doctors use surgery and radiation therapy to treat oral and throat cancer in the earliest stages. For cancer in more advanced stages, doctors use surgery combined with radiation therapy or radiation therapy combined with chemotherapy.

Your treatment plan should be developed for you specifically based on multiple factors by an integrated team of doctors including surgeons, cancer specialists (oncologists) and oncologists who specialize in treating cancer with radiation (radiation oncologists). Treatment options include:
  • Surgery. The type of surgery you may need depends on the size and location of the tumor. Doctors can surgically remove tumors that haven't grown into nearby tissues with relatively few side effects. However, if the tumor has invaded nearby tissues, the operation is more extensive.

    Sometimes surgeons need to remove bone tissue from the jaw or the roof of the mouth. To treat a cancer of your tongue or the upper part of your throat, your surgeon may need to remove tissues that you use to swallow and in some cases your voice box (larynx). If the cancer has spread beyond your mouth, your surgeon may also need to remove lymph nodes in your neck.

    You may not have any major side effects from surgery to remove a small tumor from your mouth. However, extensive surgery may require major adjustments in the way you chew, swallow, breathe and speak. You may need a prosthetic device in your mouth to replace removed portions of your teeth, gums and jaw. In more advanced cases, you may need to use tubes for feeding and breathing and an artificial voice aid for speaking.

  • Radiation therapy. Radiation therapy uses X-rays to kill cancer cells. Doctors may use this therapy alone to treat small tumors or combined with chemotherapy to treat large tumors. Radiation therapy may also be used along with surgery to destroy small amounts of cancer cells that doctors can't remove during surgery.
  • Chemotherapy. Chemotherapy uses drugs to destroy cancer cells. You take these drugs either through your veins (intravenously) or orally. The type of drugs and the length of treatment depend on the size and location of the tumor. In the case of a large and invasive tumor, chemotherapy may be used in combination with radiation therapy and in place of surgery.
  • Angiogenesis inhibitors. Cetuximab (Erbitux) is a medication that stops the growth of new blood vessels that cancers need to grow. This drug has recently been approved for use along with chemotherapy in cancers of the oral cavity.
Recovery and rehabilitation
Following removal of an extensive tumor, reconstructive surgery or speech pathology may enhance your recovery and rehabilitation.
  • Reconstructive surgery. The goal of reconstructive surgery is to improve your appearance and to help you adjust to difficulties you may have with chewing, swallowing, speaking or breathing.

    Sometimes you'll need grafts of skin or tissue from other parts of your body to rebuild areas in your mouth, throat or jaw. You may also need to have a dental prosthesis implanted to replace a part of your jaw removed during surgery. If you've had extensive surgery in your neck, you may also undergo surgery to create a hole in your neck (tracheostomy) to help you breathe more easily. If muscles you need for swallowing have been removed, you'll need surgery to create a hole in your abdomen (gastrostomy) in order to receive food directly into your stomach through a feeding tube.

  • Rehabilitation. Adjusting to life after surgery may mean working with a speech therapist and dietitian. A speech therapist can help you overcome problems with speech and swallowing. If you've lost the ability to speak, you can learn to speak by forcing air up through your esophagus (esophageal speech). Artificial devices also are available to help you speak or speak more loudly.

    A dietitian can help you choose foods that are suitable for you if you've lost some of your ability to chew and swallow. In addition, you may benefit from sessions with a physical therapist and occupational therapist to help you make adjustments in your personal life and work life.

Prevention:
Tobacco and alcohol are by far the most important risk factors for oral and throat cancer. You can greatly reduce your risk by not smoking and limiting the amount of alcohol you drink. Other steps you can take to help prevent oral and throat cancer or its progression include:
  • Use well-fitting dentures. If you wear dentures, be sure they fit properly and are well cleaned and rinsed. Oral irritation may increase your risk of oral cancer.
  • Don't chew on the tissues on the inside of your mouth (inner cheek). Doing so irritates your oral tissues. This may occur during sleep, along with teeth grinding (bruxism). Talk with your dentist if this is a problem for you.
  • Limit your exposure to the sun. Ultraviolet light damages the skin on your lips and increases your risk of oral cancer. When you're out in the sun, use lip balm that contains sunscreen and wear a wide-brimmed hat to protect your face and lips.
  • Check your mouth and tongue periodically. Standing in front of a mirror, use your forefinger and thumb to pull facial tissue aside to get a good view and feel of the tissue on the inside of your lips, your cheeks and elsewhere inside your mouth, especially under your tongue. Look for bumps and for changes in color. Use your thumbs and fingers to check for lumps and tender spots. If you notice changes, talk to your dentist or doctor. Oral and throat cancer can be successfully treated, but success depends on early detection.
  • Visit your dentist twice a year. Most dentists perform a thorough examination of your mouth during each visit. He or she should conduct a direct as well as indirect (mirrored) observation of all the tissues inside your mouth.
  • Eat a nutrient-rich diet. Aim for at least five servings of fruits and vegetables daily. A poor diet has been linked to oral and other cancers.
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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