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Overview of Mouth, Nose, and Throat Cancers

by Bradley A. Schiff, MD

Cancers of the mouth, nose, and throat develop in almost 60,000 people in the United States each year. These cancers are more common among men, but the percentage of affected women is rising because smoking has increased among women. Most affected people are between the ages of 50 and 70. However, these cancers are occurring more often in younger people.

Often, cancers of the mouth, nose, and throat are considered together by doctors because of certain similarities. Among the similarities are the type of cancer and the causes. More than 90% of cancers of the mouth, nose, and throat are squamous cell carcinomas (see Overview of Cancer : Types of Cancer). Most people who have cancers of the nose and throat use tobacco, drink alcohol, or both. Another cause of some types of mouth, nose, and throat cancer is viral infection. The human papillomavirus (HPV) can cause cancer of the mouth and throat, and the Epstein-Barr virus can cause nasopharyngeal cancer.

The most common sites of mouth, nose, and throat cancers are the voice box (larynx), inside the mouth (including the tongue, floor of the mouth, and the hard part of the roof of the mouth), and the middle part of the throat (including the base of the tongue, the tonsils, and the soft part of the roof of the mouth). For cancers that affect the bones, including the jawbone (osteosarcomas, malignant giant cell tumors, multiple myeloma, and metastatic tumors), see Primary Cancerous Bone Tumors.

Less common sites are the hollow spaces located in the bones around the nose (nasal cavity and paranasal sinuses), the nasal passages and upper throat (nasopharynx), the lower part of the throat (hypopharynx), and the salivary glands. Tumors of the thyroid gland and skin are discussed elsewhere in T he M anual .

Symptoms and Diagnosis

Symptoms vary depending on the location of the cancer. Hoarseness, a lump in the neck, a painful mouth growth, and difficulty swallowing are common symptoms of mouth, nose, and throat cancers. Some cancers inside the mouth do not cause symptoms at first but can be seen or felt by a doctor or dentist during a mouth examination.

The diagnosis is made by examining a sample of tissue from the suspected cancer. Doctors may insert a needle to get a small amount of tissue or cut out a small piece using a scalpel.

Before the best form of treatment can be selected, doctors do tests to see whether and how far the cancer has spread (staging tests). Staging tests for cancers of the mouth, nose, and throat usually include computed tomography (CT) and/or magnetic resonance imaging (MRI) scans and sometimes a positron emission tomography (PET) scan. Staging is a way for doctors to describe how advanced the cancer has become, taking into account both the size and spread (metastasis) of the cancer (see Diagnosis of Cancer : Staging). Oral cancer is staged according to the size and location of the original tumor, the number and size of metastases to the lymph nodes in the neck, and evidence of metastases to distant parts of the body. Stage I cancer is the least advanced, and stage IV is the most advanced.

Treatment

Treatment usually involves surgery and/or radiation therapy. Chemotherapy is usually not the primary form of treatment, although it is sometimes added to other treatments. Because so many factors are involved in choosing the right treatment, teams of specialists work together to plan a person's care.

The outcome of mouth, nose, and throat cancers varies greatly depending on the type, location, and stage of the cancer. In general, outcomes are better when the cancer is diagnosed and treated before it has spread.

It is important for people to eliminate risk factors, so everyone should stop using tobacco and limit how much alcohol they drink. Removing risk factors also helps prevent disease from coming back in people who have been treated for cancer.

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