Soft Palate Cancer

The soft palate and uvula are in the back and throat part of the roof of the mouth. Uncontrolled proliferation of cells in this area causes soft palate cancer. Most soft palate tumors are malignant. The most common type of cancer of this region is squamous cell carcinoma of the soft palate.

The exact cause of soft palate cancer is unknown. In the development of soft palate cancer, tobacco use, alcohol consumption, human papillomavirus (HPV) infection, precancerous lesions, poor diet, and being old are important risk factors. Soft palate cancers usually give signs and symptoms in the early stages. Avoiding risk factors is beneficial in soft palate cancer prevention.

The diagnosis of soft palate cancer can be made by biopsy. The success of treatment and survival rate may vary depending on the type, stage, and spread of soft palate cancer. The main treatments for soft palate cancer are surgery, radiation therapy, and chemotherapy.

Soft Palate and Uvula

In the upper jaw, the posterior part of the hard palate is the fleshy soft palate. The soft palate is the muscular upper-back portion of the roof of the mouth. There is a dangly thing in the back of the throat which is called the uvula. The uvula is a fleshy structure in the middle of the posterior lower border of the soft palate. The soft palate extends to the sides, forming pockets containing the tonsils and extending downwards.

The soft palate and uvula function as the closer of the nasal passage during swallowing. Thus, food does not get into the nose. Also, the soft palate helps form speech sounds. If the palate does not work properly while speaking, air escapes through the nose and a nasal voice occurs in speech.

Most soft palate and uvula tumors are malignant. However, soft palate cancers occur less frequently than other cancers of the head and neck region.

Signs and Symptoms

Persistent ulcer on the soft palate

The main signs of many cancers that develop from the soft palate and uvula are in the form of discoloration or ulcers that have existed for more than 2-3 weeks. As cancer grows, the ulcer may bleed.

Feeling a mass in the throat

Some tumors are in the form of a swollen lesion, mass, or swelling on the soft palate that has been present for more than 2-3 weeks. These tumors (especially minor salivary gland tumors) are usually swellings that are not in the form of an open wound or ulcer.

Subsequent persistent pain

Usually, cancers are painless in the early stages. But as cancer progresses, pain begins to occur (especially when swallowing). As soft palate cancer grows and invades surrounding tissues, speech, swallowing and chewing difficulties arise.

Lump in the neck

Soft palate tumors can spread to the lymph nodes in the neck and cause swelling in the form of masses. In some cases, the first sign of soft palate cancer may be a lump in the neck. However, soft palate cancer is usually detected before reaching the neck lymph nodes.

Lymph node involvement is more common in squamous cell carcinoma and high-grade mucoepidermoid carcinoma. In these cancers, approximately one-third of the patients have metastasis to the neck lymph nodes at the time of presentation.

Other symptoms

In extensive lesions extending into the nasopharynx, ear pain is common. In persons with advanced-stage soft palate cancers, spasms of the jaw muscles may be present. Because the area is easily visualized, soft palate cancers are often detected at early stages incidentally by the patient, dentist, or doctor.

Causes

It is known that tobacco use and alcohol consumption may cause soft palate and uvula cancers. Especially if the amount consumed is high and these two habits are together, the risk is higher. However, minor salivary gland cancers can also occur in the soft palate, and it is unclear what causes salivary gland cancer.

HPV virus mainly causes tonsil and base of tongue cancers in the head and neck region. HPV virus may also play a role in soft palate cancer because nowadays, HPV-positive patients with soft palate cancer are not rare.

Risk Factors

Heavy smoking

Tobacco use is a serious risk factor for soft palate cancer. There is a strong correlation between tobacco use and squamous cell carcinoma of the oral cavity and soft palate.

Excessive use of alcohol

Heavy alcohol consumption is also a risk factor for cancer of the soft palate. Because heavy alcohol consumption is common in patients with soft palate cancer.

Human Papillomavirus (HPV) infection

Human papillomavirus (HPV) can cause squamous cell carcinoma of the throat. The incidence of HPV is increased in patients with squamous cell carcinoma of the soft palate.

Being older male

Soft palate and uvula cancers are more common in elderly people. It is most common after the fifth decade. These people are mostly men.

Poor diet and vitamin deficiency

Poor diet and deficiency in some vitamins (especially vitamin A) play a role in squamous cell carcinoma of the mouth and throat. However, the evidence is less persuasive.

