Mouth and throat cancer under the spotlight

Throat cancer originates in the mucosal lining of the upper aerodigestive tract and often spreads to the lymph nodes of the neck.

The upper aerodigestive tract includes the lip, mouth, nose, sinuses, pharynx and larynx. Squamous cell carcinoma is the most common type of throat cancer.

Although the incidence of many cancers is declining, the reverse is true for throat cancer. This disease is commonly diagnosed in the third, fourth, fifth and sixth decade of life and is a result of lifestyle choices, including tobacco and alcohol use. Benign tumours arising within this region are exceptionally uncommon.

Signs and symptoms of mouth cancer include persistent complaints of bleeding from the mouth, bad breath, sore tongue, painless ulcer or coloured patches that will not go away. People experiencing these should be seen by a general practitioner to rule out potential malignancy.

Throat cancer of the pharynx and the larynx is frequently diagnosed at a late stage and has a poor outcome compared to other malignancies of the head and neck.

Throat cancer in this region usually begins with symptoms that seem harmless enough, like a sore throat, troublesome swallowing or a hoarse sounding voice. However, if throat cancer is the underlying reason, these conditions may become chronic.

Whenever a mass in the neck, enlarged lymph nodes in the neck, hoarse voice and difficulty swallowing food persists for more than six weeks, an ear, nose and throat specialist should be consulted for further examinations.

Patients with throat cancer have a greater than average risk of a second malignant tumour developing either in the throat or somewhere else in the body. Therefore, a thorough medical evaluation is necessary as a second malignant tumour may be present.

All types of malignant throat cancer are strongly associated with lifestyle and environmental risk factors, such as tobacco smoking (cigarette smokers have a lifetime increased risk for throat cancer that is 5- to 25-fold increased over the general population, alcohol consumption, exposure to ultra violet light and occupational exposure to chemicals used in workplaces and woodworking. Additionally, certain strains of viruses, including human papillomavirus (HPV), can lead to throat cancer.

Worldwide in 2002, an estimated 561,200 new cancer cases (5.2 per cent of all new cancers) were attributable to HPV. Several types of HPV are called “high-risk“ types because they can lead to cancer, including throat cancer and HPV 16 is most commonly associated with this.

There is now two Food and Drug Administration approved vaccines, Gardasil and Cevarix, that are available to protect against these high-risk HPV 16 and 18 strains that cause 90 per cent of throat cancer and 70 per cent of cervical cancers that are HPV related. The Cayman Islands Cancer Society, the Public Health Department and 11 private physicians have an ongoing partnership to make this vaccine available to the residents of the Cayman Islands.

Today, many different types of therapies are used in the treatment of throat cancer. The type of therapy used is determined by the location of the malignant tumour within the upper aerodigestive tract and also the presence of metastasis, which is defined by the number and the location of lymph nodes involved.

Surgical approaches are sometimes used to treat throat cancer. However, due to the delicate and vulnerable structures within the throat, involving nerves, vessels, muscles, etc, surgery is difficult and 100 per cent removal of all tumour cells cannot be guaranteed. Surgery is more commonly used to remove tumour spread to the lymph nodes or to remove lymph nodes to prevent further spread of the disease.

The patient should be involved in the planning of the treatment plan at all times since some therapies such as radiation therapy or chemotherapy have serious side effects.

Although early-stage throat cancer has high cure rates, up to 50 per cent of throat cancer patients present with advanced stages of the diseases. Each individual has a personal responsibility for their health and should pay attention to symptoms as described above and consult with a doctor if they are experiencing any of the signs and symptoms described above.

Dr. Ulrich Ecke is a visiting ear, nose and throat specialist at Seven Mile Medical Clinic. This article is contributed on behalf of the Cancer Society as part of its ongoing educational series leading up to the Conquering Cancer Health Fair on 10 September.

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