Is chronic vomiting a cause of throat cancer?

Chronic Vomiting and Throat Cancer Risk

Chronic vomiting is not established as a direct cause of throat cancer, but it may contribute to chronic inflammation of the esophagus, which is considered a precursor condition for the development of esophageal cancer. 1

Relationship Between Chronic Vomiting and Throat/Esophageal Tissue

• Chronic vomiting exposes the throat and esophagus to gastric acid, which can cause chronic inflammation of the esophageal mucosa 1
• Research from South Africa has found a significant association between self-induced vomiting (a cultural practice in some regions) and esophageal chronic inflammation, with an odds ratio of 1.83 1
• Chronic inflammation of the esophagus is considered a precursor condition for the development of esophageal cancer 1

Types of Chronic Vomiting Conditions

• Cyclic Vomiting Syndrome (CVS) is characterized by stereotypical episodes of acute-onset vomiting lasting <7 days with at least 3 discrete episodes in a year 2
• Chronic nausea and vomiting is defined as symptoms persisting for 4 weeks or more 3
• Causes of chronic vomiting include:
  • Gastrointestinal disorders (gastroparesis, cyclic vomiting syndrome) 3
  • Non-gastrointestinal causes (medications, vestibular disorders, neurologic disorders) 3
  • Cancer-related causes (brain tumors, GI tract involvement, treatment effects) 2, 4

Cancer-Related Vomiting vs. Other Chronic Vomiting

• Cancer-related nausea and vomiting affects approximately 70-80% of cancer patients on chemotherapy 2
• Brain tumors can cause nausea and vomiting through increased intracranial pressure, with characteristic morning predominance that improves during the day 4
• Cancer-related vomiting is often accompanied by other symptoms such as headache, mental changes, and cranial nerve palsies when caused by brain tumors 4
• Non-cancer chronic vomiting typically lacks these associated neurological symptoms 3

Warning Signs That Require Further Investigation

• Persistent throat symptoms (throat clearing, food sticking) in adults who use tobacco and/or drink excessive alcohol should be examined to exclude hypopharyngeal cancer 5
• Late symptoms of throat cancer include:
  • Neck swelling (uni- or bilateral)
  • Dysphagia (difficulty swallowing)
  • Odynophagia (painful swallowing)
  • Otalgia (ear pain)
  • Dysphonia (voice changes)
  • Dyspnea and stridor 5
• Nausea/vomiting that is persistent despite conventional antiemetic treatment, or is associated with positional changes or neurological symptoms, requires neuroimaging to rule out brain tumors 4

Clinical Implications and Management

• Patients with chronic vomiting should be evaluated for potential causes, including both gastrointestinal and non-gastrointestinal origins 3
• Management of chronic vomiting depends on the underlying cause:
  • For CVS, treatment includes preventive medications (tricyclic antidepressants, anticonvulsants) and abortive therapies during episodes 2
  • For cancer-related vomiting, treatment includes antiemetics targeting different neuroreceptors (serotonin, dopamine, corticosteroid, and neurokinin-1 receptors) 2
• Patients with chronic vomiting and risk factors for throat cancer (tobacco use, alcohol consumption) should be monitored for development of concerning symptoms 5

Conclusion

While chronic vomiting itself is not established as a direct cause of throat cancer, it may contribute to chronic inflammation of the esophagus, which is a risk factor for esophageal cancer development. Patients with persistent vomiting should be evaluated for underlying causes and monitored for development of concerning symptoms, particularly if they have additional risk factors for throat cancer.