Other risk factors

Risk factors, such as poor oral hygiene, chronic oral mucosal irritation, ill-fitting dentures, irritative mouthwashes, and previous radiation exposure were found to be associated with soft palate cancers.

Types of Tumors

Uncontrolled growth of cells in the epithelial layer covering the soft palate and uvula or other underlying tissues causes cancer. The most common malignant tumors of the soft palate include squamous cell carcinoma, minor salivary gland cancers, mucosal melanoma, Kaposi sarcoma, and non-Hodgkin lymphoma.

Squamous cell carcinoma

The most common cancer of the soft palate and uvula is squamous cell carcinoma, as well as in the mouth and throat area. However, in the soft palate, more than three-quarters of cancers are squamous cell carcinomas. HPV-associated soft palate cancer is also a type of squamous cell carcinoma.

Minor salivary gland cancers

Since there are minor salivary glands in the soft palate, cancers may arise from them. These are adenoid cystic carcinoma, mucoepidermoid carcinoma, adenocarcinoma, acinic cell carcinoma, respectively, according to their prevalence.

Mucosal melanoma

Mucosal melanoma is a rare and aggressive palate malignancy. The cause of mucosal melanoma of the palate is not clear. Mucosal melanomas, are smooth black lesions on the soft palate but may be brown or brownish gray.

Kaposi sarcoma

Kaposi sarcoma is linked to human herpesvirus 8 (HHV8) and human immunodeficiency virus (HIV). It is associated with immunosuppression. Lesions are bluish in Kaposi sarcomas.

Non-Hodgkin lymphoma

Non-Hodgkin lymphoma cases in the oral cavity usually occur at the junction of the hard and soft palate.

Benign soft palate tumors

There are also benign tumors of the soft palate. Neurofibroma, neurilemmoma, lipoma, leiomyoma, and benign minor salivary gland tumors (pleomorphic adenoma, basal cell adenoma, myoepithelioma, and cystadenoma) can also develop from the soft palate.

Diagnosis

The patient who suspects soft palate and uvula cancer should first consult an ear, nose, and throat doctor (otolaryngologist) without wasting time. Because as the diagnosis is delayed in soft palate cancers, the stage of cancer progresses and treatment becomes more difficult.

A detailed history including main symptoms, the time of onset of the palatal lesion, difficulties, and other episodes are important for diagnosis. If the patient has, the doctor will consider risk factors such as past medical history, surgical history, family history of malignancy, and tobacco, alcohol, drug use, and occupational hazards.

Physical exam

Physical examination consists of a comprehensive head and neck exam. The doctor focuses on the oral cavity and its structures. Then the doctor palpates all neck levels bilaterally to find out if lymph nodes are affected. If the otolaryngologist suspects the presence of a tumor in the soft palate after the examination, may need various imaging tests (such as MRI, CT, PET) and may want to take a biopsy from the suspicious area.

Removing a tissue sample

If the doctor who examines the patient considers the lesion in the soft palate as suspicious, he takes a tissue sample (biopsy) from the patient. The doctor takes the tissue sample transorally and under local anesthesia by making a small incision with a special knife or tearing it off with a special tool.

The biopsy is necessary for treatment planning and does not lead to the spread of the soft palate tumor. Biopsy and examination of the suspect area under anesthesia can provide additional information regarding the extent of the lesion. The pathologist examines the tissue samples removed by biopsy in detail under the microscope and makes the diagnosis of the tumor.

Imaging tests

The otolaryngologist performing the examination may require magnetic resonance imaging (MRI) or computed tomography (CT) imaging tests. Although positron emission tomography (PET) has a poor resolution, it is superior in detecting lymph node and occult metastases. Imaging tests can be done before or after the biopsy. These tests contribute to treatment planning by showing the extent and stage of the soft palate tumor.

Treatment

Treatment for soft palate cancer depends on the size and location of cancer, the patient’s overall health, and preferences. However, the main treatment for cancers developing from the soft palate is surgery. If the cancer is more advanced, it may also require non-surgical treatments like radiation therapy, chemotherapy, or both (chemoradiation) to shrink the tumor before or after surgery. These reduce the risk of cancer coming back.

Because of difficulties in soft palate reconstruction, radiation therapy has been the recommended treatment in the past for soft palate cancers. Advances in reconstructive techniques and prosthetic reconstruction have allowed for more effective surgical treatment for patients with soft palate cancers. But, for some patients, radiation may be the sole treatment needed.

