LARYNGEAL CANCER  ~ CANCER OF THE OROPHARYNX  

LIP AND ORAL CAVITY CANCER ~ THROAT CANCER

 

A lump in the neck...Cancers that begin in the head or neck usually spread to lymph nodes in the neck before they spread elsewhere. A lump in the neck that lasts more than two weeks should be seen by a doctor as soon as possible. Of course, not all lumps are cancer. But a lump (or lumps) in the neck can be the first sign of cancer of the mouth, throat, voicebox (larynx), thyroid gland, or of certain lymphomas or blood cancers. Such lumps are generally painless and continue to enlarge steadily.

Change in the voice...Most cancers in the larynx cause some change in voice. Any hoarseness or other voice change lasting more than two weeks should alert you to see your physician.  While most voice changes are not caused by cancer, you shouldn't take chances. If you are hoarse more than two weeks, see your doctor.

A growth in the mouth...Most cancers of the mouth or tongue cause a sore or swelling that doesn't go away. These sores and swellings may be painless unless they become infected. Bleeding may occur, but often not until late in the disease.

Swallowing problems...Cancer of the throat or oesophagus may make swallowing solid foods difficult. The food may "stick" at a certain point and then either go through to the stomach or come back up. If you have trouble almost every time you try to swallow something, you should see a doctor.

When found early, most cancers in the head and neck can be cured with relatively little difficulty. Cure rates for these cancers could be greatly improved if people would seek medical advice as soon as possible.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Laryngeal Cancer

Cancer of the larynx (or voicebox) is a disease in which malignant cells are found in the tissues of the larynx. The larynx is a short passageway shaped like a triangle that is just below the pharynx in the neck. The pharynx is a hollow tube about 5 inches long that starts behind the nose and goes down to the neck to become part of the oesophagus, the tube that goes to the stomach. Air passes through the pharynx and then the larynx on the way to the windpipe (trachea) and into the lungs. Food passes through the pharynx on the way to the oesophagus. The larynx has a small piece of tissue over it, called the epiglottis, to keep food from going into it or the air passages.

The larynx contains the vocal cords, which vibrate and make sound when air is directed against them. The sound echoes through the pharynx, mouth, and nose to make a personís voice. The muscles in the pharynx, face, tongue, and lips help people form words with sounds to make them understandable.

There are three main parts of the larynx:

  1. The glottis (the middle part of the larynx where the vocal cords are)
  2. The supraglottis (the tissue above the glottis)
  3. The subglottis (the tissue below the glottis). The subglottis connects to the trachea, which takes air to the lungs.

Cancer of the larynx is most commonly found in people who smoke. If a person has cancer of the larynx and smokes, smoking should be stopped.

A doctor should be seen if the following symptoms appear:

  • A sore throat that does not go away
  • Pain when swallowing
  • A change or hoarseness in the voice
  • Pain in the ear
  • A lump in the neck

If there are symptoms, a doctor will put a tube with a special light on the end of it down the patientís throat to look at the larynx. This is called laryngoscopy. If tissue that is not normal is found, the doctor will need to cut out a small piece and look at it under the microscope to see if there are any cancer cells. This is called a biopsy. The doctor will also feel the throat for lumps. The chance of recovery (prognosis) depends on where the cancer is in the larynx, whether the cancer is just in the larynx or has spread to other tissues (the stage), and the patientís general state of health.

Stages of cancer of the larynx
Once cancer of the larynx is found, more tests will be done to find out if cancer cells have spread to other parts of the body. This is called staging. A doctor needs to know the stage of the disease to plan treatment. In cancer of the larynx, the definitions of the early stages depend on where the cancer started. The following stages are used for cancer of the larynx:

Stage I
The cancer is only in the area where it started and has not spread to lymph nodes in the area or to other parts of the body (lymph nodes are small bean-shaped structures that are found throughout the body; they produce and store infection-fighting cells). The exact definition of stage I depends on where the cancer started, as follows:

Supraglottis
The cancer is only in one area of the supraglottis and the vocal cords can move normally.

Glottis
The cancer is only in the vocal cords and the vocal cords can move normally.

Subglottis
The cancer has not spread outside of the subglottis.

Stage II
The cancer is only in the larynx and has not spread to lymph nodes in the area or to other parts of the body. The exact definition of stage II depends on where the cancer started, as follows:

Supraglottis
The cancer is in more than one area of the supraglottis, but the vocal cords can move normally.

Glottis
The cancer has spread to the supraglottis or the subglottis or both. The vocal cords may or may not be able to move normally.

Subglottis
The cancer has spread to the vocal cords, which may or may not be able to move normally.

Stage III
Either of the following may be true:

  1. The cancer has not spread outside of the larynx, but the vocal cords cannot move normally, or the cancer has spread to tissues next to the larynx.
  2. The cancer has spread to one lymph node on the same side of the neck as the cancer, and the lymph node measures no more than 3 centimetres (just over 1 inch).

