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Mouth, nose & throat cancers

Monday 31 October, 2011

The mouth, nose and throat are the parts of the head and neck involved in breathing, speaking, eating and swallowing. Any part of the mouth, nose or throat may be affected by cancer.

A number of warning signs may indicate cancer in the mouth, nose and throat. Many of these symptoms may also be caused by other, less serious problems. However, if any of the symptoms described below last for more than two weeks, it is important to see a doctor or dentist. Don't wait for something to hurt: pain is not usually an early symptom.

Mouth (oral cavity)

The largest organ in the mouth is the tongue. The muscles of the tongue base continue into the upper throat (oropharynx). The tongue moves food around the mouth as we chew, then collects it together into a soft ball and moves this back into the throat to trigger a swallow.

The roof of the mouth is called the hard palate, which is bone. The soft palate is an arch of muscle behind the hard palate, going into the throat. The soft palate lifts to close off the nasal cavities and stop food going upwards, out of the nose. The mouth also includes the lips and gums.

The mouth and throat: looking into the mouth

Mouth cancer

Mouth cancer includes cancer that starts anywhere in the oral cavity:

the lips or the inside lining of the cheeks and lips
the front two-thirds of the tongue
the gums and the floor of the mouth
the roof of the mouth (the hard palate) and the area behind the wisdom teeth.

Cancer in the oral cavity is called mouth cancer. You may have no symptoms with mouth cancer. But if you do you may have:

mouth pain
a sore or swelling in your mouth or jaw that doesn't go away
white patches on your gums, tongue or mouth (leukoplakia)
red patches on your gums, tongue or mouth (erythroplakia)
changes in speech or difficulty pronouncing words
difficulty chewing or pain swallowing food
pain with swallowing
a lump in your neck
loose teeth or dentures that no longer fit.

Throat (pharynx)

The throat (pharynx) is the tube running from the back of the nose to the gullet (‘food pipe' or oesophagus) and windpipe (trachea). Its three parts are the:

nasopharynx: the cavity behind the nose and above the soft palate. This is often considered part of the respiratory (breathing) system but connects with the oropharynx.
oropharynx: the area from the soft palate and tongue base to the back of the mouth, including the tonsils. This is the transition area from the oral cavity (mouth) to the pharynx (throat) and the common cavity used for breathing and eating.
hypopharynx: the lowest part of the throat, behind the voice box (larynx). It is the transition area for food to pass to the food pipe (oesophagus).

Voice box (larynx)

The larynx sits in front of the pharynx. From top to bottom, it consists of the:

epiglottis the valve that shuts to direct food down the oesophagus, but when open allows air into the larynx (voice box). It forms the lid of the voice box
glottis (vocal cords), which vibrate to produce speech.

The larynx sits above the trachea (wind pipe), which then leads into the lungs.

Cancer of the larynx

Cancer in this area may be called laryngeal cancer or cancer of the larynx. Symptoms of cancer of the larynx may include:

swelling in your neck or throat
a persistent sore throat
a change in the sound of your voice, or hoarseness
difficulty or painful swallowing
a lump in the neck.

Throat cancer

People use the term ‘throat cancer' usually to describe cancer that develops in any of the upper throat (oropharynx), lower throat (hypopharynx), voice box (larynx) or the beginning of the food pipe (oesophagus).

Cancers are treated according to where they begin in the body. Treatment for cancer starting in the oropharynx is not the same as treatment for oesophageal cancer. Because of this it is important you know the medical name of the cancer you have. Cancer that starts in the:

oropharynx is called oropharyngeal cancer
nasopharynx is called nasopharyngeal cancer
hypopharynx is called hypopharyngeal cancer
larynx is called laryngeal cancer.

If you are not sure of the medical name for your cancer, ask your medical team.

Call the Cancer Council Helpline on 13 11 20 for more information about other cancers often confused with head and neck cancers (e.g. thyroid cancer).

Symptoms of throat cancer may include:

throat pain
a persistent sore throat or cough
coughing up bloody phlegm
voice changes or hoarseness
a dull pain around your breastbone
difficulty swallowing
a lump in your neck
an earache
numbness of the face
a feeling that your air supply is blocked.

The mouth and throat: a side view

Nose, nasal cavity and paranasal sinuses

The nasal cavity is the large, air-filled space located behind your nose. The nose and upper respiratory tract warm, moisten and filter the air you breathe. Paranasal sinuses are air-filled spaces within your head that help to lighten the weight of your skull.

