Cancers of the Mouth & Throat

A Patient's Guide to Treatment

By William M. Lydiatt, Perry J. Johnson, Jack Kusler

Addicus Books, Inc.

Copyright © 2012 William Lydiatt, M.D., and Perry Johnson, M.D.
All rights reserved.
ISBN: 978-1-886039-44-5

Contents

Acknowledgments,
Introduction,
PART I - Understanding Cancers of the Mouth & Throat,
1 Cancers of the Mouth and Throat,
2 Getting a Diagnosis,
3 Staging Cancer,
4 The Emotional Side of Cancer,
PART II - Treatment Options,
5 Surgery,
6 Radiation Therapy,
7 Chemotherapy,
8 Treating Mouth & Throat Cancer by Stage,
9 Clinical Trials,
10 Pain Management,
PART III - Post-Treatment Considerations,
11 Follow-up Care,
12 End-of-Life Issues,
Appendix,
Resources,
Glossary,
Index,
About the Authors,

CHAPTER 1

Cancers of the Mouth and Throat

If you have cancer, you are not alone. Each year, nearly 50,000 Americans develop a cancer of the lip, mouth, tongue, tonsils, throat, larynx, salivary glands, nose, and sinuses. Nearly 75 percent of these new cases are men. The incidence of mouth and throat cancer among women is, however, on the rise. As many as 500,000 are survivors of these cancers.

What Is Cancer?

Cancer is a group of cells growing out of control. Let's take a closer look at how this process occurs. Our cells contain a complicated set of instructions called DNA. These instructions tell a cell how to perform its job — that is, how to be a skin cell, a brain cell, a liver cell, and so on. They also tell the cell when to reproduce and when to die. DNA is the major constituent of our chromosomes, which determine what species we are and also what our individual traits will be, from our height and hair color to many aspects of our personality. Thus, DNA is often called the "building block" of life.

Sometimes, though, DNA can tear down what it has built. If a cell's DNA is damaged — for example, by a virus or toxic substance — the cell will usually die. Occasionally, instead, the abnormal cell will begin reproducing rapidly, creating ever greater numbers of new cells that also carry the DNA damage.

The more abnormal a cell's DNA becomes, the more abnormally the cell will behave. In turn, this increasingly abnormal behavior creates more and more mistakes within the cell. These DNA "mistakes" are called mutations. It appears that damaged cells must have between six and ten different mistakes before they begin behaving like a cancer.

Take, for example, the cells that make up the mucous membrane of the mouth and throat. These cells normally divide and reproduce only when old cells die or other cells are scraped away in normal activities such as chewing and swallowing. Under strict DNA instructions, the cells next to those that have died or been scraped away will reproduce to replace them. Once the dead cells have been replaced, the process of cell replication stops.

However, if the cells are exposed to excessive tobacco smoke, alcohol, or other hazards, their DNA may be damaged. They may pass the damage on to the next generation of cells as they reproduce. As larger and larger generations of abnormal cells are formed, they may eventually become visible as white or red patches in the mouth or throat. These are known as precancerous lesions. With time, the lesions may increase in both size and abnormality until they finally become true cancers.

Unfortunately, the out-of-control cell growth that causes cancer does not usually stop with the formation of a single tumor. Instead, the abnormal cells tend to invade surrounding tissue and can spread even farther, through the blood or through the lymphatic system. The lymphatic system includes channels, similar to veins, that carry white blood cells and nutrients and drain waste products away from tissues and cells. These channels contain rounded masses of tissue called lymph nodes, which filter bacteria, viruses, and cancer cells out of the lymphatic fluid.

When cancer spreads beyond the place where the first abnormal cells develop, each resulting new cancer is called a metastasis. When a group of cells grows into a mass that does not invade or spread elsewhere, the mass is called a benign — that is, a noncancerous — tumor, and it has a much better prognosis than cancer.

Health professionals also speak of cancers in terms of "grade". The higher the grade, the more aggressive the cancer and the likelihood that the cancer will come back after treatment. Lymph node involvement is also more likely in high-grade than low-grade tumors. High-grade cancers are more likely to spread to other areas of the body.

Causes of Mouth and Throat Cancer

Tobacco

Smoking cigarettes, or chewing or sniffing tobacco can put a person at high risk for cancer. All forms of tobacco are dangerous, but cigarette smoke is probably the most dangerous. Most people automatically think of lung cancer when they think of the risks of smoking, but cancer can form at any site that has contact with tobacco or its by-products. In fact, 90 percent of people with mouth and throat cancer have been users of tobacco in some form.

The tissues of the mouth and throat are directly exposed to harmful chemicals in tobacco, including formaldehyde, benzo-a-pyrene, nitrogen oxides, urethane, nickel, cadmium, radioactive polonium, hydrazine, and nitrosodiethylamine. These are known to damage the DNA in the cells at the site of contact.

Tobacco products can also damage other areas of the body, including the sinuses, esophagus, salivary glands, lungs, even the kidneys and bladder. All these tend to be sensitive to the effects of tobacco. Damage to these more distant parts of the body occurs after special proteins called enzymes have broken down the chemicals in tobacco. These enzymes reduce harmful substances to much smaller components that can be excreted through the urine. However, the broken-down products of tobacco can themselves be harmful. When the kidneys and bladder, for example, come into contact with these products, cellular damage can occur in those areas as well as in the mouth or throat.

Still, not everyone who uses tobacco will develop cancer, and some who have never used it will. In general, however, tobacco use is the biggest known cause of cancers of the mouth and throat. In fact, smoking 1 to 2 packs of cigarettes a day for 20 years or more gives you a risk of mouth or throat cancer that is 2 to 8 times greater than that of a nonsmoker. The more you smoke, the higher your risk. Women have a higher risk than men who smoke the same amount. One pack of cigarettes a day for a woman is roughly equivalent to 1.25 packs for a man.

Alcohol

Alcohol in large quantities (more than five drinks per day for men and somewhat fewer for women) is known to increase the risk of mouth and throat cancers — especially those at the floor of the mouth, base of the tongue, tonsils, and lower pharynx. As many as 80 percent of people with these cancers use alcohol regularly. Heavy drinking (five or more drinks per day) alone creates a risk that is five to eight times greater than that of a nondrinker. The combination of heavy alcohol use and tobacco use is particularly dangerous. For example, a person who consumes two packs of cigarettes and five drinks each day is about forty times more likely to get cancer than someone who does not smoke or drink. Hard...