Stage IV
Any of the following may be true:

  1. The cancer has spread to tissues around the larynx, such as the pharynx or the tissues in the neck. The lymph nodes in the area may or may not contain cancer.
  2. The cancer has spread to more than one lymph node on the same side of the neck as the cancer, to lymph nodes on one or both sides of the neck, or to any lymph node that measures more than 6 centimetres (over 2 inches).
  3. The cancer has spread to other parts of the body.

Recurrent
Recurrent disease means that the cancer has come back (recurred) after it has been treated. It may come back in the larynx or in another part of the body.

How cancer of the larynx is treated
There are treatments for all patients with cancer of the larynx. Three kinds of treatment are used:

  • Radiation therapy (using high-dose x-rays or other high-energy rays to kill cancer cells)
  • Surgery (taking out the cancer)
  • Chemotherapy (using drugs to kill cancer cells)

Radiation therapy uses high-energy x-rays to kill cancer cells and shrink tumours. Radiation may come from a machine outside the body (external radiation therapy) or from putting materials that produce radiation (radioisotopes) through thin plastic tubes in the area where the cancer cells are found (internal radiation therapy). External radiation to the thyroid or the pituitary gland may change the way the thyroid gland works. The doctor may wish to test the thyroid gland before and after therapy to make sure it is working properly. Giving drugs with the radiation therapy to make the cancer cells more sensitive to radiation (radiosensitization) is being tested in clinical trials. Radiation given in several small doses per day (hyperfractionated radiation therapy) is also being tested in clinical trials. If smoking is stopped before radiation therapy is started, there is a better chance of surviving longer.

Surgery is a common treatment of cancer of the larynx. A doctor may remove the cancer and part of the larynx using one of the following operations:

  1. A cordectomy takes out only the vocal cord.
  2. A supraglottic laryngectomy takes out only the supraglottis.
  3. A partial or hemilaryngectomy removes only part of the larynx.
  4. A total laryngectomy removes the entire larynx. During this operation, a hole is made in the front of the neck to allow the patient to breathe. This is called a tracheostomy. If cancer has spread to lymph nodes, the lymph nodes will be removed (lymph node dissection).
  5. Laser surgery may be used for very early cancers of the larynx. During laser surgery, a narrow, intense beam of light is used to cut out the cancer.

Chemotherapy uses drugs to kill cancer cells. Chemotherapy may be taken by pill, or it may be put into the body by a needle in a vein or muscle. Chemotherapy is called a systemic treatment because the drug enters the bloodstream, travels through the body, and can kill cancer cells throughout the body.

People with larynx cancer have a higher risk of getting other cancers in the head and neck area. Clinical trials of chemoprevention therapy are testing whether certain drugs can prevent second cancers from developing in the mouth, throat, windpipe, nose, or oesophagus (the tube that connects the throat to the stomach).

Because the larynx helps with breathing and talking, a patient may need special help adjusting to the side effects of the cancer and its treatment. A patient may need to learn a new way of talking, or may need a special device to help with talking. The patientís doctor will consult with several kinds of doctors who can help determine the best treatment. Trained medical staff can also help the patient recover from treatment and adjust to new ways of eating and talking.

Stage I Laryngeal Cancer
Treatment depends on where the cancer is found in the larynx.

If cancer is in the supraglottis, treatment may be one of the following:

  1. External beam radiation therapy
  2. Surgery to remove the supraglottis (supraglottic laryngectomy)
  3. Surgery to remove the larynx (total laryngectomy)

If the cancer is in the glottis, treatment may be one of the following:

  1. Radiation therapy
  2. Surgery to take out a vocal cord (cordectomy)
  3. Surgery to remove part of the larynx (hemilaryngectomy) or total laryngectomy
  4. Laser surgery

If the cancer is in the subglottis, treatment will probably be radiation therapy. In some cases, a hemilaryngectomy may be done.

Stage II Laryngeal Cancer
Treatment depends on where the cancer is found in the larynx.

If the cancer is in the supraglottis, treatment may be one of the following:

  1. External-beam radiation therapy
  2. Surgery to remove the supraglottis (supraglottic laryngectomy) or the entire larynx (laryngectomy).
  3. Radiation therapy may be given after surgery.
  4. A clinical trial of several small doses of radiation per day (hyperfractionated radiation therapy).
  5. A clinical trial of chemoprevention therapy to prevent a second cancer in the mouth, throat, windpipe, nose, or oesophagus.

If the cancer is in the glottis, treatment may be one of the following:

  1. Radiation therapy.
  2. Surgery to remove part of the larynx (hemilaryngectomy) or total laryngectomy.
  3. A clinical trial of several smaller doses of radiation per day (hyperfractionated radiation therapy).
  4. A clinical trial of chemoprevention therapy to prevent a second cancer in the mouth, throat, windpipe, nose, or oesophagus.

