Mouth and Throat Cancer

Mouth and throat cancer typically starts in the mucous membranes of the oral cavity or throat. Cancer can also develop in the lips or salivary glands. Here, you will find an overview of the risk factors, diagnosis, and treatment of these tumors.

At a Glance

The main risk factors for tumors in the mouth and throat are tobacco and alcohol consumption.
In the early stages, tumors in the mouth or throat usually do not cause any discomfort.
It is important to pay attention to changes in the mucous membranes to detect tumors in the mouth early and clarify them if they last longer than 2 weeks.
If a tumor is suspected, a specialist examines the oral cavity and throat and, if necessary, takes tissue samples to detect cancer.
There are various options for treating mouth and throat cancer: The main options are usually surgery and radiation therapy, often combined with chemotherapy.
After treatment, patients may need to practice chewing, swallowing, and speaking and may need to change their eating habits.

Note: The information in this article cannot replace a doctor’s examination and should not be used for self-diagnosis or treatment.

What are Mouth and Throat Cancer?

Mouth and throat cancer are usually malignant tumor diseases that start in the mucous membranes of the mouth and throat. Experts refer to these as squamous cell carcinomas.

Salivary Gland Cancer

Salivary gland cancer can also occur in the mouth and throat region. These tumors develop from the small salivary glands located in the mucous membranes of the mouth and throat. Malignant tumors can also develop in the large salivary glands in front of the ear and at the base of the mouth. They can develop from many different types of cells and therefore exhibit different behaviors.

What Symptoms Do Mouth and Throat Cancer Cause?

A malignant tumor in the mouth or throat usually does not cause any discomfort initially. Therefore, it is important to clarify changes in the mucous membranes of the oral cavity if they last longer than two weeks.

As the disease progresses, symptoms vary depending on the location, size, and aggressiveness of the tumor. These symptoms may include:

If the tumor is in the oral cavity, it can cause pain, restricted tongue movement, and difficulty swallowing and speaking.
In the nasopharynx, the tumor can make it difficult to breathe through the nose and cause nosebleeds.
A tumor in the oropharynx or deep throat can cause difficulty swallowing, throat pain that may radiate to the ear, and a sensation of a lump in the throat when speaking. However, for many people, swelling in the neck is the first symptom. Swelling is a sign that the tumor has likely already spread to the cervical lymph nodes.
A tumor in the large salivary glands is initially noticeable as a painless swelling. Later, pain or damage to facial nerves can cause paralysis or numbness.

Are There Risk Factors for Mouth and Throat Cancer?

Like almost all cancers, mouth and throat cancers are based on genetic changes in the cells’ genetic makeup. As a result, normal body cells turn into malignant cancer cells and begin to grow uncontrollably. Most of these genetic changes occur randomly during a person’s lifetime. However, there are also risk factors that can support this process.

The main risk factors for mouth and throat cancer include:

Consumption of alcohol and tobacco
Certain reddish and whitish changes in the mucous membranes that are considered precancerous
Infection with human papillomavirus (HPV)

Other risk factors include:

For nasopharyngeal cancer: Infection with Epstein-Barr virus (EBV)
For lip cancer: UV radiation from frequent sun or solarium exposure

How Does Mouth and Throat Cancer Progress?

Malignant tumors in the mouth and throat often develop from precancerous lesions. These are tissue changes where the cells are clearly altered compared to the original tissue. These cells can later turn into cancer.

Metastases

Malignant tumors in the mouth and throat can spread to the surrounding lymph nodes at an early stage. Therefore, doctors usually treat these areas as well. In some patients, the tumor spreads to other organs through the bloodstream. The lungs are most commonly affected, and less frequently, the liver and bones. In nasopharyngeal cancer, bone metastases are more common.

Secondary Tumor

Due to the main risk factors of tobacco and alcohol, a second head and neck, lung, or esophageal cancer can develop in patients with oral or throat cancer.

What Happens if Mouth or Throat Cancer is Suspected?

If a malignant disease of the mouth or throat is suspected, doctors examine the entire mouth, throat, and larynx of the patient.

Otolaryngology and/or oral and maxillofacial surgery specialists are primarily involved in the diagnosis. Sometimes, other doctors, such as family physicians or dentists, take the first diagnostic steps.

