Kim Richard Jones, M.D., Ph.D.
Adult and Pediatric Otolaryngology
Kathy Yu, M.D., M.P.H.
Adult and Pediatric Otolaryngology
 
Carolina ENT Associates 55 Vilcom Center Drive, Suite 140
Chapel Hill, NC 27514
phone: 919.942.7278
fax: 919.942.9029
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Lump in Throat

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I see many patients in my office who are worried they may have mouth or throat cancer. I would like to briefly go over the risk factors for these cancers, their symptoms, and when you should consider seeing a doctor.

Risk Factors for Cancer

Most cancers of the mouth or throat are what are called squamous cell cancers. These cancers come from the lining of the mouth and throat (called mucosa), and they can occur anywhere from the lips to the esophagus. In the mouth, they can occur on the gums, the tongue, and the inside of the cheek. In the throat, they can occur on the tonsils, the pharynx (the part of the throat that goes behind the tongue where you can’t see it), and the larynx (the voice box). Further down, they can occur in the esophagus. However, the risk factors for squamous cell cancer are the same no matter where it is: exposure to tobacco and alcohol! Smoking, of course, exposes every bit of mucosa, from the lips to the larynx. Furthermore, pipe and cigar smoke can be just as hazardous as cigarette smoke. Snuff and chewing tobacco, on the other hand, are more likely to cause mouth cancer. Drinking alcohol increases by several-fold the risk of getting cancer from tobacco. They do not have to be taken together to have this effect!

Although it is wonderful if someone is able to stop smoking or drinking to excess, it is important to remember that persons who smoke have an increased risk of mouth and throat cancer for up to twelve years after they stop. The good news is that after this time, their risk falls to approximately that of a non-smoker.

Symptoms of Cancer

The symptoms of squamous cell cancer depend on where it occurs. Thus, each area will be covered separately below.



Mouth

Although oral cancers can have a variety of appearances, one advantage is that they are usually visible at an early stage. They can appear as “punched out” areas where the mucosa is eaten away, or as raised, irregular growths that are usually red and irritated-looking. They can be painful or painless, but are often sensitive to acidic or spicy foods. Any unusual growth or area in the mouth that has not gone away in three weeks or is getting larger needs to be examined by an otolaryngologist, although fortunately many of these will turn out to be benign.



Pharynx


The pharynx includes both the part of the mouth from the tonsils back and the area of the throat that is behind and below the tongue. The throat area of the pharynx usually cannot be seen directly because the tongue is in the way. Cancers of the pharynx are usually painless in their early stages, and are notorious for not being noticed until they have grown large enough to interfere with swallowing. I should note that the nagging sensation of something stuck in the throat is a common symptom that is usually benign (please see “Lump in Throat” to the left), but the only way to be sure of this is to be examined by a throat specialist using a special telescope. Finally, one symptom that is classic for cancer of the pharynx is pain on swallowing that radiates to the ear. Again, although this is often caused by a benign condition such as acid reflux, anyone with this symptom should an ENT doctor.



Larynx


Cancers of the larynx are often picked up earlier than other throat cancers. This is because even small cancers of the vocal cords will rather quickly cause a person’s voice to become hoarse. Thus, although hoarseness is a very common symptom that almost always comes from something benign, anyone who has been hoarse for three weeks or more probably needs an exam of their larynx. Unfortunately, there can also be cancers of the larynx that do not involve the vocal cords. Like cancers of the pharynx, these can grow quite large before being discovered, and most commonly present as a difficulty in swallowing.

When Should You Be Worried
About Mouth or Throat Cancer?


The level of concern you should have about having mouth or throat cancer in some ways should be proportional to your personal history of tobacco and alcohol use. That is, if you smoked a pack a day for twenty years, your level of concern should be pretty high, whereas if you never smoked, that hoarseness or irritation in your throat is probably not cancer. Having said that, I have seen some bad cancers in people who never smoked or drank. Certainly, any symptom among those mentioned in the sections above that gets worse over a period of weeks should be evaluated, but mild or intermittent symptoms, especially in a non-smoker, can probably be safely watched for a month or so. Ultimately, the decision depends on your level of concern. If you are lying awake at night worried that you may have cancer, the easiest thing to do is to have someone evaluate you and hopefully put your mind at ease.
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