CONDITIONS

Throat and Mouth Cancer

What Is Throat and Mouth Cancer

Throat and mouth cancer is also known oral cancer.  These cancers are the most common type of head and neck cancers. The majority of oral cancers arise from the tongue, the lips, and the floor of the mouth. However, it can also arise from the salivary glands, gums, lining of the cheek, roof of the mouth, and even behind the molars or wisdom teeth.

Nearly all oral cancers arise from squamous cells, which are the cells that line the mouth, lips, tongue, and cheeks. As a result, they are called squamous cell carcinomas. However, not all masses or growths in the mouth are cancer. Some may be benign growths (non-cancerous tumors) or others may be precancerous, which means they may develop into cancer.

More than 45,000 people in the United States will be diagnosed with oral cancer in 2015. Worldwide, it is estimated there are more than 450,000 new cases. Unfortunately, the incidence of oral cancer has been increasing over the last decade. Other studies estimate that 115 people are diagnosed with oral cancer every day in the US. Further, one person dies from oral cancer every hour. If these cancers are detected early, patients have an 80-90% survival rate. However, those patients with a late diagnosis of oral cancer have a 43% survival rate at 5 years. It is hypothesized that a great public awareness of these cancers coupled with more effective screening protocols by medical and dental professionals may yield more early diagnoses and improved survival rates

What Causes Throat and Mouth Cancer

The majority of throat and mouth cancers occur due to two reasons. First, chronic exposure to alcohol and tobacco increases your risk of developing oral cancer. Secondly, infection with the HPV-16 (human papilloma virus 16), which is also known to be a risk factor for developing cancer of the cervix. A small percentage of patients are diagnosed with oral cancers of unknown reasons, however, it is believed that this may be secondary to genetic disposition.

It is known that throat and mouth cancer, as well as all other cancers, are a disease characterized uncontrolled cellular growth. Normally, specific genes within the DNA (genetic material) of cells have functions to regulate cell division. Genes involved in cell replication, or division, cellular growth, and cellular survival are called oncogenes, while those involved in limiting cell growth and division and induce cell death when necessary are called tumor suppressor genes (such as TP53 and RB1 genes).

When cell DNA is damaged, these genes may be altered and the oncogenes are turned on and the tumor suppressor genes are turned off. As a result, there is uncontrollable cell growth and possible cancer. These changes to the DNA of cells are caused by the environment, but changes or mutations to DNA can also be inherited. If these mutations in the DNA correspond to genes that are involved with effective and correct cell replication, a person’s risk for developing kidney cancers and other cancers may be increased.

Risk Factors For Throat and Mouth Cancer

Risk factors for oral cancer include:

  • Tobacco use, including cigarettes, cigars, pipes, and chewing tobacco
  • Heavy alcohol use
  • Excessive sun exposure to your lips
  • HPV-16

Diagnosing Throat and Mouth Cancer

A diagnosis of throat and mouth cancer will likely start with a visit to your primary care physician, who will obtain a thorough medical history and then perform a physical examination. This may also occur in the setting of a dental exam with your dentist. In addition, he or she will then utilize any of the following tools to arrive at a diagnosis:

An endoscopy is a procedure that involves passing a small camera down your mouth and into your throat to inspect the area for cancerous changes, masses, or infection. It requires sedation or anesthesia and will likely occur in a hospital or outpatient surgical setting. In the case of oral cancers, it allows excellent visualization of the mouth and throat.

A CT scan also uses x-rays to generate an image, but it has several advantages compared to the chest x-ray. It will show the precise location, shape, and size of masses. In order to obtain even sharper images, some patients are asked to drink or receive IV contrast. This contrast makes some tissues appear brighter, which makes the images and the structures more apparent and easier to discern. Allergies to contrast medium may cause hives, flushing, shortness of breath, and low blood pressure. If you have had a reaction to contrast before, you should inform your physician. In addition to masses (such as cancers), it can show enlarged lymph nodes, which may have cancer cells. Many patients will have CT scans of the chest, as well as the abdomen to look for cancer spread, which may involve the liver, adrenal glands, or other internal organs. The CT scan may also involve the brain to look for cancer metastasis. A CT scan may also be used to obtain biopsies of masses or cancers what lie deep within or nearby other vital structures, which is termed CT guided needle biopsy.