If the doctor finds suspicious areas or tumors in the body, tissue samples are taken. It can be determined under a microscope whether the removed tissue is cancerous. Depending on the location of the tumor, general anesthesia may be necessary for taking tissue samples.

Suspected Tumor in the Large Salivary Glands

If a tumor is suspected in the large salivary glands, the doctor takes a tissue sample using a needle. Experts refer to this as fine-needle biopsy or fine-needle aspiration.

Spread Diagnosis

Under general anesthesia, the doctor examines the mouth, throat, and larynx region, as well as the trachea, bronchi, and esophagus near the Adam’s apple. The goal is to find out how much the tumor has spread and whether a second tumor is present.

The doctor also uses imaging techniques to examine the spread of the tumor. The following examinations may be considered:

Ultrasound of the salivary glands, neck, and abdomen
Computed tomography (CT) / magnetic resonance imaging (MRI) of the larynx, neck, and possibly the chest
X-ray of the jawbone
Bone scintigraphy
Positron emission tomography and CT (PET/CT)

How Can Mouth and Throat Cancer Be Treated?

There are different treatment options for patients with mouth or throat cancer. Doctors consider the following factors when choosing the appropriate form of treatment:

Location of the tumor
Spread and aggressiveness of the tumor
Possible outcomes of treatment
The patient’s health and needs

Surgery is considered if doctors can completely remove the tumor. The patient’s general condition must also allow for surgery. Depending on the tumor’s condition, doctors may need to temporarily secure the patient’s breathing through an artificial connection to the trachea (tracheostoma). If the entire larynx also needs to be removed, the tracheostoma remains permanently. This is especially true for advanced tumors deep in the larynx. If the risk of recurrence increases, radiation therapy or radiation chemotherapy is administered after surgery. This is especially necessary in the case of advanced disease.

In many patients with tumors in the large or small salivary glands, surgery is also an important step in treatment. The goal here is also to completely remove the tumor. As with mouth and throat cancer, some patients undergo radiation therapy and less frequently radiation chemotherapy afterward.

Removal of Cervical Lymph Nodes

Doctors usually need to remove lymph nodes in certain areas of the neck. Experts refer to this as neck dissection. The reason for this procedure is that many patients have hidden lymph node metastases, even if the doctor does not detect suspicious cervical lymph nodes during examination or ultrasound.

Radiation and Chemotherapy

For some patients, surgery is not possible or desired for the tumor in the mouth or throat. In this case, radiation therapy may be considered. Doctors usually combine this with chemotherapy.

Tumors growing in the nasopharynx are particularly sensitive to radiation therapy and radiation chemotherapy.

Treatment Outcomes

When doctors remove a tumor from the mouth or throat, the tissue in that area is subsequently lost. As a result, chewing, swallowing, and speaking can be significantly restricted for patients. Therefore, doctors try to replace the missing tissue whenever possible. This can help prevent or alleviate functional disorders. Removal of the Adam’s apple results in voice loss. The patient must relearn vocal speech.

Radiation therapy or radiation chemotherapy can alter healthy tissue. Among other things, this can lead to dry mouth, difficulty swallowing, or damage to the teeth and jaw.

Surgery or radiation to the cervical lymph nodes can cause swelling of the face and neck. Experts refer to this as lymphedema.

If Cancer Cannot Be Cured

If the patient can no longer be cured, experts refer to a palliative situation. The main goal of treatment is to slow tumor growth to prolong the patient’s life and alleviate complaints. In this case, doctors determine the course of action individually. The following therapies are possible:

Chemotherapy
Targeted therapy
Immunotherapy
Radiation therapy
Surgical measures

In this situation, early supportive care is also important for patients: This includes measures that ensure pain management or adequate nutrition, for example. Seeking psychological support can also be beneficial for patients.

What is the Follow-Up Care for Mouth and Throat Cancer?

Patients with mouth or throat cancer should continue to attend regular doctor or clinic appointments after treatment. The goal of these follow-up care appointments is to monitor the patient’s health status and take precautions against the consequences of the disease or treatment. Detecting the recurrence of the disease (relapse) or a second tumor at an early stage is also important.

Appointments are initially made at shorter intervals and then at longer intervals. During the appointment, the doctor inquires about complaints and physically examines the patient. Regular examinations using imaging methods may also be added:

Ultrasound scan of the neck
Computed tomography (CT) and/or magnetic resonance imaging (MRI)
Positron emission tomography and CT (PET/CT)

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