The nose, nasal cavity and sinuses transmit warmed air to the lungs via the throat.

Nasal and sinus cancers

Cancers that develop in these areas are called nasal and sinus cancers. Symptoms of nasal and sinus cancers may include:

a decreased sense of smell
a persistent blocked nose, particularly in one nostril
numbness of the face or within the mouth
nosebleeds
mucus draining in the back of your nose or throat
frequent headaches or sinus pressure
difficulty swallowing and loose or painful teeth
a lump on/in your face, nose or mouth
pressure or pain in your ears
a bulging or watery eye, double vision or complete or partial loss of your eyesight.

The lymph nodes in your neck

The neck region, which is very close to the mouth, nose and throat, contains major groups of lymph nodes (also called lymph glands). These are small, bean-shaped nodules of tissue that are part of the lymphatic system.

Cancer affecting lymph nodes in the neck

When cancer cells begin to spread, the lymph nodes are one of the first places they will go. Cancers of the mouth, nose and throat can spread to these nodes.

This is not lymphatic cancer or lymphoma as the cancer did not start in the lymph nodes. Cancer that spreads from the place it began to other parts of the body is still referred to by the name of the organ where it began.

How common are cancers of the mouth, nose and throat?

Each year, more than 660 people in Victoria are diagnosed with a cancer in the mouth, nose and throat area. Men are three times more likely to be diagnosed with the disease. It is more common in people over 50 years of age.

Risk factors

Many factors can place someone at risk for cancers in the mouth, nose and throat. Having one or more of the following factors doesn't mean you'll get cancer, or that your cancer was caused for that reason. Some cancers happen by chance and we do not know what caused them.

Tell your health care team if you use tobacco, alcohol or other drugs. Your doctors will consider it when caring for you, and they may help you quit. Quitting smoking may improve your chances of responding to treatment. If you need help or advice, call the Quitline on 13 7848.

Risk	Description
Tobacco or marijuana use	Smoking cigarettes or pipes, using chewing tobacco and dipping snuff causes about 85% of cancers in these parts of the body.
Alcohol use	A person's risk increases with the amount of alcohol consumed. Using both tobacco and alcohol further increases the risk.
Human papilloma virus (HPV)	HPV infection is associated with some cancers of the oropharynx.
Age	Cancers of the mouth, nose and throat are most common in people aged 50 or older.
Sex	Men are about three times more likely to get cancers of the mouth, nose and throat.
Race	People from some cultural backgrounds may be more likely to develop cancers in this part of the body. For example, people from certain parts of China may have an increased risk of nasopharyngeal cancer.
Leukoplakia or erythroplakia	Having white or red patches in your mouth may lead to oral cancer. These are pre-cancerous conditions and require treatment.
Epstein-Barr virus (EBV)	EBV may cause nasopharyngeal cancer.
Sun exposure	Ultraviolet (UV) radiation may cause lip cancer and is the main cause of skin cancer in these parts of the body.
Inhalation of certain chemicals or dusts	Breathing in sulphuric acid mist, asbestos fibres, dry-cleaning solvents, or certain types of paint or nickel may increase the risk.
Chewing areca nut (known as betel nut or paan)	Chewing this type of palm tree seed, often wrapped in leaves, may cause oral cancer.
Diet	Some studies suggest a diet low in beta-carotene (found in some fruits and vegetables) may be a slight risk factor.

Human papilloma virus (HPV)

HPV is a virus that for a long time has been known to cause cervical cancer. It has more recently been linked to tumours in the tonsils and base of the tongue. The HPV-16 subtype is associated with these tumours.

Doctors are trying to find out whether the virus is associated with other head and neck cancers.

It is believed that we are all exposed to HPV many times throughout our life. However, we know it usually goes away after a few months without causing any problems. We do not yet know why and when a viral infection can trigger a cancer growth. But research continues in this area.

The benefit of the HPV vaccine for cervical cancer is being investigated in head and neck cancer. It will be some time before we know how effective this might be in helping prevent or treat head and neck cancers.

Information reviewed by: Dr Annette Lim, Medical Oncology Fellow, Peter MacCallum Cancer Centre; Members of the Western and Central Melbourne Integrated Cancer Service Head and Neck Tumour Group.