A magnetic resonance imaging (MRI) study also provides detailed soft tissue “pictures.” As opposed to CT scans, which utilizes x-rays, MRIs use magnetic radio waves to generate images. MRIs are particularly useful for imaging the brain and spinal cord. Gadolinium, a contrast, is often used to produce even better MRI images.

PET scans, also known as positron emission tomography, are especially useful to look for cancer spread. This study involves injecting a special radioactive sugar (flourodeoxyglucose, or FDP) into the vein. The amount of radioactivity is very low and will not cause you harm. After the injection, a special scanner will pick up areas in your body where the sugar has accumulated. As cancer cells are very active and require a great amount of energy (sugar), the FDP will concentrate in these areas. The PET scan does not produce extremely detailed images, but rather indicates spread of cancer throughout the body.

Bone scans can also be performed to detect spread of cancer to bones. During this procedure, a radioactive dye is injected in the vein, where is it transported to areas of bone with abundant activity, which may occur in cancerous and non-cancerous states.

A simple chest x-ray or radiograph will usually be performed, as it is convenient, cheap, and will reveal if the cancer has progressed to the lungs.

If a suspicious mass is identified via the aforementioned tests, a biopsy may need to be performed to ensure proper diagnosis. During a biopsy, a small amount of tissue is removed from the suspicious mass and then assessed under the microscope. A biopsy is commonly performed as a fine needle aspiration, or FNA, which utilizes CT imaging and a long, thin needle to pierce the skin and to obtain a small tissue sample of the mass. A pathologist will then study the biopsy to determine if the mass is benign or malignant and will then identify the exact type of malignancy.

Symptoms of Throat and Mouth Cancer

Common signs and symptoms of throat and mouth cancer include:

  • A sore that doesn’t heal
  • A lump of thickening of the skin or lining of your mouth
  • A white or reddish patch on the inside of your mouth
  • Loose teeth
  • Poorly fitting dentures
  • Tongue pain
  • Jaw pain or stiffness
  • Difficult or painful chewing
  • Difficult or painful swallowing
  • Sore throat
  • Feeling that something is “caught” in your throat

Prognosis

Prognosis refers to the likely course of a disease or ailment. To determine the prognosis of throat and mouth cancer, many factors must be considered. For example, the age of the patient and his or her functional status, or level of functioning, also plays a vital role in prognosis. Generally, younger and higher functioning patients will do best. Further, the amount of tumor able to be removed, also known as resected, impacts prognosis. If the entire tumor is removed,

prognosis improves, while if only part of the tumor is removed, prognosis will likely deteriorate. If the tumor recurs, or comes back after removal, the prognosis is worse. Generally, the earlier the cancer is detected, the better the prognosis.

Also very important for prognosis is staging and grading of the cancer. Staging of a cancer is the process of classifying how far a cancer has spread, while grading determines the makeup and characteristics of the cancer’s cells. In addition to prognostic value, staging and grading can help predict what therapy is ideal and the effectiveness of the therapy. The American Joint Committee on Cancer (AJCC) has standardized staging system that employs the size of the tumor (T), the number of involved lymph nodes (N), and the presence of metastasis (M). Thus, it is referred to as the TNM staging system. The more advanced each of these categories, i.e. tumor size, the higher the number that follows the letter. The size of the tumor ranges from 0-4, while the staging of involved lymph nodes varies from 0-2 and the presence of metastases is determined with 0 or 1. A combination of these three variables and numbers then determines the stage of the cancer.

