Oral and throat cancer

Hospitals with particular experience in treating patients with head and neck tumors can demonstrate this through certification.

For an overview of specialized centers for head and neck tumors certified by the German Cancer Society (DKG), visit the OncoMap website. 

Do you have further questions about dealing with the condition in everyday life and additional support options? For information on this topic, visit the Cancer Information Service of the German Cancer Research Center’s website (in German).

If you have any questions about cancer of the oral cavity, contact the Cancer Information Service by dialing 0800 - 420 30 40 (toll free) or send an email to krebsinformationsdienst@dkfz.de 

Oral cancer and throat cancer are malignant diseases that typically originate in the oral cavity and throat. Specialists refer to them as squamous cell carcinoma. 

Salivary gland cancer 

Salivary gland cancer can also occur in the oral and throat. These tumors originate in the small salivary glands that are located in the mucous membrane of the mouth and throat. Malignant tumors can occur in the large salivary glands located in front of the ear and floor of the mouth, too. They can originate from a variety of cell types and accordingly behave in different ways.

At the start, a malignant tumor in the oral cavity or the throat is accompanied by no symptoms. Therefore, it is important to have changes in the mucous membrane examined when they persist for more than 2 weeks. 

As the disease progresses, symptoms can arise, which depend on the location, size, and aggressiveness of the tumor. Symptoms include the following: 

• If the tumor is located in the oral cavity, the patient may experience pain, limited tongue mobility, and difficulty swallowing and speaking. 
• A tumor in the nasopharynx can impede breathing and cause nose bleeds.  
• A tumor in the oralpharynx or further down in the throat can, in advanced stages, cause difficulty swallowing and a sore throat, which can be felt in the ear and cause muffled speech. For many, the first symptom is swelling of the throat. Swelling is an indication that the tumor has most likely already spread to the cervical lymph nodes. 
• A tumor in the large salivary glands is initially detected because of painless swelling. Later, it can cause pain, or paralysis or numbness due to damage to the facial nerves. 

Oral cancer and throat cancer, similar to almost all cancers, are a result of genetic cell mutations. These mutations cause normal somatic cells to turn into malignant cancerous cells, which start to grow uncontrollably. Many of these genetic mutations occur over the course of one’s life by chance. However, there are risk factors that impact this.

The following are considered risk factors for cancer of the oral cavity and throat:

• the consumption of alcohol and tobacco
• certain changes in the mucous membrane that appear red and white and that are considered precancerous
• an infection with the human papillomavirus (HPV)

Another risk factor for cancer of the nasopharynx is:

• an infection with the Epstein-Barr virus (EBV)

Another risk factor for lip cancer is:

• UV radiation through frequent exposure to the sun or to solariums

More information on carcinogenesis is available on the Cancer Information Service of the German Cancer Research Center’s website (in German).

Malignant tumors in the oral cavity or the throat often develop from precancerous conditions. They are changes in the tissue whose cells have changed significantly from those in the original tissue. These cells can then develop into cancer. 

Metastases 

Malignant tumors in the oral cavity and throat can spread early on into the surrounding lymph nodes. Therefore, doctors often treat them as well. In some patients, the tumor spreads via the blood into other organs. Most often, the lungs are affected; less often the liver and the bones. Bone metastases are more common in nasopharynx cancer. 

Secondary tumor 

When the main risk factors, tobacco and alcohol, are present, a secondary cancer in the head-neck area, in the lungs, or in the esophagus can occur along with oral and throat cancer. 

If a malignant condition of the oral cavity or the throat is suspected, doctors examine the entire oral cavity and throat area, as well as the larynx. 

Throat, nose, and ear specialists and/or oral-maxillofacial surgeons are involved in the diagnosis. Sometimes other doctors make the initial diagnosis, such as general practitioners or dentists. 

If the doctor finds a suspicious area or a tumor, a tissue sample is taken. A microscope is able to detect if the tissue sample is cancerous. Depending on the location of the tumor, general anesthetic is needed when taking the tissue samples. 

If a tumor in the salivary glands is suspected, a needle is used to take a tissue sample. Specialists call this a fine needle biopsy or fine needle aspiration. 

Staging diagnostics 

Under general anesthesia the doctor examines the mouth, throat, and larynx, as well as the trachea, bronchi, and esophagus. The goal is to find out how far the tumor has spread and if a secondary tumor exists. 

The doctor uses imaging techniques to determine if the tumor has spread. The following examinations are considered: 

• ultrasound of the salivary glands, the throat, and the abdomen
• computed tomography (CT)/magnetic resonance imaging (MRI) of the throat and neck, and possibly also the chest
• X-ray of the jaw bone
• bone scintigraphy
• positron emission tomography and CT (PET/CT)

For more information about the process and possible risks of the various examination methods, visit the Cancer Information Service of the German Cancer Research Center’s website (in German).