If the cancer is in the subglottis, treatment may be one of the following:

  1. Radiation therapy.
  2. Surgery to remove part of the larynx (hemilaryngectomy) or total laryngectomy.
  3. A clinical trial of several smaller doses of radiation per day (hyperfractionated radiation therapy).
  4. A clinical trial of chemoprevention therapy to prevent a second cancer in the mouth, throat, windpipe, nose, or oesophagus.

Clinical trials are evaluating the use of several smaller doses of radiation per day (hyperfractionated radiation therapy).

Stage III Laryngeal Cancer
Treatment depends on where the cancer is found in the larynx.

If the cancer is in the supraglottis, treatment may be one of the following:

  1. Surgery to remove the cancer with or without radiation therapy.
  2. Radiation therapy. Surgery to remove the larynx (laryngectomy) may be needed if the cancer does not shrink after radiation.
  3. A clinical trial of several smaller doses of radiation per day (hyperfractionated radiation therapy)
  4. A clinical trial of chemotherapy followed by radiation therapy or chemotherapy combined with radiation therapy. Surgery to remove the larynx (laryngectomy) may be needed if the cancer does not shrink after chemotherapy and radiation.
  5. Clinical trials of chemotherapy, the use of drugs to make the cancer cells more sensitive to radiation (radiosensitizers), or new forms of radiation.
  6. Chemoprevention therapy to prevent a second cancer in the mouth, throat, windpipe, nose, or oesophagus.

If the cancer is in the glottis, treatment may be one of the following:

  1. Surgery with or without radiation therapy.
  2. Radiation therapy. Surgery to remove the larynx (laryngectomy) may be needed if the cancer does not shrink after radiation.
  3. A clinical trial of several smaller doses of radiation per day (hyperfractionated radiation therapy)
  4. A clinical trial of chemotherapy followed by radiation therapy or chemotherapy combined with radiation therapy. Surgery to remove the larynx (laryngectomy) may be needed if the cancer does not shrink after chemotherapy and radiation.
  5. Clinical trials of chemotherapy, the use of drugs to make the cancer cells more sensitive to radiation (radiosensitizers), or new forms of radiation.
  6. Chemoprevention therapy to prevent a second cancer in the mouth, throat, windpipe, nose, or oesophagus.

If the cancer is in the subglottis, treatment may be one of the following:

  1. Surgery to remove the larynx (total laryngectomy), some of the tissue around it, the thyroid gland while preserving the parathyroid glands located near the thyroid, and the lymph nodes in the neck. Surgery is usually followed by radiation therapy.
  2. Radiation therapy if a patient cannot have surgery.
  3. A clinical trial of several smaller doses of radiation per day (hyperfractionated radiation therapy)
  4. Clinical trials of chemotherapy, the use of drugs to make the cancer cells more sensitive to radiation (radiosensitizers), or new forms of radiation.
  5. Chemoprevention therapy to prevent a second cancer in the mouth, throat, windpipe, nose, or oesophagus

Stage IV Laryngeal Cancer
Treatment depends on where the cancer is found in the larynx. If the cancer is in the supraglottis, treatment may be one of the following:

  1. Surgery to remove the larynx (total laryngectomy) followed by radiation therapy.
  2. Radiation therapy. Surgery to remove the larynx (laryngectomy) may be needed if the cancer does not shrink after radiation.
  3. A clinical trial of several smaller doses of radiation per day (hyperfractionated radiation therapy)
  4. A clinical trial of chemotherapy followed by radiation therapy or chemotherapy combined with radiation therapy. Surgery to remove the larynx (laryngectomy) may be needed if the cancer does not shrink after chemotherapy and radiation.
  5. Clinical trials of chemotherapy, the use of drugs to make the cancer cells more sensitive to radiation (radiosensitizers), or new forms of radiation.
  6. Chemoprevention therapy to prevent a second cancer in the mouth, throat, windpipe, nose, or oesophagus.

If the cancer is in the glottis, treatment may be one of the following:

  1. Total laryngectomy followed by radiation therapy.
  2. Radiation therapy. Surgery to remove the larynx (laryngectomy) may be needed if the cancer does not shrink after radiation.
  3. A clinical trial of several smaller doses of radiation per day (hyperfractionated radiation therapy)
  4. A clinical trial of chemotherapy followed by radiation therapy or chemotherapy combined with radiation therapy. Surgery to remove the larynx (laryngectomy) may be needed if the cancer does not shrink after chemotherapy and radiation.
  5. Clinical trials of chemotherapy, the use of drugs to make the cancer cells more sensitive to radiation (radiosensitizers), or new forms of radiation.
  6. Chemoprevention therapy to prevent a second cancer in the mouth, throat, windpipe, nose, or oesophagus.