The grade of a cancer cell describes how similar or dissimilar the cell looks compared to a healthy cell observed under a microscope. Healthy tissue will have many different types of cells grouped together. If the tumor has many different types of cells and appears similar to healthy tissue, it is termed differentiated, or a low-grade tumor. Conversely, if the tumor appears very different from the healthy tissue, it is termed poorly differentiated, or a high-grade tumor. In general, the lower the grade of tumor, the better chance of treatment, survival, and prognosis.

As with most cancers, the prognosis of the disease depends on the type of cancer as well as the individual patients and the response to treatments. According to the Cancer Research UK, men have a 40% survival rate at 5 years, while women have a 43% survival rate at 5 years for oral cancer. Those with a diagnosis of lip cancer have a 5-year survival of 89%. And, men with tongue cancer have a 44% 5 year survival, while women have a 55% 5-year survival rate.

Living With Throat and Mouth Cancer

People with cancer not only face physical challenges, but also mental and emotional challenges. It is important to understand your illness and treatment as it can make you feel more in control. Taking care of your emotional health is also vital. Family and friends can be an important source of support for you during this challenging time.

In addition, it is helpful to consider the following:

  • Explore all treatment options. Educate yourself on potential treatment methods and ask your doctor questions. Be sure to seek out reliable sources both online and in print. See the resources section for sources of information on brain cancer.
  • Weigh the benefits and risks of each treatment options. Ask yourself what the aim of your treatment should be, and what you wish to accomplish as you live with the disease.
  • Consider palliative care, a type of medical care specialized to help patients with terminal illnesses remain comfortable while living out their disease.
  • Live out your dreams and goals to help you be as happy as possible. Don’t let prognosis or statistics discourage you from accomplishing want you want to accomplish.

Screening

At the current time, the United States Preventive Task Force, or USPTF, cites insufficient evidence available to recommend routine screening for oral cancers in adults without symptoms.

Prevention

Unfortunately, there is no guaranteed preventative method to stop throat and mouth cancer from developing.  However, cases of throat and mouth cancer that are diagnosed early are less likely to progress and to carry worse a worse prognosis than cases that are diagnosed at later stages.

If you experience any of the symptoms of oral cancer, contact your physician immediately.

Medication And Treatment

Throat and mouth cancer can be treated in many ways. The specific treatment plan will be designed by a collaborative effort between you and your physician. It will take into consideration your overall health, the characteristics of the cancer, and your individual health and treatment concerns.

Surgery – to remove all or part of the cancer may be necessary. If it is a small mass, it may be a simple surgical resection, or removal. However, if it is an extensive tumor, it may involve removing part of your jawbone, tongue, or other parts of your mouth or throat. Assuming the cancer has spread to your throat or neck, the surgeon may perform a neck dissection to remove tumor and to remove cancerous lymph nodes or to detect the presence of cancer in the lymph nodes (known as a lymph node dissection). After an extensive surgery, it may be necessary to reconstruct part of your mouth and/or throat. Surgeons can utilize grafts of bone or muscle from other parts of your body to perform this reconstruction. It is vital to aim for the best reconstruction possible as the mouth and throat are critical for speaking, eating, and may change your appearance significantly.

Radiation – this treatment involves high energy x-rays focused on a specific site to kill cancer cells. The efficacy of radiation is cumulative; so multiple sessions of radiation are necessary for optimal treatment. Radiation may be used as the sole treatment (especially for early cancers that are well localized) or in combination with surgery or chemotherapy. In cases of severe cancer, it may also be utilized to control symptoms, such as pain. Side effects of radiation include fatigue, skin damage, tooth decay, dry mouth, mouth sores, bleeding gums, and necrosis of nearby structures to the cancer. 