Treating doctors

Ear, nose, and throat doctors (otolaryngologists) experienced in head and neck surgery mainly undertake diagnosis, treatment planning, and surgery in soft palate and uvula cancers. Radiation oncologists for radiation therapy and medical oncologist for chemotherapy also participate in the treatment process. In addition, depending on the need, plastic reconstructive surgeons, dentists, speech-language pathologists, psychologists, and specialists from other branches can participate in the diagnosis and management process.

Surgery

Surgery is the treatment of choice for soft palate cancers. The choice of the surgical technique is based on the location and size of the soft palate tumor.

The head and neck surgeon usually performs the surgery via a transoral approach without the need to use facial incisions. While the use of transoral robotic surgery for oropharyngeal cancer may be advantageous, transoral robotic surgery is rarely used for the surgery of soft palate. In addition, an external surgical approach may also be necessary for very advanced soft palate cancers.

Studies have shown that surgery provides higher disease-free survival compared with non-surgical approaches. But, some soft palate tumors may be inoperable because of their size or extent of involvement. In these cases, radiation therapy may be the only treatment option.

Tumor removal

During soft palate tumor surgery, the main goal is to remove all cancerous tissues without leaving tumor cells behind. At this time, the cancerous tissues of the soft palate are removed with sufficient safety margins. This means that the surgeon removes the tumor along with some healthy soft palate and uvula tissue surrounding it.

Lymph node removal

Surgical treatment includes removal of the lymph nodes in the neck (neck dissection) where the disease is most likely to spread. Neck dissection is a very important step in the treatment of soft palate cancers. Neck dissection is one-sided for soft palate cancers that do not involve the midline. Bilateral neck dissection should be performed for malignant soft palate tumors involving the midline.

Recent studies have shown that metastasis rates to neck lymph nodes in soft plate cancers are higher than other sites of the oral cavity. That is why the treatment of soft palate cancers should be aggressive which involves neck dissection.

Reconstruction

Depending on the location and spread of the soft palate cancer, reconstructive surgery may be necessary after tumor removal. If the tissues removed with the tumor of the soft palate are excessive during surgical treatment, it may also be necessary to carry tissue from the surrounding or distant areas for repair. The rehabilitation of the resulting defect after tumor removal may be with a prosthesis. Sometimes, a second team can join the surgical team for the repair phase.

Normalization after surgery

The patient can stay in intensive care for a few days after surgery. During the hospitalization, the patient is given antibiotics against infections, pain relievers, and other necessary medications. The patient carries over the drain, which drains fluid and blood accumulation from the surgical site for a while. During this period, most of the patients feed by a tube that extends from the nose to the stomach. Over time, the patient feeds orally and can speak comfortably.

Radiation therapy

Radiation therapy is the treatment of tumors by giving radiation. Radiotherapy destroys cancer cells and shrinks or eliminates tumors. Today’s radiation devices can be directed to the tumor with minimal damage to the surrounding healthy tissues. As such, an external beam of radiation directed at the tumor destroys mainly the rapidly dividing cancer cells.

Radiation therapy is usually an additional treatment after surgery in soft palate cancers. If the complete removal of the tumor is impossible, if the soft palate cancer is aggressive or has spread to lymph nodes or other structures, such as nerves or vessels, the doctor may recommend post-surgical radiation therapy.

Radiation therapy can be the main treatment for soft palate cancers without surgery, in combination with chemotherapy (chemoradiation). This choice depends on factors such as the patient’s health status and the experience of the doctors planning treatment. Also, if complete surgical removal of a soft palate cancer is impossible or unsafe the doctor may recommend radiation therapy as the primary treatment. However, radiation therapy alone is ineffective for malignant salivary gland tumors of the soft palate due to their radiation resistance.

Chemotherapy

Chemotherapy cannot be the sole treatment for soft palate cancers like many tumors of the head and neck region. Doctors often add chemotherapy to radiation therapy because it increases the effectiveness of the treatment. Chemotherapy together with radiation therapy (chemoradiation) may be an alternative to surgery. In particular, the treatment of non-Hodgkin lymphomas is primarily with chemoradiation.

Targeted therapy

Nowadays, as a result of the developments in the pharmaceutical industry, the more advanced type of chemotherapy, targeted therapy has emerged. Targeted therapy, although still in its early stages, can be successful in many cancer treatments, including soft palate cancer.