If the cancer is in the subglottis, treatment may be one of the following:

  1. Total laryngectomy, removal of the thyroid gland, and removal of some of the tissue around the larynx and the lymph nodes in the neck. Surgery is usually followed by radiation therapy.
  2. Radiation therapy if a patient cannot have surgery. Clinical trials are testing new ways of giving radiation therapy and the use of radiosensitizers.
  3. A clinical trial of several smaller doses of radiation per day (hyperfractionated radiation therapy)
  4. A clinical trial of chemotherapy and hyperfractionated radiation therapy given at the same time.
  5. Clinical trials of chemotherapy, the use of drugs to make the cancer cells more sensitive to radiation (radiosensitizers), or new forms of radiation.
  6. Chemoprevention therapy to prevent a second cancer in the mouth, throat, windpipe, nose, or oesophagus.

Recurrent Laryngeal Cancer
Treatment depends on the kind of treatment the patient had when first treated. If the patient had surgery alone, the patient may have surgery again or radiation therapy. If the patient had radiation therapy alone, additional radiation therapy or surgery may be considered. If the patient failed surgery and radiation therapy, clinical trials of chemotherapy may be given to relieve symptoms.

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Lip and Oral Cavity Cancer

Cancer of the lip and oral cavity is a disease in which cancer cells are found in the tissues of the lip or mouth. The oral cavity includes the front two thirds of the tongue, the upper and lower gums (the gingiva), the lining of the inside of the cheeks and lips (the buccal mucosa), the bottom (floor) of the mouth under the tongue, the bony top of the mouth (the hard palate), and the small area behind the wisdom teeth (the retromolar trigone).

Cancers of the head and neck are most often found in people who are over the age of 45. Cancer of the lip is more common in men than in women, and is more likely to develop in people with light-coloured skin who have been in the sun a lot. Cancer of the oral cavity is more common in people who chew tobacco or smoke pipes.

A doctor should be seen if a person finds a lump in the lip, mouth, or gums, finds a sore in the mouth that doesnít heal, or has bleeding or pain in the mouth. Another sign of a cancer of the mouth or gums is when dentures no longer fit well. Often lip and oral cavity cancers are found by dentists when examining the teeth.

If there are symptoms, a doctor will examine the mouth using a mirror and lights. The doctor may order x-rays of the mouth. If tissue that is not normal is found, the doctor will need to cut out a small piece and look at it under the microscope to see if there are any cancer cells. This is called a biopsy. The patient will be given a substance to take feeling away from the area for a short time (a local anaesthetic) so no pain is felt. The doctor will also feel the throat for lumps.

The chance of recovery (prognosis) depends on where the cancer is in the lip or mouth, whether the cancer is just in the lip or mouth or has spread to other tissues (the stage), and the patientís general state of health.

Stage of cancer of the lip and oral cavity
Once cancer of the lip and oral cavity is found, more tests will be done to find out if cancer cells have spread to other parts of the body. This is called staging. A doctor needs to know the stage of the disease to plan treatment. The following stages are used for cancer of the lip and oral cavity:

Stage I
The cancer is no more than 2 centimetres (about 1 inch) and has not spread to lymph nodes in the area (lymph nodes are small bean-shaped structures that are found throughout the body; they produce and store infection-fighting cells).

Stage II
The cancer is more than 2 centimetres, but less than 4 centimetres (less than 2 inches), and has not spread to lymph nodes in the area.

Stage III
Either of the following may be true:

  1. The cancer is more than 4 centimetres.
  2. The cancer is any size but has spread to only one lymph node on the same side of the neck as the cancer. The lymph node that contains cancer measures no more than 3 centimetres (just over one inch).

Stage IV
Any of the following may be true:

  1. The cancer has spread to tissues around the lip and oral cavity. The lymph nodes in the area may or may not contain cancer.
  2. The cancer is any size and has spread to more than one lymph node on the same side of the neck as the cancer, to lymph nodes on one or both sides of the neck, or to any lymph node that measures more than 6 centimetres (over 2 inches).
  3. The cancer has spread to other parts of the body.

Recurrent
Recurrent disease means that the cancer has come back (recurred) after it has been treated. It may come back in the lip and oral cavity or in another part of the body.

How cancer of the lip and oral cavity is treated

There are treatments for all patients with cancer of the lip and oral cavity. Two kinds of treatment are used:

  • Surgery (taking out the cancer)
  • Radiation therapy (using high-dose x-rays or other high-energy rays to kill cancer cells)

Chemotherapy (using drugs to kill cancer cells) is being tested in clinical trials.

Surgery is a common treatment of cancer of the lip and oral cavity. The doctor may remove the cancer and some of the healthy tissue around the cancer. The doctor may also remove the lymph nodes in the neck (lymph node dissection).

