It first begins as a small gradual growth. It’s so small, you don’t notice it for months to years. Then when you do notice it, it has spread. It’s grown now to envelop and consume its surrounding areas. There, it begins to multiply into smaller satellite regions, where it begins the entire growth cycle all over again. This is what happens with cancer; once it spreads, it spreads rapidly.
 
Similarly, news about cancer spreads quickly as well and when it does it creates quite a stir. In Texas, for instance, there was a lot of controversy surrounding mandatory inoculation for teenaged girls against the human papilloma virus (HPV) to prevent cervical cancer. The proponents for this were arguing about the dire consequences for young girls who were not vaccinated based on the latest research linking various types of HPV with cervical cancer.
 
Recently, this debate has resurfaced again, and this time with a much greater constituency. Due to a recent research study published in the May 10th issue of The New England Journal of Medicine linking HPV to higher incidence of not only cervical but throat cancer, advocates for the mandatory inoculation are now including a much wider age and gender group. With a growing population of young minors who engage in risky sexual behavior, and because this has been shown to heighten the risk of contracting HPV, the implications for mandatory vaccines has become a hot topic for debate across the US.
 
News Today, Gone Tomorrow
 
Although controversial, news like this can yield tremendous benefits. It
raises public awareness and with it a moderation of risky behavior. In the 1990’s, for instance, the average teenaged smoker found themselves being the minority rather than the majority. Backed by  a huge ad campaign with a mass of celebrities taking up the cause, teenage smoking dropped 40% in the late 90’s. Also, after research about the dire consequences of second hand smoke hit the news, more and more restaurants and offices banned smoking. Yet, as the news subsided and as the smoke cleared, an unexpected outcome resurfaced. Recent statistics show that as a good number of the smoking population are kicking the habit, a greater number of women are lighting up for the very first time. This is the problem with media remission; there’s no way of knowing what may or may not develop later on.
 
Mass Media and Mass Hysteria
 
In my practice, I don’t see very many patients with head and neck cancers. Yet, whenever there’s any news about throat cancer, I almost always see a jump in the number of patients worried about the “lump” in their throat. This happens to be the other downside to mass media coverage. It can trigger a lot of false alarms. In the vast majority of cases, the sensation of a “lump” that patients complain of is usually due to irritation from either post-nasal drip from the nose (from many possible reasons), or more commonly from acid reflux. During medical school, there was a sexist term used to describe a condition where a young nervous woman would come in complaining of a “lump” in her throat. Many of us referred to this as “globus hystericus”: globus meaning ball, and you can guess what hystericus meant. Thankfully, this term is not used anymore, and we now know that both men and women can have similar symptoms, like constant throat clearing, cough, hoarseness, difficulty or pain with swallowing, post-nasal drip, tightness, or burning related with this lump in the throat sensation. Oftentimes this is associated with a common acid reflux condition that affects the throat tissues called laryngopharyngeal reflux disease or LPRD.
 
The Facts About Throat Cancer
 
Throat cancer is more common in middle to older aged men who are long-time smokers, and heavy drinkers. But just with any other biologic phenomenon, there are the exceptions who are younger, and don’t smoke, who get throat or oral cavity cancer. However, this is rare. The more common scenario is that of a young man who notices a small lump on the side of his neck. Since he smokes, the first thing he thinks about is cancer. He may have had an uncle or a cousin who underwent the same experience and was found to have cancer.
 
Naturally, everyone’s mind reacts the same way in this situation. In most cases, it’s usually due to gland inflammation or infection, and not cancer. The timing, presence of pain, rate of growth, location and size, and the history can guide us whether to treat it conservatively, or to order immediate tests. Typically, if an inflamed or swollen gland is the most likely possibility, then conservative treatment is prescribed, with or without antibiotics or allergy medications. Sometimes acid reflux treatment and dietary changes are recommended.
 
Beyond the routine testing measures, the important part is the follow-up. Usually, within 2-4 weeks, any form of inflammation or infection should subside. If the lump is still there, or if it continues to grow, then it should be re-examined and any appropriate tests can be ordered at that time, whether it be a biopsy or an imaging test.
 
Throat Cancer: Up Close and Personal
 
Normally, you have thousands of tiny glands (about 1/4 of an inch) concentrated mostly in your neck, armpits and groins, and to a lesser degree in the rest of your body. These glands normally drain the lymphatic vascular system, which is a network of channels that parallels your blood vessels. These channels help drain the clear fluid surrounding the cells in your body. Passage of “lymphoid” fluid through the lymph nodes “educates” the immune cells inside your lymph nodes—teaching your body what’s part of you and what’s foreign. Any kind of irritation, inflammation or infection can cause these lymph nodes to swell and enlarge temporarily, for days to weeks. However, in the small chance that this swelling is due to cancer, in most cases, it will not get smaller. The challenge for the doctor is to determine if the enlarged lymph node is from the former or the latter.
 
Obviously, we can’t order CAT scans, MRIs, and do biopsies on everyone with a swollen gland, especially when there is only a 1-2% chance that it is cancer. That’s why it’s more important to take a thorough history and to perform a proper physical exam, and to make sure to follow-up. For most people, the lump eventually does go away. And even if it does turn out to be a tumor, many bumps of this type in the head and neck area are mostly benign.
 
Last Word Of Caution
 
There’s one more thing ... many people keep feeling or rubbing the lump on the neck to see if it is getting smaller, or just out of sheer habit. Yet, just like news and publicity about cancer can aggravate a lot of people your lymph nodes can swell when irritated, so your rubbing action can actually make it bigger. I know it’s difficult, but don’t rub, and leave it alone. For most lymph node enlargements due to inflammation and infection, warm compresses help by brining more blood flow and heat to increase the healing process. In other words, try the conservative measures before jumping to conclusions.
 

West Side ENT