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Michael Douglas and Throat Cancer FAQ

Michael Douglas Has Stage IV Throat Cancer; Experts Weigh In
By
WebMD Health News
Reviewed by Laura J. Martin, MD

Sept. 1, 2010 -- Actor Michael Douglas last night stunned a television audience with the announcement that he has "late stage IV throat cancer."

What is this disease? How is it treated? Based on what he's revealed, what do we know about Douglas's treatment and prognosis?

To answer these and other questions, WebMD spoke with two experts:

  • Gady Har-El, MD, chairman of the department of otolaryngology-head and neck surgery at New York's Lenox Hill Hospital.
  • Ted Teknos, MD, co-director of the head and neck disease committee and professor of otolaryngology-head and neck surgery at Ohio State University Comprehensive Cancer Center-James Cancer Hospital, Columbus, Ohio.

 

What is throat cancer?

Surprisingly, doctors don't use the term "throat cancer." Several different kinds of cancer can involve different parts of the throat and mouth.

Michael Douglas says he has a walnut-sized tumor at the base of his tongue. If that's truly where his cancer started, he likely has oropharyngeal cancer.

Oropharyngeal cancer may involve the base of the tongue, the tonsils and surrounding tissues, the soft palate, or the front and back walls of the throat.

Doctors use the term "insidious" to describe base-of-tongue tumors. That's because there is no pain sensation at the base of the tongue, so the tumors can become quite advanced before symptoms appear.

What causes throat cancer?

Another reason to suspect that Douglas's throat cancer is oropharyngeal cancer is his statement that the cancer probably was caused by smoking and drinking.

"Smoking is a major cause of oropharyngeal cancer," Har-El tells WebMD. "Drinking alcohol, as far as the statistics can tells us, is not as bad by itself. But the combination of drinking and smoking is the worst combination."

Although it may account for Douglas's cancer, it does not account for the sudden rise in oropharyngeal cases that doctors are seeing.

"This is a disease that is increasing really at a dramatic rate, particularly in the male population," Teknos says. "Not that long ago, this only made up about 18% of head and neck cancers. Now it makes up a full third and is increasing at a very rapid rate."

What's causing the rise in cases, Teknos says, is a surge in the number of cases caused not by smoking and drinking but by human papillomavirus -- HPV, the sexually transmitted virus best known as a cause of cervical cancer and genital warts.

Teknos says an Ohio State study recently found that people with more than six lifetime oral sex partners have the greatest oropharyngeal cancer risk. It's not yet clear why some people with HPV get this throat cancer while others do not. But it does appear that decades can elapse between HPV infection and the appearance of cancer.

"The infection may happen in a person's 20s and only manifest as cancer in the 40s," he says. "We are doing a lot of research to try to identify what is different in people who get the cancer. Because many are exposed, but only a few get cancer."

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