Radiation therapy uses high-energy x-rays to kill cancer cells and shrink tumours. Radiation may come from a machine outside the body (external radiation therapy) or from putting materials that produce radiation (radioisotopes) through thin plastic tubes or needles in the area where the cancer cells are found (internal radiation therapy). If smoking is stopped before radiation therapy is started, the patient has a better chance of surviving longer.

Chemotherapy uses drugs to kill cancer cells. Chemotherapy may be taken by pill, or it may be put into the body by a needle in a vein or muscle. Chemotherapy is called a systemic treatment because the drug enters the bloodstream, travels through the body, and can kill cancer cells throughout the body.

If the doctor removes all the cancer that can be seen at the time of the operation, the patient may be given chemotherapy after surgery to kill any cancer cells that are left. Chemotherapy given after an operation to a person who has no cancer cells that can be seen is called adjuvant chemotherapy. Chemotherapy given before surgery to try and shrink the cancer so it can be removed is called neoadjuvant chemotherapy.

Hyperthermia is a new treatment being tested in certain patients. It uses a special machine to heat the body for a certain period of time to kill cancer cells. Because cancer cells are often more sensitive to heat than normal cells, the cancer cells die and the cancer shrinks.

Because the lips and mouth are needed to eat and talk, a patient may need special help adjusting to the side effects of the cancer and its treatment. The doctor will consult with several kinds of doctors who can help determine the best treatment for the patient. Trained medical staff can also help a patient recover from treatment and adjust to new ways of eating and talking. A patient may need plastic surgery or help learning to eat and speak if a large part of the lip or mouth is taken out.

Stage I Lip and Oral Cavity Cancer
Treatment depends on where the cancer is in the lip or mouth.

Lip cancer
If the cancer is in the lip, treatment may be one of the following:

  1. Surgery.
  2. Radiation therapy.

Tongue cancer
If the cancer is in the tongue, treatment may be one of the following:

  1. Surgery.
  2. Surgery followed by radiation therapy to the neck.
  3. Radiation therapy to the mouth and the neck.

Buccal mucosa cancer
If the cancer is in the lining of the inside of the cheeks and lips (buccal mucosa), treatment may be one of the following:

  1. Surgery.
  2. Radiation therapy.

Floor of the mouth cancer
If the cancer is in the bottom (floor) of the mouth, treatment may be one of the following:

  1. Surgery.
  2. Radiation therapy.

Lower gum cancer
If the cancer is in the lower gums (gingiva), treatment may be one of the following:

  1. Surgery.
  2. Radiation therapy.

Retromolar trigone cancer
If the cancer is in the small area behind the wisdom teeth, (retromolar trigone), treatment may be one of the following:

  1. Surgery to remove part of the jawbone.
  2. Radiation therapy followed (if needed) by surgery.

Upper gums and hard palate cancer
If the cancer is in the upper gums (gingiva) or the top bony part of the mouth (hard palate), treatment may be one of the following:

  1. Surgery.
  2. Surgery followed by radiation therapy.

Stage II Lip and Oral Cavity Cancer
Treatment depends on where the cancer is in the lip or mouth.

Lip cancer
If the cancer is in the lip, treatment may be one of the following:

  1. Surgery.
  2. External and/or internal radiation therapy.

Tongue cancer
If the cancer is in the tongue, treatment may be one of the following:

  1. Radiation therapy.
  2. Surgery and radiation therapy.

Buccal mucosa cancer
If the cancer is in the lining of the inside of the cheeks and lips (buccal mucosa), treatment may be one of the following:

  1. Radiation therapy.
  2. Surgery.
  3. Surgery plus radiation therapy.

Floor of the mouth cancer
If the cancer is in the bottom (floor) of the mouth, treatment may be one of the following:

  1. Surgery.
  2. Radiation therapy.
  3. Surgery followed by internal or external radiation therapy.

Lower gum cancer
If the cancer is in the lower gums (gingiva), treatment may be one of the following:

  1. Surgery.
  2. Radiation therapy.

Retromolar trigone cancer
If the cancer is in the small space behind the wisdom teeth (retromolar trigone), treatment may be one of the following:

  1. Surgery to remove part of the jawbone.
  2. Radiation therapy followed (if needed) by surgery.

Upper gum or hard palate cancer
If the cancer is in the upper gums or the top bony part of the mouth (hard palate), treatment will probably be surgery followed by radiation therapy.

Stage III Lip and Oral Cavity Cancer
Treatment depends on where the cancer is in the lip or mouth. In addition to the treatments listed below, a patient will probably have radiation therapy to the neck with or without surgery to remove lymph nodes in the neck (lymph node dissection).

Lip cancer
If the cancer is in the lip, treatment may be one of the following:

  1. Surgery to remove the cancer plus internal or external radiation therapy.
  2. Radiation therapy.
  3. A clinical trial of chemotherapy followed by surgery or radiation therapy.
  4. A clinical trial of surgery followed by chemotherapy.
  5. A clinical trial of surgery, radiation therapy, and chemotherapy.
  6. A clinical trial of a new radiation therapy technique (superfractionated).

