Throat Years

Throat Years




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Throat Years


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Jennifer Welsh is a Connecticut-based science writer and editor with over ten years of experience under her belt. She’s previously worked and written for WIRED Science, The Scientist, Discover Magazine, LiveScience, and Business Insider. 
William Truswell, MD, is a board-certified facial plastic surgeon and otolaryngology (head and neck) surgeon. He is president of the American Board of Facial Plastic and Reconstructive Surgery and treats skin cancer patients as part of his practice.

Throat cancer is a subgroup of head and neck cancers. It typically refers to cancers that originate in the pharynx (the throat). 1 Thickened white patches on the lining of the throat are usually the earliest signs of cancer or a precancerous condition in the throat.


The most common type of throat cancer is called squamous cell carcinoma (SCC). This and other types of throat cancers are most often caused by environmental factors, including smoking or chewing tobacco. Infection with human papillomavirus (HPV) is an increasing cause as well. 2 Additional exposures that increase the risk for throat cancers include alcohol and betel quid, a stimulant used in Asia.

According to the National Cancer Institute, there were more than 53,000 cases of oral and pharynx cancer in 2020. Approximately 10,000 patients who have been diagnosed with these cancers died. The five-year survival rate for these cancers is about 66%. 3

This article reviews the appearance of several types of throat cancers and briefly describes their symptoms . 


Some throat cancers begin as oral leukoplakia, a general term for a white lesion in the mouth of an unknown cause. 


Leukoplakias are premalignant lesions, which means they’re not cancerous yet, but could develop into cancer. About 3% to 17.5% of these lesions are or will become cancerous in 15 years, 4 while others go away independently.


Common symptoms of oral leukoplakia include a persistent cough and sore throat lasting for more than three weeks. 


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Other throat and mouth cancers show up as red patches called erythroplakias. These are rare, isolated, velvety patches in the mouth and/or throat that typically show up in older patients. 5


Erythroplakia lesions are usually premalignant, but most of these red patches become cancerous, so it’s important to get them checked out. They typically affect middle-aged and elderly people, and are usually linked to tobacco and alcohol use. 5

Sometimes, lesions are a mix of red and white, referred to as erythroleukoplakias or “speckled leukoplakias.” Although the lesions most commonly occur on the floor of the tongue, they can also develop on tissues behind the back teeth, including the upper throat.

A classic sign of oral cancer is a persistent rough patch that looks like a sore and has a raised border. Unlike some ulcers and other lesions like canker sores , these are minimally painful.


A primary tumor of the throat can appear as a nodular mass on the floor of the mouth, tongue, tonsil, or wall of the throat. The mass will tend to be irregular, fixed, and relatively painless, but can interfere with swallowing and make you feel like you have something caught in your throat. This is most common in people with a long history of smoking.


Metastasis is the spread of cancer from its original location. Head and neck cancers can spread through the lymphatic system, which is another circulatory system of the body. In the lymphatic system, fluid flows to lymph nodes, where white blood cells act to remove or neutralize foreign substances and invaders such as bacteria, viruses, and cancer cells.


If throat cancer spreads through the lymph vessels, it will likely land in the lymph nodes of the neck. There, it can produce non-tender masses (lymphadenopathy) and then seed new tumors in other parts of the body.


When a primary tumor grows to a large size, it can cause difficulty swallowing or talking, earaches, headaches, spitting up blood, and sometimes partial airway obstruction.


Some throat cancers, specifically those associated with a human papillomavirus (HPV) infection, cause a swollen tongue.


Infection with HPV is one of the major causes of throat cancer. About 10% of men and 3.6% of women have oral HPV. 2 Many cases clear on their own, but some persist for years, which is when cancer can develop.


HPV-related oropharyngeal cancers are limited to the throat, while those caused by smoking, tobacco use, or other environmental triggers are found in the mouth and lips as well. 


The characteristic symptoms of HPV-associated throat cancer include a swollen tongue, tiny lumps inside the mouth, and mouth numbness. The persistence of symptoms is a telltale sign, particularly in younger people who do not smoke.

Human papillomavirus is an infection that we can prevent. The HPV vaccine is very safe and effective at preventing infections, genital warts, and precancers. 6

Another type of throat cancer, submucous fibrosis, is defined by the hardening of mucosal tissues. It is most often caused by the chewing of betel nut in Southeast Asian cultures, but also sometimes seen in people who chew tobacco. 


Submucous fibrosis is typically a precancerous disorder, but can become malignant in between 1.5% and 15% of cases. 7


These lesions typically start in the mouth and gums, but can also involve the throat. They can cause burning sensations after eating spicy foods, and cause pain when eating and difficulty opening the mouth.


Coughing up blood is extremely rare. It can result from timor cells eroding into blood vessels. This is a sign of end-stage disease with a grim prognosis. An additional symptom is loose teeth, which can develop as the tumor spreads to the bones of the jaw and teeth.


You may also notice changes in the voice if cancer spreads to the larynx. Large primary tumors can prevent swallowing, leading to poor nutrition. Weight loss and persistent fatigue may result from this or be the result of widespread metastasis.


