When to worry about a persistent sore throat

Sore throat
A sore throat may get better in a day or two or linger for a while. The key is to know when this common symptom may require for a trip to the doctor.

Most everyone has had a sore throat at some point. Maybe it was caused by a virus, seasonal allergies or cheering on your favorite team. In most cases, a sore throat gets better in a day or two. Sometimes, it may linger for a while. The key is to know when this common symptom may require for a trip to the doctor, especially when it may be caused by a serious disease, including cancer.

In this article, we’ll explain:

If you’ve been diagnosed with throat cancer and would like to learn more about treatment options we offer, or if you’re interested in a second opinion on your diagnosis and treatment plan, call us or chat online with a member of our team.

Common causes for a sore throat

Viral infections are the primary reason for most sore throats. As the name implies, their most common cause is the common cold. Adults have an average of two to three colds per year, and children have even more of these uncomfortable, but benign viral infections, according to the U.S. Centers for Disease Control and Prevention (CDC). Influenza is another frequent cause of a sore throat, and, like a cold, is a viral infection that usually clears up in about a week to 10 days. COVID-19, an unfortunately familiar virus these days, may also cause a sore throat, sometimes for a prolonged period.

Other possible causes of a sore throat include:

  • Viral illnesses, such as mononucleosis, chicken pox, measles and croup
  • Overuse of your voice
  • Environmental factors like exposure to molds, bad air quality, pollution or chemical vapors
  • Allergens like pollen that may cause nasal drainage
  • Acid reflux
  • Laryngitis, an inflammation of the voice box
  • A persistent dry cough or hoarseness
  • An irritated epiglottis, the flap of tissue at the base of the tongue
  • Tonsillitis, or an inflammation of the tonsils in the back of the throat or tonsil stones, caused by food debris getting caught in the tonsil folds
  • Strep throat and other bacterial infections like streptococcus pyogenes (group A streptococcus)

Those with repeated bacterial throat infections like strep or tonsillitis may undergo a tonsillectomy to remove the tonsils, which may reduce the frequency of the infections. (This is especially true for those who get more strep more than seven times in a year.)

“Sore throat is very common,” says Beomjune Kim, DMD, MD, Head and Neck Surgeon at City of Hope Atlanta. “The only time you have to be really worried is if it persists over several weeks, despite adequate treatment.”

When should you be concerned and consult a doctor?

You should call your doctor if your sore throat:

  • Is accompanied by a high fever (101 degrees or more)
  • Persists despite treatment
  • Is painful when swallowing to the point you can’t sleep
  • If a rash appears
  • If the pain intensifies
  • Unusual bad breath or a foul taste in your mouth
  • Ear or jaw pain
  • A persistent hoarse, raspy or breathy voice
  • Swelling in the face or neck
  • A sore in the mouth or throat, especially if you’re a smoker, use tobacco or frequently drink alcohol
  • Unexplained weight loss

“If it’s chronic, over three or four weeks, then you have to be worried,” Dr. Kim says. “Difficulty breathing, coughing up or vomiting up blood are worrisome signs.”

Tests used to find the cause of your sore throat

To help find the cause of sore throat, the doctor will likely perform a thorough physical exam and perhaps a blood test and swab the throat to rule out strep or a bacterial infection. The exam may also help to rule out symptoms due to other viral infections, like prolonged COVID-19.

If a more serious condition is suspected, the doctor may perform a flexible endoscopic exam, in which a long, flexible tube with a tiny camera and light attached to the end is inserted to see the inside of the throat more clearly. Depending on what this exam reveals, the doctor may order a biopsy of the tonsil or a lymph node.

Benign and malignant tumors may grow in the tissue that lines the throat, the tongue and the larynx (voice box). Both cancerous and non-cancerous tumors or lesions may cause throat pain and other symptoms.

The physician may also order an imaging study of the chest and abdomen to help learn whether cancer is present and whether it has spread to other parts of the body.

Cancers that may be associated with a sore throat?

While a persistent sore throat is the most common early warning sign for throat cancer, many patients are asymptomatic in early stages of the disease.

Throat cancers are often discovered by a dentist or doctor treating another condition. Still, an ongoing sore throat accompanied by a cough, difficulty swallowing, swelling or a lump in the mouth, throat or neck and other persistent symptoms, may indicate throat cancer and require medical attention.

There are three main types of throat cancer:

Laryngeal cancer affects the tissues of the larynx or voice box and may include the vocal cords and the areas above and below them.

Pharyngeal cancers may affect the area behind the nose, the throat behind the mouth and the bottom part of the throat just above the larynx or the hypopharynx near the opening to the.

Oropharyngeal cancers are known as oral cavity cancers, and may affect the lips, inside of the cheeks, gums, the tongue and the hard palate or the roof of the mouth.

Most throat cancers, like 90 percent of all head and neck cancers, are squamous cell carcinoma, which forms in the thin, flat cells that line much of the throat. Cancers other than throat cancers may also cause a sore throat, cough, hoarseness, difficulty or pain when swallowing and swollen lymph nodes in the neck. These cancer types include:

More than 70 percent of oropharyngeal cancers are caused by the human papillomavirus (HPV). In fact, HPV is a more common risk factor for throat cancer than tobacco or alcohol use. The positive impact of the HPV vaccine in preventing throat cancers may not be seen for many years, says Dr. Kim, who urges those eligible to get the vaccine. The CDC recommends the vaccine for 11- to 26-year-olds, and, if recommended by a doctor, for patients up to age 45.

“I want to tell people to reduce their chance of developing cancer by avoiding smoking, chewing tobacco or excessive alcohol use and following safe sexual practices,” Dr. Kim said. “Prevention is the key.”

If you’ve been diagnosed with throat cancer and would like to learn more about treatment options we offer, or if you’re interested in a second opinion on your diagnosis and treatment plan, call us or chat online with a member of our team.