Tongue cancer
If the cancer is in the tongue, treatment may be one of the following:

  1. External beam with or without internal radiation therapy.
  2. Surgery followed by radiation therapy.

Buccal mucosa cancer
If the cancer is in the lining of the inside of the cheeks and lips (buccal mucosa), treatment may be one of the following:

  1. Surgery to remove the cancer and the tissue around it.
  2. Radiation therapy.
  3. Surgery plus radiation therapy.
  4. A clinical trial of chemotherapy followed by surgery or radiation therapy.
  5. A clinical trial of surgery followed by chemotherapy.
  6. A clinical trial of surgery, radiation therapy, and chemotherapy.

Floor of the mouth cancer
If the cancer is in the bottom (floor) of the mouth, treatment may be one of the following:

  1. Surgery to remove the cancer and lymph nodes in the neck. Part of the jawbone may also be removed if necessary.
  2. External beam therapy with or without internal radiation therapy.
  3. A clinical trial of chemotherapy followed by surgery or radiation therapy.
  4. A clinical trial of fractionated (smaller doses) radiation therapy.

Lower gum cancer
If the cancer is in the lower gums (gingiva), treatment will probably be radiation therapy given before or after surgery to remove the cancer.

Retromolar trigone cancer
If the cancer is in the small space behind the wisdom teeth (retromolar trigone), treatment may be one of the following:

  1. Surgery followed by radiation therapy.
  2. A clinical trial of chemotherapy followed by surgery or radiation therapy.
  3. A clinical trial of surgery followed by chemotherapy.
  4. A clinical trial of fractionated (smaller doses) radiation therapy.

Upper gum or hard palate cancer
If the cancer is in the top part of the gums (gingiva) or the top bony part of the mouth (the hard palate), treatment may be one of the following:

  1. Radiation therapy.
  2. Surgery plus radiation therapy.

For all stage III lip and oral cavity cancers, clinical trials are testing chemotherapy combined with radiation therapy.

Stage IV Lip and Oral Cavity Cancer
Treatment depends on where the cancer is in the lip or mouth. In addition to the treatments listed below, a patient will probably have radiation therapy to the neck with or without surgery to remove lymph nodes in the neck (lymph node dissection).

Lip cancer
If the cancer is in the lip, treatment may be one of the following:

  1. Surgery to remove the cancer plus internal or external radiation therapy.
  2. A clinical trial of radiation therapy.
  3. A clinical trial of chemotherapy combined with radiation therapy.
  4. A clinical trial of fractionated (smaller doses) radiation therapy.

Tongue cancer
If the cancer is in the tongue, treatment may be one of the following:

  1. Surgery to remove the tongue and the voicebox (larynx) below it followed by radiation therapy.
  2. Radiation therapy to relieve symptoms.
  3. A clinical trial of chemotherapy combined with radiation therapy.
  4. A clinical trial of fractionated (smaller doses) radiation therapy.

Buccal mucosa cancer
If the cancer is in the lining of the inside of the cheeks and lips (buccal mucosa), treatment may be one of the following:

  1. Surgery to remove the cancer and the tissue around it.
  2. Radiation therapy.
  3. Surgery plus radiation therapy.
  4. A clinical trial of chemotherapy combined with radiation therapy.
  5. A clinical trial of fractionated (smaller doses) radiation therapy.

Floor of the mouth cancer
If the cancer is in the bottom (floor) of the mouth, treatment may be one of the following:

  1. Surgery to remove the cancer followed by radiation therapy.
  2. Radiation therapy followed by surgery.
  3. A clinical trial of chemotherapy combined with radiation therapy.
  4. A clinical trial of fractionated (smaller doses) radiation therapy.

Lower gum cancer
If the cancer is in the lower gums (gingiva), treatment may be one of the following:

  1. Surgery, radiation therapy, or both.
  2. A clinical trial of chemotherapy combined with radiation therapy.
  3. A clinical trial of fractionated (smaller doses) radiation therapy.

Retromolar trigone cancer
If the cancer is in the small space behind the wisdom teeth (retromolar trigone), treatment may be one of the following:

  1. Surgery followed by radiation therapy.
  2. A clinical trial of chemotherapy combined with radiation therapy.
  3. A clinical trial of fractionated (smaller doses) radiation therapy.

Upper gum or hard palate cancer
If the cancer is in the top part of the gums (gingiva) or the top bony part of the mouth, treatment may be one of the following:

  1. Surgery plus radiation therapy.
  2. A clinical trial of chemotherapy combined with radiation therapy.
  3. A clinical trial of fractionated (smaller doses) radiation therapy.

