Persistent sore throat "may be a sign of cancer"



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GPs with patients who have persistent neck pain, combined with shortness of breath, difficulty swallowing or ear pain, should consider cancer as the cause, according to new research.

Currently, it is recommended that patients with persistent hoarseness or unexplained lump in the neck be investigated for throat or laryngeal cancer.

However, Weilin Wu, of Cancer Research UK, said patients should not be alarmed.

"The sore throat alone was not linked to laryngeal cancer," he said.

"But, most importantly, this study also provides the best evidence to date to support the current recommendation to refer older patients with persistent hoarseness."

The larynx is part of the throat found at the entrance of the trachea that helps breathe and talk.

In the UK, there are about 2,000 new cases of laryngeal cancer each year.

The study, conducted by the University of Exeter, analyzed patient records from more than 600 general clinics and studied 806 patients diagnosed with laryngeal cancer and 3,559 control patients. It is published in the British Journal of General Practice.

Lead author Elizabeth Shephard said that this was the first real view of all the symptoms that may be important for laryngeal cancer.

"The significance of the study is that we found that hoarseness is important for laryngeal cancer, but the risk of laryngeal cancer increases significantly when combined with a recurrent sore throat," she said.

Laryngeal Cancer

  • Most common in men
  • Strongly linked to tobacco and alcohol use
  • Early diagnosis improves outcome
  • Radiotherapy, surgery and chemotherapy are the main treatments
  • If the cancer is advanced, the patient may have to have surgery to remove part or all of the larynx
  • These patients will no longer be able to speak or breathe in the usual way.
  • They will breathe through a permanent hole in the neck (stoma) and will require additional treatment to help restore the voice
  • This may include a throat implant or an electrical device that you hold against your throat to produce sound

Source: NHS Options

One of the study's authors, Prof Willie Hamilton, was the clinical leader for the current guidelines of the National Institute for Health and Excellence Care (NICE).

He said his research is important because "it has demonstrated the potential severity of some combinations of symptoms previously considered low risk."

"When NICE's guidance for cancer research was published, there was no evidence of GP practices to guide this – nor to inform GPs," he said.

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Smoking may increase risk of laryngeal cancer

But he points out that they are not just talking about any sore throat – "the sore throat has to be significant enough to go to the GP."

"We are all accustomed to sore throats, but the sore throats that are reported to GPs are already unusual because they have been out of patient standards."

And it is the combination of persistent symptoms – sore throat, hoarseness, and breathing or swallowing problems – which can be a warning sign, he said.

Dr. Shephard said the study will feed NICE guidelines when they are updated.

"It's vital to select the right patients for referral. If we get people earlier, we can diagnose cancer at an earlier stage and they will have access to the right treatment."

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