There are various treatment options for patients with oral and throat cancer. Doctors consider the following when selecting the appropriate form of treatment: 

• the location of the tumor
• if the tumor has spread and how aggressive it is
• possible side effects of the treatment
• the patient’s general condition and needs

Tumor operation  

An operation is considered if it is probable that the doctor can remove the tumor completely. The patient’s overall health should also allow for an operation. Depending on the tumor, it may be necessary for doctors to facilitate the patient’s breathing temporarily through an artificial connection to the trachea (tracheostoma). The tracheostoma remains in place permanently if the larynx must also be removed. This is mainly the case if the tumor is in advanced stages and located deep in the throat.

If there is increased risk of a relapse, the operation is followed by radiotherapy or chemoradiotherapy. They are especially necessary if the disease is in an advanced stage. 

For many patients with a tumor of the large or small salivary glands, surgery is an important step in treatment. The goal in this case is to remove the tumor completely. As is the case with oral and throat cancer, treatment for some patients is followed by radiotherapy, and less often chemoradiotherapy. 

Removing the cervical lymph nodes 

Typically, it is necessary for doctors to remove lymph nodes from some areas of the throat. Specialists call this a neck dissection. The reason for this type of surgery is that even if a doctor does not find suspicious cervical lymph nodes during a palpation examination or from an ultrasound, hidden lymph node metastases are present in many patients.

Radiotherapy and chemotherapy

For some patients, a tumor operation of the oral cavity or the throat is not possible or not wanted. In this situation, radiotherapy is considered. Often, the doctor combines it with chemotherapy. 

Special tumors that grow in the nasopharynx are very receptive to radiation and chemoradiotherapy. 

Side effects of treatment 

When a doctor removes a tumor from the mouth and throat, tissue in this area must be removed as well. This can severely limit a person’s ability to chew, swallow, and even speak. Therefore, doctors attempt to replace the missing tissue to the best of their ability. This can help to prevent functional impairments and alleviate their repercussions. If the larynx is removed, it may result in a loss of the voice. The patient must first relearn voiced speaking.

Radiation or chemoradiotherapy can alter healthy tissue. This can lead to dryness of the mouth, swallowing difficulties, or damage to the teeth and jaw. 

An operation on or radiotherapy of the cervical lymph nodes can lead to swelling of the face and neck. Specialists call this lymphedema. 

If the cancer cannot be cured

Palliative care is the term used by experts to describe a situation in which a patient cannot be cured. The most important objective of the treatment is to stop the growth of the tumor, prolong the life of the patient, and alleviate the symptoms. In this situation, doctors create an individual treatment plan for the patient. The following treatments are considered: 

• chemotherapy
• targeted treatment
• immunotherapy 
• radiotherapy
• surgical measures

In these situations, it is important to provide the patient with supportive treatments early on. These include, for example, pain treatment or measures that ensure proper nutrition. Furthermore, it may be helpful to offer the patient psychological support. 

For details about these treatments and the associated side effects, visit the Cancer Information Service of the German Cancer Research Center’s website (in German). 

Rehabilitation (rehab) is designed to prevent or alleviate the effects of the illness or its treatment. For patients with oral and throat cancer, this can include, for example, treating speech and swallowing difficulties, or nutrition consultation. For people in work, returning to work is also one of the goals of rehabilitation. 

Those who want to do rehab can discuss this with the doctors treating them. They certify the need for rehabilitation. The clinic social services in hospitals and local cancer advice centers and health insurance providers also answer any questions about rehab. 

Patients with cancer of the oral cavity or throat should select a hospital with a special oncology department known for expertise in voice, speech, and swallowing rehabilitation as needed. 

More information on rehabilitation after an oncological disorder is available on the Cancer Information Service of the German Cancer Research Center’s website (in German).

Patients with oral and throat cancer must regularly schedule aftercare appointments at their doctor’s office or the hospital after treatment. The objectives of these aftercare appointments are to monitor the general condition of the patient and offer supportive measures to alleviate side effects of the illness or its treatment. Furthermore, they are designed to recognize signs of a relapse or secondary tumor early on. 

The appointments are initially scheduled at shorter intervals, then longer ones. During the appointment, the doctor looks for symptoms and performs a physical examination. In addition, regular examinations using imaging techniques may be considered: 

• ultrasound of the neck
• computed tomography (CT)/magnetic resonance imaging (MRI)
• positron emission tomography and CT (PET/CT)

Other aspects checked during aftercare are chewing, swallowing, and speech impairments. If necessary, the patient can be referred to an appropriate therapist, for example, a speech therapist. Patients experiencing difficulties in getting proper nutrition can receive nutrition consultation. Psychological counseling is also available as part of aftercare. 

Quitting a smoking habit 

Additionally, part of aftercare can include helping a patient quit smoking and give up alcohol. Even after the tumor is treated, tobacco and alcohol remain serious risk factors for a relapse or other tumors in the head-neck area. 

A tumor in the oral cavity or throat can create difficulties in chewing, swallowing, and speaking. Even after treatment, functions of the mouth and throat can be impaired. It is not possible for all patients to hide these impairments, and they can greatly impact social situations. 

The patient must first learn to live with any limitations. With some impairments, exercises can improve the situation, for example, chewing, swallowing, and speech therapy. 

Financial hardship 

This illness can compromise a person’s job situation. That is why it is important for patients to obtain professional rehabilitation socio-legal advice to avoid financial hardship.