Recurrent Lip and Oral Cavity Cancer
Treatment depends on the type of treatment the patient had before. If radiation therapy was given, the patient may have surgery when the cancer comes back. If surgery was used, the patient may have more surgery, radiation therapy, or both. Patients may want to consider taking part in a clinical trial of new chemotherapy drugs, chemotherapy plus additional radiation therapy, or hyperthermia.

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Cancer of the oropharynx

Cancer of the oropharynx is a disease in which cancer cells are found in the tissues of the oropharynx. The oropharynx is the middle part of the throat (also called the pharynx). The pharynx is a hollow tube about 5 inches long that starts behind the nose and goes down to the neck to become part of the oesophagus (tube that goes to the stomach). Air and food pass through the pharynx on the way to the windpipe (trachea) or the oesophagus. The oropharynx includes the soft palate (the back of the mouth), the base of the tongue, and the tonsils.

Cancer of the oropharynx most commonly starts in the cells that line the oropharynx.  for more information on cancer that started in the lymph cells of the oropharynx.)

A doctor should be seen if a person has a sore throat that does not go away, trouble swallowing, a lump in the back of the mouth or throat, a change in the voice, or pain in the ear.

If there are symptoms, a doctor will examine the throat using a mirror and lights. The doctor will also feel the throat for lumps. If tissue that is not normal is found, the doctor will need to cut out a small piece and look at it under the microscope to see if there are any cancer cells. This is called a biopsy.

The chance of recovery (prognosis) depends on where the cancer is in the throat, whether the cancer is just in the throat or has spread to other tissues (the stage), and the patientís general state of health. After the treatment, a doctor should be seen regularly because there is a chance of having a second cancer in the head or neck region.

Stages of cancer of the oropharynx
Once cancer of the oropharynx is found, more tests will be done to find out if cancer cells have spread to other parts of the body. This is called staging. A doctor needs to know the stage of the disease to plan treatment. The following stages are used for cancer of the oropharynx.

Stage I
The cancer is no more than 2 centimetres (about 1 inch) and has not spread to lymph nodes in the area (lymph nodes are small bean-shaped structures that are found throughout the body; they produce and store infection-fighting cells).

Stage II
The cancer is more than 2 centimetres, but less than 4 centimetres (less than 2 inches), and has not spread to lymph nodes in the area.

Stage III
Either of the following may be true:

  • The cancer is more than 4 centimetres.
  • The cancer is any size but has spread to only one lymph node on the same side of the neck as the cancer. The lymph node that contains cancer measures no more than 3 centimetres (just over one inch).

Stage IV
Any of the following may be true:

  • The cancer has spread to tissues around the oropharynx. The lymph nodes in the area may or may not contain cancer.
  • The cancer is any size and has spread to more than one lymph node on the same side of the neck as the cancer, to lymph nodes on one or both sides of the neck, or to any lymph node that measures more than 6 centimetres (over 2 inches).
  • The cancer has spread to other parts of the body.

Recurrent
Recurrent disease means that the cancer has come back (recurred) after it has been treated. It may come back in the oropharynx or in another part of the body.

How cancer of the oropharynx is treated
There are treatments for all patients with cancer of the oropharynx. Three kinds of treatment are used:

  • Surgery (taking out the cancer).
  • Radiation therapy (using high-dose x-rays or other high-energy rays to kill cancer cells).
  • Chemotherapy (using drugs to kill cancer cells).

Hyperthermia (warming the body to kill cancer cells) is being tested in clinical trials.

Surgery is a common treatment of cancer of the oropharynx. A doctor may remove the cancer and some of the healthy tissue around the cancer. If cancer has spread to lymph nodes, the lymph nodes will be removed (lymph node dissection). A new type of surgery called micrographic surgery is being tested in clinical trials for early cancers of the oropharynx. Micrographic surgery removes the cancer and as little normal tissue as possible. During this surgery, the doctor removes the cancer and then uses a microscope to look at the cancerous area to make sure there are no cancer cells remaining.

Radiation therapy uses high-energy x-rays to kill cancer cells and shrink tumours. Radiation may come from a machine outside the body (external radiation therapy) or from putting materials that produce radiation (radioisotopes) through thin plastic tubes in the area where the cancer cells are found (internal radiation therapy). External radiation to the thyroid or the pituitary gland may change the way the thyroid gland works. The doctor may wish to test the thyroid gland before and after therapy to make sure it is working properly. Giving drugs with the radiation therapy to make the cancer cells more sensitive to radiation (radiosensitization) is being tested in clinical trials. If smoking is stopped before radiation therapy is started, there is a better chance of surviving longer.

Chemotherapy uses drugs to kill cancer cells. Chemotherapy may be taken by pill, or it may be put into the body by a needle in the vein or muscle. Chemotherapy is called a systemic treatment because the drug enters the bloodstream, travels through the body, and can kill cancer cells throughout the body.

People with oropharyngeal cancer have a higher risk of getting other cancers in the head and neck area. Clinical trials of chemoprevention therapy are testing whether certain drugs can prevent second cancers from developing in the mouth, throat, windpipe, nose, or oesophagus (the tube that connects the throat to the stomach).