Chemotherapy – uses medication via oral or intravenous routes to kill rapidly diving cells (which is characteristic of cancer cells, but other cells in the body divide quickly as well and may be killed by the chemotherapy, such as hair cells leading to baldness during chemotherapy). High-grade tumors may respond well to chemotherapy and shrink the tumor prior to a possible surgery, which makes resection easier for the surgeon. Besides the aforementioned baldness, chemotherapy may also cause loss of appetite, nausea, vomiting, weight loss, lethargy, and an increased risk of infection.

Targeted – utilizes drugs to identify and attack only the cancer cells, while avoiding normal healthy cells. Targeted therapy with Cetuximab (Erbitux) is used in some cases of oral cancers. This targeted therapy blocks a specific receptor known as the epidermal growth factor receptor, or EGFR.

Complementary and Alternative Treatment

As the definitive treatment for throat and mouth cancer remains chemotherapy, radiation, and surgery, alternative treatments for this condition should only be considered after traditional interventions have been initiated or completed.

Complementary medicine, which refers to interventions performed in addition to traditional or standard treatment, are numerous and may provide additional symptom relief and improved quality of life for many patients. According to the National Center for Complementary and Integrative Health, these include:

Acupuncture – is particularly effective in alleviating treatment-related nausea and vomiting in cancer patients. It may even help control cancer pain. Although complications from acupuncture are rare, it is important to ensure that the needles are properly sterilized. Many cancer patients have weakened immune systems and more prone to infections.

Ginger – may help to control nausea secondary to cancer chemotherapy, especially when used along with standard anti-nausea medications.

Massage therapy – may help to alleviate symptoms experienced by many cancer patients, such as pain, nausea, anxiety, and depression. However, the massage therapist should be careful to avoid deep or too rigorous massage prior to physician approval, especially directly over a tumor or around sensitive skin, which is common following radiation treatments.

Mindfulness-based Stress Reduction – as a type of meditation, mindfulness-based stress reduction can help cancer patients by relieving anxiety, stress, fatigue, and general mood and sleep disturbances. As a result, this can lead to an overall improvement in quality of life.

Yoga – preliminary studies suggest that yoga may improve anxiety, depression, and stress in patients with cancer. It may also alleviate fatigue in breast cancer patients. However, additional studies need to be completed for better evidence and conclusions.

Hypnosis, relaxation therapies, and biofeedback – various studies are currently assessing the benefits of these activities in cancer patients.

Herbal supplements – a 2008 review of research regarding herbal supplements and cancer concluded that the scientific evidence is limited and many clinical trials were not well designed. Furthermore, there are specific concerns regarding some herbal supplements in terms of medication interactions. Thus, any use of herbal medications should be discussed thoroughly with your physician.

When To Contact A Doctor

If you are experiencing any of the signs or symptoms of throat and mouth cancer (see above), you should seek medical attention as soon as possible. The earlier a diagnosis can be made, the earlier treatment can begin, which generally leads to improved outcomes and better prognosis.

Unless the symptoms are life threatening, you can make an appointment within a reasonable time period and do not need to visit the emergency department.

 

 

Resources

 

Questions For Your Doctor

Your medical team may consist of several healthcare professionals, including your primary care physician, otolaryngologist (ENT), oncologist, oral surgeon, dentist, and an oncologic surgeon.

The National Cancer Institute offers a Web where you can find a cancer center near you.

The National Cancer Institute offers a Web site where you can find a cancer center near you.

Questions For A Doctor

When you go to see your doctor, it’s good to have a list of the questions you’d like to have answered. Take a moment to write down some of the things you want to know. Your questions for your doctor might include some of these:

  • How far advanced is my cancer?
  • What are my options for treatment?
  • What is my prognosis?
  • What treatment would you recommend, and why?
  • What are the possible side effects?
  • Does my insurance cover these treatments?
  • What changes will I need to make in my day-to-day life?
  • Is there anything else I should know about my cancer?

Resources

Other useful resources to help you learn about oral cancer can be found at:

The Oral Cancer Foundation