Tongue Base and Tonsil Cancer
What is the Oropharynx?
Cancer of the oropharynx includes that behind the last molar (“wisdom tooth”). It is thus distinct from ” oral cavity” areas in front of the last molar, that is in the mouth. The specific areas, or “subsites” of the oropharynx are the tonsils, tonsilar arches, soft palate, walls of the pharynx, and the base and first 1/3 of the tongue. The front 2/3 of the tongue is in the oral cavity, and thus considered a different area for medical purposes. Thus, cancers of areas behind the last molar, but above the windpipe (larynx) and foodpipe (esophagus), are oropharynx cancer. Cancers of our 3 major salivary glands (parotid, submaxillary, sublingual) are considered separately, as well as those of the jaw bones, muscles and thyroid. In practice, it is important to identify the area the cancer arose from, even if it subsequently spread to other areas. Some-times, a cancer will start in the mouth or larynx but extend into the oropharynx. It is the area it originally arose from which determines what type of cancer it is. In practice, the most common types of cancer to arise in the oropharynx are from the tonsils and tongue base, and most research has been done on therapy for these areas.Cells in the throat are subjected to lots of injury from heat and abrasion, and thus must divide frequently to replace those lost due to injury and old age. Normally, cells divide quickly as we develop in the womb and through infancy, and then the rate slows down considerably, just to replace cells that die. The division of cels in the throat and elsewhere is under very tight control, regulated by the genes within the cells. Cancer starts in a single, abnormal cell unable to control it’s division processes. When this control is lost, the cell may start to divide in ahaphazard, uncontrolled manner, creating many similar altered cells, and grow to form a swelling of abnormal cells, called a “tumor”. A“benign” tumor only grows within it’slocal area, it does not spread to distant organs, and it is not cancer. In contrast, a“malignant” tumorcan spread toany area of the body,it is cancer. It is this ability to spread, or “metastasize”, to vital organs which makes a cancer so dangerous. Cancers of the throat tend to grow to large sizes locally before they spread, but any cancer can spread at any time.
How Common is Oropharynx Cancer?
Each year in the United States there are about 8,000 new cases of oropharynx cancer leading to 3,000deaths annually from this disease. Men are affected twice as often as women. Overall, oropharynx cancer represents about 1% of all new cancers each year. There are about 150,000 new cancers of the entire head and neck area each year, which causes 20,000 deaths annually. This is important since a person who gets one cancer of the head and neck area is at markedly increased risk to develop another one in a different area (that is another “primary”). It is also more common in those who have (or had) lung , pancreas, esophagus or colon cancers. Oropharynx cancer is more common in blacks than whites, and in those of “lower socioeconomic status” (poor people). The average patient is 60 years old.
What Causes, or Increases Risk for Oropharynx Cancer?
Like any cancer, the exact reason why one person gets oropharynx cancer and another does not remainsunknown. However, several“risk factors” have been shown to be be much more likely to be present in mouth cancer patients:
- Tobacco Usage– This is the single strongest risk factor for developing cancers of the head and neck, and especially mouth, esophagus, and oropharynx. Any form of tobacco taken through the mouth, whether smoked or chewed, increases the risk over time. It often takes several decades of use to get cancer but children who use chewing tobacco (often to emulate famous baseball players) have gotten mouth cancer. The more tobacco that is used, for a longer period of time, the higher the chance to get mouth cancer. Likewise, when use is stopped, the risk declines almost to normal over a 5 to 10 year period.
- Alcohol Usage– Is the next strongest risk factor after tobacco. Occasional wine or beer may raise risk very slightly, if at all, but frequent use of strong drinks like whiskey will increase cancer risk to the mouth, throat, esophagus (food pipe), stomach and pancreas. Furthermore,combining alcohol with tobacco will have a “super additive” effect to greatly increase cancer risk for all of these areas. This means that the risk is much more than twice as high as for using either tobacco or alcohol alone. Like tobacco, people who stop frequent drinking will gradually lower their cancer risk to nearly that of non-drinkers.
- Poor Oral Hygiene– The more unclean the mouth and throat are, the more it is subject to constant irritation from grime. Each teaspoon of saliva contains about one billion bacteria, which are making waste products which cling to teeth and tonsils (“plaque”). This allows gum disease (pyorrhea) to lead to subsequent tooth loss. Although plaque itself is not showto cause cancer, it helps other chemicals (like in smoke) to stick in the mouth and throat, irritate it, and stimulate the cells to divide. The more cells divide, the more chance one of them will become cancerous. That is why the common thread of many risk factors is irritation, leading to lots of cell division.
- Ill-Fitting Dentures irritate the gum lining (“gingiva”) and trap debris. This can lead to tongue cancers over time.
- Betel-Nut Chewing in Indian populations is strongly associated with tooth loss, mouth and throat cancer, again the common factor is prolonged irritation.
- Infections such as syphilis and some viruses can lead to cancer over time, these cause throat sores which heal poorly. The constant attempt to heal leads to chronic cell division and thus more chance for cancer. Viruses can also get into the mouth cells themselves and change the genes in them to form a cancer cell. This elaborate process is called “oncogene activation”.
