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Soft Palate Cancer

What to Expect at Your Doctor’s Visit

Step 1: History

First, your head and neck specialist will take a thorough history of your health and address any specific concerns you may have.

Your doctor might ask questions such as:

  • How long has the problem been there?
  • Is it getting worse, better or staying the same?
  • Does it come and go?
  • Have you tried anything to make it better?
  • Is it painful?
  • Do you have any lumps or bumps in your neck?
  • Are you having difficulty with hearing?
  • Do you have any lumps or bumps anywhere else in your body?
  • Are you losing weight?
  • Are there any other problems associated with your main problem?
  • Do you have any other medical issues?
  • Have you had any surgeries in the past?
  • What medications do you take? And do you have any allergies?
  • Have you ever been exposed to radiation in the area?
  • What do you (or did you) do for a living?
  • Do you have a family history of cancer?

Step 2: Physical Exam

Next, your doctor will examine you. Typically, if you’re seeing a specialist in head and neck disorders, you will get a thorough physical examination focused on the area of concern. The oropharynx, including the soft palate, typically requires a specialist to evaluate. It is particularly challenging for a general doctor to see and feel this area without specialized equipment.

Your doctor might do some of the following:

  • Look inside and probably even feel inside your mouth
  • Feel your neck thoroughly and carefully to check for any lumps or bumps
  • Look inside your ears
  • Look inside the front of your nose
  • Check your cranial nerves by asking you to move your face, stick your tongue out, lift your shoulders, follow his or her fingers around with your eyes, do some simple hearing tests and test your sense of touch all over your face

A few special diagnostic tests might be required as part of your physical exam.

  • Pharyngoscopy and/or Laryngoscopy (looking at your oropharynx, hypopharynx and larynx): This can be done in a few ways, including with a headlight and mirror placed on the roof of your mouth to look down, or with a flexible camera placed through your nose.
  • Flexible pharyngo-laryngoscopy: Your doctor may spray your nose with some medications and then slowly and carefully place a flexible tube-like camera through your nose down into your throat. Just sit still, breath slowly and listen to your doctor’s instructions.
  • Indirect mirror examination: Your doctor will distract you while placing a small mirror into the back of your throat through your mouth. The doctor will ask you to breathe differently and make sounds as he or she observes your oropharynx.
Indirect Transnasal Flexible Endoscopy (Laryngoscopy) Indirect Mirror Examination (Laryngoscopy)
 27_nasal_scope  Print
Your doctor may spray your nose with some medications and then slowly and carefully place a flexible tube with a camera through your nose down into your throat. Just sit still, breathe slowly and listen to your doctor’s instructions. Your doctor will distract you while placing a small mirror into the back of your throat through your mouth. The doctor will ask you to breathe through your mouth and make sounds as he or she examines your throat.

Step 3: Reviewing Tests

After getting your history and performing a physical exam, your doctor will review any imaging, laboratory work and pathology results you may have already had. Be sure to bring all of these with you to your appointment. Bring actual discs of any scans you’ve had, as well as any reports of those scans. If you are seeing a head and neck cancer specialist after a lesion was removed by a non-cancer specialist, you need a thorough review of the pathology to discuss whether additional treatment is necessary. Try to obtain the actual glass slides that were prepared by the pathologist with the specimen taken during your biopsy procedure so your doctor can conduct a complete review. You might need more tissue removed or further treatment.

Step 4: Recommendations

Finally, your doctor will make recommendations about your next steps. This will likely include reviewing some of the studies you’ve already had done or ordering more tests. Once your doctor has all the necessary information, you should be given a preliminary stage and discuss treatment plans.

If the tumor is very large and is putting your breathing at risk, your doctor might recommend you undergo a tracheotomy, which is a breathing tube placed into the front part of your neck directly into your windpipe.

Also, if you are just not able to get enough nutrition by mouth because of the tumor, your doctor might recommend that you receive a feeding tube. This will help make sure you are in good shape to undergo the treatment that you will need to beat the cancer. If you have lost weight, your doctor may give you a choice of getting enough nutrition by mouth by increasing the number of calories in your diet or by undergoing placement of a feeding tube. There are a variety of nutritional supplements that you can eat or drink that can help to achieve that goal. You may want to meet with a nutrition expert early in the course of your treatment. Note that for esophageal cancers, your doctor will probably recommend a special type of feeding tube called a J-tube (or jejunal feeding tube). This is different from a G-tube (gastric tube). This is important because if surgical resection is a possible treatment for your cancer, sometimes your stomach is used as a new esophagus, and it is better if the stomach doesn’t have a feeding tube in it. The J-tube is placed in the jejunum, which is the organ further down the GI tract from the stomach.

