When is a sore throat not just a sore throat? - A Specialist’s Insight

Over the past 15 years there has been a change in the pattern of patients who present with cancers of the tonsil and the back of the tongue. As clinicians, we have seen a change in the factors that cause these cancers. Previously, a typical patient would be someone in their 60s who has a history of significant smoking and alcohol use. We are now seeing patients who are much younger, (sometimes as young as 35), who are non-smokers or have only a very minor history of smoking. The shift in the type of people affected by this cancer is because of something called the Human Papilloma Virus (HPV). HPV is the virus that is most commonly associated with cervical cancer. Usually the exposure to this virus would have occurred in the distant past and stayed dormant in the tonsil tissue at the back of the throat until it becomes a problem later in life. We now know that this type of cancer responds really well to therapy and it is important to catch it as early as possible.

What are the symptoms I should look out for?

If you have a sore throat that lasts for more than 6 weeks continuously you should see your GP. The other ‘red flag’ symptoms to look out for are: increasing difficulty with swallowing, persistent pain in one ear, difficulty when opening the mouth, unexpected weight loss, episodes of coughing up blood, a persistent feeling of a lump in the throat or an actual lump in the neck region that you can feel.  

How long should I wait before I get a lump in the neck checked by my GP?

One of the most common ways that a cancer in the tonsil or the back of the tongue presents is with a painless lump in the neck. There are lots of reasons that someone can develop a lump in the neck and the most common cause of this is infection. However if the lump in the neck persists for more than 6 weeks, particularly if you have had 1-2 courses of antibiotics and it isn’t better, it should be investigated with an ultrasound or a CT scan and a biopsy.

If I do have cancer, is it treatable?

The simple answer is yes, it is usually very treatable but each individual case is different. It can either be treated with surgery or radiotherapy or possibly a combination of both. One of the newer ways we are able to treat these cancers is by reaching the cancer through the mouth with the use of a surgical robot. This decreases the patients’ recovery time and enables a quick recovery to relatively normal swallowing function.

Your cancer should be treated at a centre which specialises in looking after Head and Neck Cancer patients. A list of these is available at https://www.canrefer.org.au.

Dr Julia Crawford, SVPHS ENT and Head and Neck Specialist