How to treat a bloody uvula

Doctor's letter : Mouth and throat cancer

EXPLANATIONCancer sores can develop anywhere on the mucous membranes in the mouth - i.e. on the lip, the inside of the cheek, the tongue, the roof of the mouth or throat, but also in the tonsil region. Around 90 percent of these tumors are ulcers on the surface of the mucous membrane. These are so-called carcinomas, very dangerous canker sores that tend to form daughter tumors, i.e. metastases, even at an early stage. Very rarely, melanomas, the technical term for black skin cancer, can even occur in the oral cavity. According to estimates by the Berlin Robert Koch Institute, around 10,000 people in Germany develop mouth and throat cancer every year.

According to the cancer registry, more than 400 people in Berlin are diagnosed with cancer of the mouth and throat for the first time every year. This frequency ranks eleventh among all new cancer cases - among men it is even fifth. Around three quarters of those affected are men, most of them between 55 and 65 years of age. However, since the 1990s the incidence has decreased in men, while it has increased in women. "One reason for this is that smoking behavior has changed and more and more women smoke, while the number of men is falling," says Marc Bloching, chief physician at the clinic for ENT medicine, head and neck surgery and communication disorders at the Helios Clinic Berlin-Buch .

Symptoms Mouth and throat cancer often goes undetected for a long time. Hoarseness, sore throat and earache, bad breath, dry cough and sharp pains, for example when drinking fruit juices, are often misinterpreted by those affected. Mucosal changes, especially open mouth ulcers that stay and grow for more than a week, are an alarming sign. If pronounced speech and swallowing disorders or spontaneous bleeding occur, the tumor is in an advanced stage.

causes The main risk factors are smoking and regular consumption of alcohol. This is because the poisons act directly on the surface of the mucous membrane and can contribute to changes in the genetic material there - and thus ultimately to the development of cancer. According to experts, poor oral hygiene can also promote the development of cancer. Another main trigger is the human papillomavirus (HPV). These were discovered as the cause of cervical cancer (see page 44) by the physician Harald zur Hausen (who received the Nobel Prize in Medicine for this). "HPV also plays an important role in the development of mouth and throat cancer," says Marc Bloching. This means that oral sex can cause this type of cancer if an infection with HPV occurs. However, it is important to note that an HPV infection does not necessarily mean that cancer will develop. Girls have the option of getting vaccinated against the virus before their first sexual intercourse. Vaccination for boys is now also approved.

DIAGNOSIS Changes in the mucous membrane, especially open ulcers in the mouth that remain and grow for more than a week, are a warning sign and should be examined by an ENT specialist or dentist. They specialize in tumor detection in this region. Because the same applies to this cancer: the earlier it is detected, the greater the chances of recovery. However, many people shy away from going to the doctor. For them, the mouth is a taboo zone for completely irrational reasons. For some, even larger than the genital area.

ENT doctors can identify deeper tumors endoscopically, i.e. using a tube with a small camera attached to the tip. The patients then come to Marc Bloching's clinic with a suspicion that is corroborated there - through direct clinical examination and through reflections, ultrasound and computed tomography (CT). All of these procedures provide doctors with further information on whether - and if so, how far - a possible tumor has spread. The diagnosis is confirmed by the histological examination of a tissue sample by the pathologist.

If the cancerous ulcer is smaller than five millimeters, there is an almost 100 percent chance of healing. However, if it turns out that the tumor has already spread to the lungs or other distant organs, this makes treatment much more difficult. In many cases, a cure is no longer possible. "Then we carry out palliative treatment to improve the quality of life for the rest of the life," says ENT chief doctor Marc Bloching.

THERAPY Although tumors in the mouth and throat can be identified relatively easily and early, around 4,500 people die from them every year. Five years after the diagnosis, around half of those affected are still alive. However, there are big differences, depending on which area of ​​the mouth and throat area is exactly affected: The five-year survival rate for lip cancer is 90 percent, for tongue, floor of the mouth or throat tumors, on the other hand, only 30 percent. This is also because the ulcers are usually diagnosed too late and have already metastasized in the lymph nodes of the neck. There is also the risk that the proliferating ulcers will break into the large vessels in the neck and thus wash cancer cells into the bloodstream. In doing so, they can cause fatal carotid artery bleeding.

There are different ways to treat a tumor in the mouth and throat. However: "Whole congresses argue about the right form of treatment," says chief physician Marc Bloching. The most important goals at his house are (a) freedom from tumors and (b) quality of life, interventions are always based on the anatomical structures. “In the past, surgery for mouth and throat cancer would have resulted in extensive facial mutilation. That doesn't have to be the case today, ”he says. "From the outside, the patient looks the same as before."

In general, the type of treatment depends on the stage of the tumor and the location in the mouth and throat where it is located. While surgery is almost always the best choice for small tumors, a so-called multimodal approach is advisable for larger tumors, i.e. a combination of surgery, radiation and possibly chemotherapy. However, the sequence first surgery, then radiation is usually better than the other way around. Radiation treatment has the disadvantage that surgery is more difficult afterwards, as the surrounding healthy tissue is damaged and does not heal as well.

As part of the tumor operation, the throat is also cleared, during which any existing lymph node metastases can be discovered. This is often performed endoscopically: What would have required long skin incisions in the past, today only requires a small access for the special instruments in many cases. If bone is lost from the lower jaw during the operation, it can be replaced with bone from the hip or fibula, for example. Removed mucous membrane can be replaced with a skin graft from the forearm.

After the operation, which, despite all the progress, represents a considerable interference with the patient's self-image and quality of life, there is the option of psycho-oncological care. Regular, specialized follow-up examinations are always required in order to identify and treat possible tumor recurrences at an early stage.

The editors of the magazine "Tagesspiegel Kliniken Berlin 2016" compared the Berlin clinics that treat this disease. For this purpose, the treatment numbers, the hospital recommendations of the outpatient doctors and the patient satisfaction were compiled in clear tables in order to make it easier for the patient to choose a clinic. The magazine costs 12.80 euros and is available in the Tagesspiegel shop.

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