Symptoms alone cannot diagnose throat cancer. If you’re worried about cancers of the head and neck, perform periodic oral self-exams. 8 Making regular dental visits can also be a good way to monitor for any unusual growths or lesions.


A diagnosis of throat cancer is made after much testing and examination by your doctor. Tests will include a physical exam, where your doctor will use their hands to feel for swollen lymph nodes and other nodules. They’ll also test to see if you have HPV.


They will do an endoscopy (a procedure in which a tiny camera is fed into your mouth through a tube), a biopsy of any suspicious lesions, and imaging like a computed tomography (CT) scan or magnetic resonance imaging (MRI). 1


If you’re a smoker and have unusual or persistent symptoms aligned with those above, speak to your doctor about getting further testing.

Centers for Disease Control and Prevention. HPV and oropharyngeal cancer .
National Institutes of Health, National Cancer Institute, Surveillance, Epidemiology, and End Results Program. Oral cavity and pharynx cancer—cancer stat facts .
World Health Organization International Agency for Research on Cancer. Leukoplakia .
World Health Organization Interational Agency for Research on Cancer. Erythroplakia .
Centers For Disease Control and Prevention. Reasons to get vaccinated against HPV .
Shih YH, Wang TH, Shieh TM, Tseng YH. Oral submucous fibrosis: a review on etiopathogenesis, diagnosis, and therapy . Int J Mol Sci . 2019;20(12):2940. doi:10.3390/ijms20122940
American Association of Oral and Maxillofacial Surgeons. Warning signs of oral cancer . 

By Jennifer Welsh

Jennifer Welsh is a Connecticut-based science writer and editor with over ten years of experience under her belt. She’s previously worked and written for WIRED Science, The Scientist, Discover Magazine, LiveScience, and Business Insider. 

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Dr. Marcelo Campos works as a primary care doctor at Atrius Health. He is a lecturer at Harvard Medical School and a clinical assistant professor at Tufts University School of Medicine. Dr. Campos completed medical school …
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Ahem! Ahem! Ever feel the need to move the mucus that annoyingly sits all the way at the back of your mouth? Most of us do at one time or another. The sensation usually lasts for just a few days when dealing with symptoms of a common cold.
But what happens if throat clearing lingers for weeks or months? That nagging feeling may be uncomfortable for the person who has the problem, and might also bother friends and family who hear the characteristic growling sound.
So what causes all that throat clearing? There are many causes, but I’ll focus here on four of the most common culprits. It’s important to know that throat clearing lasting more than two to three weeks deserves an evaluation from a medical professional.
Post-nasal drip is probably the most common cause of throat clearing.
Your nose makes nasal mucus to help clear infections and allergens, or in response to irritants such as cold weather. A frequently runny nose can be quite disturbing. Just as mucus can drip toward the front of the nose, some mucus may also drip from the back of the nose toward the throat, sometimes getting close to the vocal cords. If the mucus is too thick to swallow, we try to force it out with a loud AHEM!
Solutions: The best solution to this problem is to treat the cause of post-nasal drip. An easy way to do it without medications is to try nasal irrigation with a neti pot. If you notice no improvement, different types of nasal sprays may help. It is best to discuss these options with a health professional, because some sprays may cause your symptoms to worsen. The key is to understand what is causing excess mucus production.
Another common cause of throat clearing is laryngopharyngeal reflux (LPR). Acid in your stomach helps digest food. But excess stomach acid sometimes flows backward up the tube called the esophagus that links throat to stomach. This may splash on the vocal cords or throat, causing irritation and throat clearing.
Not everyone with acid reflux experiences a burning sensation in the throat. Nor does everyone have heartburn, which is a classic sign of a related condition called gastroesophogeal reflux disease (GERD). Some people merely feel an urge to clear their throat or have a persistent cough.
Solutions: Eating an anti-reflux diet and not lying down shortly after eating may help in some cases. Often, people have to use medications for several weeks or months to lower stomach acid production.
A common class of heart and blood pressure medicines can also cause throat clearing. These are called ACE inhibitors. The funny thing is that these medications can trigger the urge even after years of people taking them daily without experiencing that symptom. If that’s the cause there is an easy fix. The sensation would be completely gone after stopping the medication, although in some cases it can take several weeks to abate. It is very important to talk to your doctor before stopping a prescribed medicine, so you can switch to something else.
Damaged nerves responsible for sensation around the throat area is another possible cause. These issues are more difficult to treat, and are usually diagnosed after most of the other possibilities are ruled out. People often have this type of throat clearing for many years.
Solutions: A multidisciplinary team with ear, nose, and throat doctors (otolaryngologists) and neurologists may need to investigate the problem. Medicines that change how a person perceives sensation can help.
There are many other reasons for throat clearing. Some people, for instance, just have a tic of frequently clearing their throat. Noticing any clues that point to the root cause can help. Maybe constant throat clearing happens only during spring, pointing toward allergies, or perhaps after drinking coffee, a reason to consider reflux.
An observant eye and jotting notes in a diary may help shine a light on the problem and its possible solutions. Very often, when the cause remains elusive, your primary care doctor may recommend a trial of treatment as a way to diagnose the problem.

Marcelo Campos, MD ,
Contributor


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