TONGUE
BASE
AND
TONSIL
CANCER
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").
What Causes, or Increases Risk for Oropharynx Cancer?
Like any cancer, the exact reason why one person gets oropharynx cancer and another
does not remains unknown. 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.
The Cancer Group Institute'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.