Hyperthermia uses a special machine to heat the body for a certain period of time to kill cancer cells. Because cancer cells are often more sensitive to heat than normal cells, the cancer cells die and the cancer shrinks.

Because the oropharynx helps in breathing, eating, and talking, patients may need special help adjusting to the side effects of the cancer and its treatment. A doctor will consult with several kinds of doctors who can help determine the best treatment. Trained medical staff can also help patients recover from treatment and adjust to new ways of eating and talking. Plastic surgery, or help learning to eat and speak, may be needed if a large part of the oropharynx is taken out.

Stage I Oropharyngeal Cancer
Treatment will be surgery to remove the cancer or radiation therapy

Stage II Oropharyngeal Cancer
Treatment will be surgery to remove the cancer or radiation therapy

Stage III Oropharyngeal Cancer
Treatment may be one of the following:

  1. Surgery to remove the cancer followed by radiation therapy.
  2. Radiation therapy.
  3. A clinical trial of chemotherapy followed by surgery or radiation therapy.
  4. A clinical trial of chemotherapy combined with radiation therapy.
  5. A clinical trial of new ways of giving radiation therapy.

Stage IV Oropharyngeal Cancer
If the cancer can be removed by surgery, treatment may be one of the following:

  1. Surgery to remove the cancer followed by radiation therapy.
  2. Radiation therapy.
  3. A clinical trial of radiation therapy combined with chemotherapy.
  4. A clinical trial of new ways of giving radiation therapy.

If the cancer cannot be removed by surgery, treatment may be one of the following:

  1. Radiation therapy. Clinical trials are testing new ways of giving radiation therapy.
  2. A clinical trial of chemotherapy followed by surgery or radiation therapy.
  3. A clinical trial of radiation therapy given with chemotherapy or with drugs to make the cancer cells more sensitive to radiation therapy (radiosensitizers).
  4. A clinical trial of hyperthermia plus radiation therapy.

Recurrent Oropharyngeal Cancer
Treatment may be one of the following:

  1. Surgery to remove the cancer.
  2. Radiation therapy.
  3. A clinical trial of chemotherapy.
  4. A clinical trial of hyperthermia plus radiation therapy.

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Throat Cancer

People who smoke or otherwise use tobacco are at risk of developing tumours of the throat. Excessive alcohol use also increases risk, and smoking and alcohol use together constitute an extreme risk for the development of throat cancers.  However, this doesn't mean that only patients who use tobacco and alcohol are at risk of developing throat cancer.            

Symptoms & Signs

  • hoarseness that does not resolve in 1 to 2 weeks

  • sore throat

  • neck pain

  • difficulty swallowing

  • swelling in the neck

  • weight loss

  • cough

  • coughing up blood

  • abnormal (high pitched) breathing sounds

Most cancers of the throat develop in adults older than 50, and men are 10 times more likely than women to develop throat cancers.  An examination of the neck and throat may show cancers of the throat. The sputum may appear bloody. A lump may appear on the outside of the neck. A laryngoscopy, which is examination by use of a tube with a small lighted camera (laryngoscope), allows the physician to look into the mouth and down the throat to see the tumour.

A neck or cranial CT scan or cranial MRI may show throat cancer. These tests will also help determine if the cancer has spread to lymph nodes in the neck.

Biopsy and analysis of tissues that appear abnormal may confirm the presence of a cancerous tumour.  Treatment is aimed at destruction of the cancer and prevention of spread of the cancer to other parts of the body.

When the tumour is small, either surgery or radiation therapy alone can be used to eliminate the tumour. When the tumour is larger or has spread to lymph nodes in the neck, combination radiation and chemotherapy is often used to preserve the voice box and is successful in most cases.

Surgical removal of the tumour, including all or part of the vocal cords (laryngectomy) may be necessary in some cases. If a laryngectomy is required, a surgical prosthesis (artificial vocal cords) may be implanted, voice aids may be used, or speech therapy may be recommended to teach alternative methods of speaking.

Many patients also need swallowing therapy after treatment to help them adjust to the changes in their throat. Throat cancers can be cured in 90% of patients if detected early. If the cancer has spread to surrounding tissues or lymph nodes in the neck 50-60% of patients can be cured. If the cancer has spread (metastasized) to parts of the body outside the head and neck, the cancer is not curable and treatment is aimed at prolonging quality of life.

After treatment patients generally need therapy to help with speech and swallowing. A small percentage of patients (5%) will not be able to swallow and will need to be fed through a feeding tube.

Throat Cancer Complications

  • airway obstruction
  • loss of voice and speaking ability
  • disfigurement of the neck or face
  • hardening of the skin of the neck
  • difficulty swallowing
  • spread of the cancer to other body areas (metastasis)

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