General Information

Travel Information

Division Information

The mouth, nose and throat

The mouth, nose and throat are the parts of the head and neck involved in breathing, speaking, eating and swallowing.

The roof of the mouth is formed by the hard palate, which is bone, and behind it, the soft palate, made of muscle. Above the palate and behind each nostril are the two nasal cavities. These are separated by bone. At the back is an area called the nasopharynx, which opens into the throat (pharynx). Air goes this way when we breathe.

Looking into the mouth, we can see only the front part of the tongue. It sits within the jawbone and continues out of sight down the throat, so that the back of the tongue forms the front wall of the throat. The tongue is almost all muscle. The throat is muscle too. It is a tube that runs from the back of the nasal cavities to half way down the neck, where it branches. The back branch is the oesophagus (gullet), the narrow but elastic tube that carries food to the stomach. The front branch is the airway that goes to the lungs. At the top of the airway is the voice box (larynx) and this opens onto the windpipe (trachea).

All these parts are important for eating. The tongue moves food around the mouth as we chew, then collects it together into a soft ball and moves this back into the throat to trigger a swallow. The soft palate lifts to close off the nasal cavities and stop food going upwards. The throat then squeezes the food down to the oesophagus. The top of the oesophagus relaxes to let the food in and the muscular wall of the oesophagus continues to squeeze the food downwards. At the same time, to stop the food going the wrong way, the larynx acts as a valve to close off the airway. The valve is formed by two folds of skin (the vocal cords) coming together.

These parts also play an important role in speech. As we breathe out, air pushes up beneath the vocal cords and causes them to vibrate, producing the sound we know as voice. The voice resonates in the throat and the nasal cavities, like sound in a concert hall, and the tongue and lips shape it into the sounds of speech.
 

The thyroid gland and the salivary glands are also in this area. The thyroid gland is U-shaped, with its two lobes wrapped either side of the windpipe, just below the larynx. The salivary glands, which release saliva into the mouth, are mainly clustered in the floor of the mouth under the tongue, on the side of the face just in front of the ear, and under the jawbone.

Cancers of the mouth, nose and throat

Any part of the mouth, nose or throat may be affected by cancer.

A cancer may start in:

• the epithelium: cells that form the lining of the mouth, nose, pharynx or larynx

• the salivary glands or thyroid gland.

The most common type of cancer in this area is called a squamous cell carcinoma. The squamous cells form part of the epithelium. Squamous cell carcinomas most often occur on the lip, the tongue, the floor of the mouth under the tongue or the area at the back of the mouth: the tonsils, soft palate or base of the tongue.

As the cancer develops, the cancer cells increase in number and spread into surrounding tissues (including muscle and bone) and/or to the lymph nodes in the neck. From there it may spread to other parts of the body, although cancers of the mouth, nose and throat are generally slow to do this.

Causes of mouth, nose and throat cancers

The exact causes of cancers of the mouth, nose and throat are not known. However, we do know that smoking and alcohol are important risk factors. More than 80% of these cancers occur in people who smoke cigarettes, cigars or pipes. Heavy drinkers are also at increased risk. People who drink heavily and smoke are at greater risk again.

A few people who have never used tobacco or alcohol develop these cancers, indicating that other factors are also important.

Cancer of the lip can be caused by the ultraviolet radiation in sunlight. A hat plus lotion or lip balm containing sunscreen will reduce the risk. Pipe smokers are also especially prone to cancer of the lip.

Cancers of the nose can be linked to inhaling certain chemicals and hardwood dusts, usually in the workplace.

How common are cancers of the mouth, nose and throat?

Each year, more than six hundred people in Victoria are diagnosed with cancer in the mouth, nose or throat. These cancers are more common in men.

How is this cancer diagnosed?

• What are the symptoms?

• Doctors and other health professionals you may see

• Tests for these cancers

  • Computerised tomography (CT) scan

  • Magnetic resonance imaging (MRI)

  • Positron emission tomography (PET) scan

• 'Staging' the disease

What are the symptoms?

A number of warning signs may indicate cancer in the mouth and throat area, although these symptoms may also be caused by other, less serious problems. Don't wait for something to hurt: pain is not usually an early symptom.

If any of the symptoms listed below last for more than two weeks, it is important to see a doctor or dentist:

• a sore in the mouth that does not heal

• any swelling, lump, or thickening in the mouth or neck

• a persistent blocked nose

• a persistent ear ache

• a white patch on the gum, tongue or lining of the mouth (leukoplakia)

• a red patch on the gum, tongue or lining of the mouth (erythroplakia)

• a cough, sore throat or a feeling that something is caught in the throat

• blood-stained sputum or mucus

• changes in the voice, such as hoarseness

• pain in the mouth and throat area

• difficulty moving the jaw or tongue, or chewing, or swallowing

• numbness anywhere in the mouth

• swollen lymph nodes in the neck (although this is most likely to be caused by a harmless infection).

Cancers of the nasal areas may cause a range of other symptoms including hearing difficulty, headache, pain in the face or upper jaw, bleeding through the nose, and blocked sinuses.