Speaking and swallowing after surgery

Difficulties in swallowing and speech are common complaints before and after treatment for oral and throat malignancies. In particular, surgical resection of oral or throat structures can cause difficulties in swallowing, speech, and communication. In this respect, depending on the scope of soft palate tumor surgery, the method of reconstruction, and additional postoperative treatments, there may be some impairment in the patient’s speech and swallowing.

There are also successful surgical procedures that will alleviate or eliminate swallowing and speech problems that may develop in patients after the surgical removal of the soft palate tumor. Apart from that, rehabilitation specialists in speech and swallowing therapy may help with rehabilitation that may be necessary after surgery or radiation therapy.

Feeding after tumor surgery

During the hospitalization period, the patient feeds by a tube extending from the nose to the stomach or intravenously for a period determined by the surgeon. The patient becomes orally fed normally over time. But early consultation with swallow professionals is important for assisting the patient in regaining some pre-treatment function to prevent malnutrition and aspiration.

Taste functions after cancer treatment

No deterioration in taste is expected after soft palate tumor surgery. However, if the patient has also received radiation therapy, the patient may encounter such problems. Radiation therapy can also cause dry mouth due to its side effects. In these cases, ADA approved mouthwash (eg, Biotene Dry Mouth Oral Rinse, or as a different choice: TheraBreath Dry Mouth Oral Rinse, etc.) may be beneficial for the patient.

Prognosis

The survival rate mostly depends on early diagnosis, type of cancer, and appropriate management. That is why, an early biopsy of the soft palate lesion that does not regress with medical treatment, allows early diagnosis and minimal treatment with better survival chances.

Almost half of the patients present with the spread of the tumor beyond the soft palate. Common sites of spread include the tonsils, hard palate, and base of the tongue. Tumor size, stage of cancer, presence of neck lymph node, and distant metastases are factors associated with decreased survival rates. The exact site of the soft palate cancer does not influence the survival outcome.

Follow-up care

Recurrence of soft palate cancer can occur many years after initial treatment. So, continuous follow-up is important. For post-treatment observation, patients should receive regular follow-up several times a year for the first 5 years after treatment and once a year after the 5th year.

Some soft palate cancers have high recurrence rates and slow growth patterns. In this respect, the importance of long-term follow-up in soft palate malignancies is crucial. That is why doctors recommend follow-up for over 10 years for most soft palate cancers.

Recurrence of the cancer

Even in the case of recurrence of soft palate cancer, the prognosis is excellent in terms of survival. In this respect, if soft palate cancer recurs after treatment, it is not the exhaustion of all remedies. Depending on the extent of previous treatment and the spread of recurrent soft palate cancer, treatment options such as repeat surgery, radiation therapy, and chemotherapy are still available.

Recurrence of soft palate cancers years or even decades after initial treatment can develop depression and social anxiety in patients. Support groups and counseling with a psychologist can assist patients in relieving their concerns.

Prevention

Don’t use tobacco

To minimize the possibility of occurrence and also recurrence of soft palate cancer, one should not use tobacco. Patients who receive surgical and non-surgical treatments for soft palate cancer should definitely stop tobacco use.

Stop or limit alcohol consumption

The patient may receive quit counseling for social risk factors such as alcohol to reduce the risk of developing soft palate cancer, its recurrence, and poor treatment outcomes. Even the use of alcohol-containing oral care products increases the risk, in terms of regularly and continuously exposing the mouth to alcohol. So, the use of alcohol-free products (for example, ADA approved mouthwash such as, TheraBreath Fresh Breath, CloSYS Sensitive Gentle Mint, CloSYS Ultra Sensitive Unflavored, or as a different choice: Tom’s of Maine Natural Wicked Fresh, etc.) reduces the cancer risk.

Protect yourself against human papillomavirus (HPV)

HPV infection has increased in importance as a risk factor in the development of some throat cancers. To reduce the risk of HPV transmission, a full course of HPV vaccination can help.

Get the regular dental care

Dentists are usually the first to notice the beginning signs of soft palate cancer during their routine exams. So, regular dental checkups are important for the early detection of soft palate cancer.

Live a healthy life

Patients should exercise regularly, eat a healthy diet, and keep their morale high. Apart from this, another important thing is that patients should have their follow-up, examination, and tests regularly.