References

1 Ang KK, Harris J, Wheeler R, Weber R, Rosenthal DI, Nguyen-Tân PF, Westra WH, Chung CH, Jordan RC, Lu C, Kim H, Axelrod R, Silverman CC, Redmond KP, Gillison ML. Human papillomavirus and survival of patients with oropharyngeal cancer. N Engl J Med. 2010 Jul 1;363(1):24-35. doi: 10.1056/NEJMoa0912217. Epub 2010 Jun 7.

2 Blot WJ, McLaughlin JK, Winn DM, et al. Smoking and drinking in relation to oral and pharyngeal cancer. Cancer research. Jun 1 1988;48(11):3282-3287.

3 D'Souza G, Kreimer AR, Viscidi R, et al. Case-control study of human papillomavirus and oropharyngeal cancer. The New England journal of medicine. May 10 2007;356(19):1944-1956.

4 Moreno-Lopez LA, Esparza-Gomez GC, Gonzalez-Navarro A, Cerero-Lapiedra R, Gonzalez-Hernandez MJ, Dominguez-Rojas V. Risk of oral cancer associated with tobacco smoking, alcohol consumption and oral hygiene: a case-control study in Madrid, Spain. Oral oncology. Mar 2000;36(2):170-174.

5 Koivunen P, Rantala N, Hyrynkangas K, Jokinen K, Alho OP. The impact of patient and professional diagnostic delays on survival in pharyngeal cancer. Cancer. Dec 1 2001;92(11):2885-2891.

6 Roistacher SL, Tanenbaum D. Myofascial pain associated with oropharyngeal cancer. Oral surgery, oral medicine, and oral pathology. May 1986;61(5):459-462.

7 Rogers SN, Vedpathak SV, Lowe D. Reasons for delayed presentation in oral and oropharyngeal cancer: the patients perspective. The British journal of oral & maxillofacial surgery. Jul 2011;49(5):349-353.

8 Spiro RH, Thaler HT, Hicks WF, Kher UA, Huvos AH, Strong EW. The importance of clinical staging of minor salivary gland carcinoma. Am J Surg. 1991 Oct;162(4):330-6.

9 Krause CJ, Carey TE, Ott RW, Hurbis C, McClatchey KD, Regezi JA. Human squamous cell carcinoma. Establishment and characterization of new permanent cell lines. Arch Otolaryngol. Nov 1981;107(11):703-710.

10 Licitra L, Perrone F, Bossi P, et al. High-risk human papillomavirus affects prognosis in patients with surgically treated oropharyngeal squamous cell carcinoma. Journal of clinical oncology: official journal of the American Society of Clinical Oncology. Dec 20 2006;24(36):5630-5636.

11 Eveson JW, Cawson RA. Tumours of the minor (oropharyngeal) salivary glands: a demographic study of 336 cases. Journal of oral pathology. Jul 1985;14(6):500-509.

12 Referenced with permission from The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Head and Neck Cancers V.2.2016. © National Comprehensive Cancer Network, Inc 2016. All rights reserved. Accessed December 7, 2016. To view the most recent and complete version of the guideline, go online to www.nccn.org.

13 Jan JC, Hsu WH, Liu SA, Wong YK, Poon CK, Jiang RS, Jan JS, Chen IF. Prognostic factors in patients with buccal squamous cell carcinoma: 10-year experience. J Oral Maxillofac Surg. 2011 Feb;69(2):396-404.

14 Sinha P, Lewis JS Jr, Piccirillo JF, Kallogjeri D, Haughey BH. Extracapsular spread and adjuvant therapy in human papillomavirus-related, p16-positive oropharyngeal carcinoma. Cancer. 2012 Jul 15;118(14):3519-30.

15 Pradhan SA, Rajpal RM. Marginal mandibulectomy in the mangement of squamous cancer of the oral cavity. Indian J Cancer. 1987;24;167-171.

16 Maddox WA, Urist MM. Histopathological prognostic factors of certain primary oral cavity cancers. 1990 Dec;4(12):39-42; discussion 42, 45-6.

17 Piccirillo JF, Costas I, Reichman ME. Chapter 2: Cancers of the Head and Neck. Ries LAG, Young JL, Keel GE, Eisner MP, Lin YD, Horner M-J (editors). SEER Survival Monograph: Cancer Survival Among Adults: U.S. SEER Program, 1988-2001, Patient and Tumor Characteristics. National Cancer Institute, SEER Program, NIH Pub. No. 07-6215, Bethesda, MD, 2007.