Doctors and other health professionals you may see

Your doctor or dentist will examine you and refer you for tests to see if you have cancer. If the tests show you have cancer or may have cancer, your doctor will refer you to a specialist who will examine you and may ask your to have more tests. If you have cancer, one or more specialists will advise you about treatment options.

Your treatment team may include:

• head and neck surgeons: ear, nose and throat surgeons or general surgeons with further specialist training

• oral and maxillofacial surgeons: specialist dentists trained in surgery to the mouth and jaw

• reconstructive plastic surgeons: who reconstruct body parts damaged or lost through disease, medical treatment or accident

• radiation oncologists: who are responsible for radiotherapy

• medical oncologists: who are responsible for chemotherapy

• dentists: who are responsible for oral health care

• radiologists: who diagnose using x-ray technologies

• speech pathologists: who help with speech or swallowing difficulties

• dietitians: who recommend the best diets to follow while you are in treatment and recovery

• physiotherapists: who help people get moving after surgery and illness

• occupational therapists: who help people get back to normal activities

• social workers: who offer counselling and other assistance

• maxillofacial technicians: who make 'spare parts' to replace tissue of the face or mouth that has been removed

• prosthodontists: specialist dentists who are experts in oral rehabilitation and the fitting of 'spare parts'

• clinical psychologists: who provide support for people with emotional and social concerns.

Tests for these cancers

The doctor will examine you carefully. He or she may put a small mirror into the back of your mouth to look at your throat, or feel inside the mouth with a gloved finger. To see the larynx and throat more clearly, the doctor may use a laryngoscope (a thin tube with a light at the end), passed through your nose or into your mouth. This can be uncomfortable, but it doesn't hurt. An anaesthetic spray is often used to make it more comfortable.

The doctor may then do a biopsy: take a small piece of tissue from the abnormal area to send to a pathology laboratory for examination. You may have a small injection to numb the area first. The whole procedure usually takes about fifteen minutes. For a few people, a general anaesthetic may be needed, with a brief stay in hospital.

If the doctor suspects a thyroid cancer, a fine needle aspiration biopsy will be done. This takes about a minute and uses a syringe and needle. You may also need a thyroid scan. This involves having an injection of a small amount of a radioactive material, which is taken up by the cells in the thyroid gland. A special camera detects any cancer cells, which show up because they take up the material in a different way from other cells. The material loses its radioactivity very quickly so it does no harm.

Fine needle aspiration may also be done to diagnose other unusual lumps in the neck.

If the biopsy shows a cancer, your doctor may do other tests to find out its location, size and shape. This will help your doctor to plan your treatment. Tests may include x-rays to check whether the cancer affects any bones in your face or neck. You may also need to have one or more of the following tests.
 

Computerised tomography (CT) scan

The CT scan is a special type of x-ray that gives a three-dimensional (3-D) picture of the organs and other structures (including any tumours) in your body.

CT scans are usually done at a hospital or a radiology clinic. It takes about thirty to forty minutes to complete this painless test. You may be asked not to eat or drink before the scan.

You will have a liquid dye, in a drink and/or an injection, before the scan. This dye makes your organs appear white on the scans that are taken, so anything unusual will show more clearly.

You will be asked to lie on a table while the CT scanner, which is large and round like a doughnut, moves around you. Most people are able to go home as soon as their scan is over.
 

Magnetic resonance imaging (MRI)

This test is like a CT scan, but it uses magnetism instead of x-rays to build up pictures of your body.

Like a CT scan, MRI is painless, and the magnetism is harmless. You will be asked to lie on a couch inside a large metal tube, which is open at both ends. The test may take up to an hour. The tube makes some people feel claustrophobic (afraid of being in a small space). You can usually take someone into the room with you to keep you company. The machinery can be quite noisy.

The test takes fifteen to twenty minutes.
 

Position emission tomography (PET) scan

This test looks at the how tissue in your body is behaving. It can give valuable extra information to the CT or MRI scans. You will be injected with a glucose solution containing a very small amount of radioactive material. The scanner can 'see' the radioactive material, which shows where the glucose is being used in the body. Cancer cells show up as areas where glucose is being used by actively growing cells.

'Staging' the disease

The tests described above show whether you have cancer. They will also show where the primary cancer is and whether the cancer cells have spread to other parts of your body (this is known as metastasis). This helps your doctors 'stage' the disease so they can work out the best treatment for you.

The staging system used for cancers of the mouth, nose and throat is known as the 'TNM system' (T=tumour, N=nodes, M=metastases).

• T followed by a number between 1 and 4 shows the size of the cancer. A higher number after the T (for example T3 or T4) means it is larger.

• N plus a number from 0 to 3 describes whether the cancer has spread to lymph nodes in the area, and if so, the size of the nodes. Higher numbers are used for nodes that are more seriously affected by the cancer.

• M followed by 1 shows that the cancer has spread to other organs or to lymph nodes that are not near the primary cancer. M0 cancers have not spread in this way.

Doctors combine this information to determine the stage of the cancer, from Stage 1 (I) to Stage 4 (IV). For example, a cancer assessed as T1, N0, M0 (small cancer, lymph nodes not affected and no metastasis) would be called a Stage 1 (I) cancer.

Ask your doctor to explain the stage of your cancer in a way you can understand. This will help you to choose the best treatment for your own situation.