- Lowered Immunity such as from AIDS or transplant anti-rejection drugs will increase the risk for many cancers, including those of the “aero-digestive tract” (i.e. the area from the nose and mouth to the lungs and stomach). This will be especially important in combination with the other risk factors noted above.
- Precancerous “Plaques” can develop in the mouth and throat, from chronic irritation. These may be white in color (“leukoplakia”) or red (“erythroplasia”) and may or may not become cancerous. They must be monitored closely.
- History of Cancer of the aero-digestive tract can mean as much as 5% chance of a separate simultaneous cancer, and a 25% chance of developing another cancer in this area over time (especially if risks like smoking are continued).
What are the Symptoms of Oropharynx Cancer?
A cancer must grow to 1 billion cells to be just 1 cm. (about 1/2) across, so a very early cancer will have no symptoms and likely go undetected. As it grows, it produces symptoms in it’s local area, and eventually in distant areas as it spreads. A throat cancer may be first noticed by the patient or their dentist, with these possible findings:
1) A Sore that Doesn’t Heal is one of the American Cancer Societies “7 signs of cancer” and the most frequent symptom of mouth cancer. It can be flat, raised or a pit (ulcer), and is usually hard and not very tender. It tends to grow slowly.
2) Local Pain is possible as the tumor enlarges, especially if it invades nerves. The throat shares nerves with the ears , so some deep cancers cause pain in these areas (‘referred pain”). Interestingly, the further back in the mouth or throat a cancer arises, the deeper in the ear the pain appears.
3) Difficulty Chewing, Swallowing or Speaking is caused by mechanical factors the tumor enlarges. Dentures may not fit anymore; one side of the face or neck may become swollen. If a duct from a salivary gland is blocked, it may also swell. The patient may lose weight from difficulty with eating.
4) Swelling in the Neck is possible as the lymph nodes in the neck are invaded. The chance for this increases with enlarging cancer and those near the mid- line of the throat; at diagnosis as many as 80% of patients may have spread to neck (“cervical”) lymph nodes. This swelling is usually firm and painless. Neck lymph nodes can also swell up from non-cancerous conditions such as infection, so swelling alone does not prove cancer. However, larger, harder and more persistent swellings are more likely to be cancerous.
5) Nerve Syndromes result from lymph nodes getting invaded by cancer, then enlarging and pressing upon crucial nerves for the face. The nerves then fail. Two particular syndromes include the Jacod’s (leading to trouble with facial expression, eye and jaw movement) and Villaret’s (trouble swallowing and tongue and neck movement problems). These will worsen if untreated.
6) Distant Spread Symptoms are uncommon with mouth cancer until the tumor has grown very large locally and spread to lymph nodes in the neck. Cancer can spread to any area in the body, but most likely goes to lung, liver, bone brain. New symptoms in these areas are very suspicious for spread in the patient with a large throat cancer. The chance of distant spread from a small cancer (< 3 cm.) is less than 2%, so an extensive procedure to look for symp- tomless spread to distant body areas is not warranted.
The base of tongue and tonsil are very close to each other in the back of the throat, and are behind the last molar in the mouth. This is important since disease starting in front of the tonsils are considered “oral” disease, while those arising in back of the teeth are “oropharynx” problems. The Tonsils and Base of Tongue are in this oropharynx, along with the tissue making up the back of the throat (called the “posterior pharyngeal wall”).It is critical to get prompt diagnosis and proper treatment for an “oropharynx” cancer problem, this can literally make the difference between life and death. Understanding your options will give you the peace-of-mind that you have done everything possible to ensure a successful outcome for yourself or a loved one.
Seeking cancer information for rare cancers can be challenging, but a medical search engine can help you find the information you’re looking for. From common cancers like breast cancer to the more rare tonsil cancer, the Internet is a good place to start your searching.
CancerAnswers’s material explains, in plain English, the definition, types, risk factors, frequency, evaluation, historical and latest effective treatments for base of tongue and tonsil cancers. We describe surgery, radiation and chemotherapy along with their side effects and results. While we don’t promise a cure, we tell you everything you need to know to help you make the correct choices today for an “oropharynx” cancer problem.
This is just an excerpt from our Complete Cancer Treatment Transcript. Much more, including latest treatments, can be sent to you by email when you order the complete transcript at a nominal cost.
Are you from San Diego?
WOW! Good thing you kept your wits enough to fight off the bugger. Glad you’re ok. The worse thing to happen to me on that street was when I encountered a pack of dogs late one night. I kept a safe distance behind them until I got home. Take care.
hope4cancer.org – cool!!!!
Nice post — this really hits home for me.
Wait…which one is Britney?
I love these stories! Keep making them!
You think everything sounds like existentialism.
I think its a great work & it certainly will make many realise that how precious their love is.
Thanks for writing, I very much liked
Oh thank you!
thank!
Many thanks!