Ulysses S. Grant and Throat Cancer: A Well-Documented Historical Story

The symptom that sent a president to a specialist

Ulysses S. Grant's cancer began with something ordinary. Smithsonian Magazine reports that he had pain at the base of his tongue, and that it made eating difficult. He saw a throat specialist in October 1884, at 62. The physician found carcinoma.

Grant's doctors did not tell him to quit cigars. Smithsonian reports they told him to hold it to three a day.

Knowing the illness was terminal, he set out to finish his memoirs, and Mark Twain's involvement secured him a better publishing deal. He wrote, and when he was too tired to write he dictated. Smithsonian reports he judged the manuscript complete on July 20, 1885. He died three days later, with his family present. The National Park Service records it simply: "Ulysses S. Grant died of throat cancer on July 23, 1885 in Mount McGregor, New York."

Nineteenth-century medicine had almost nothing to offer him. Modern medicine has a great deal, and the rest of this page is about that.

Where the tumor sat, and what that region is called

The base of the tongue is not part of the mouth in medical terms. It belongs to the oropharynx, which the National Cancer Institute describes as running from the soft palate above to the hyoid bone in the neck below. The region takes in the base of the tongue, the tonsils and their surrounding tissue, the soft palate, and the walls of the throat.

That distinction matters because the oropharynx has its own staging system and its own biology. NCI states that "most oropharyngeal cancers are squamous cell carcinomas," meaning they arise from the flat lining cells of the throat.

The virus that split this disease in two

Grant's era knew tobacco and alcohol as the drivers. NCI still calls them "the two most important risk factors for head and neck cancers," and notes that using both together carries more risk than either alone.

What has changed is human papillomavirus. NCI states that "about three-quarters of all oropharyngeal cancers are caused by chronic HPV infection," most often HPV type 16. HPV is a common virus spread by intimate contact, and most infections clear on their own.

This is not a nuance. NCI reports that the American Joint Committee on Cancer "uses separate staging systems for human papillomavirus (HPV)-related squamous cell carcinoma of the oropharynx" and for p16-negative cancers of the oropharynx, so HPV-positive and HPV-negative tumors are staged on entirely different scales. The outlook differs sharply as well. NCI cites three-year overall survival of 93 percent for a low-risk HPV-positive group, against 46.2 percent for a high-risk group defined largely by HPV-negative disease and smoking history.

Two people can have a tumor of the same size in the same place and face very different odds. The p16 test on the biopsy is what tells them apart.

When to get checked

Head and neck symptoms get blamed on colds, allergies, and reflux for months at a time. Use three weeks as the cutoff.

• A sore throat that has lasted more than three weeks, especially on one side only
• Pain or difficulty swallowing, which doctors call dysphagia, that is not improving
• A lump in the neck that has been there more than three weeks, even if it does not hurt
• Hoarseness lasting more than three weeks with no laryngitis to explain it
• A white or red patch in the mouth, on the gums, or on the tongue that will not heal
• One-sided ear pain with a normal ear exam, which can be referred pain from the throat
• Unexplained weight loss, a persistent feeling of something stuck in the throat, or coughing up blood

Being a nonsmoker does not exclude you. HPV-related disease often appears in people who never smoked, and a painless neck lump is frequently its first sign.

How the diagnosis is made

NCI lists the working tools as PET-CT scanning, magnetic resonance imaging, endoscopy to look directly at the throat, and "biopsy and p16 testing to assess for HPV status."

Order matters here. Imaging maps the extent, but tissue names the disease, and the p16 result changes both the stage assigned and the treatment discussed.

What treatment involves

NCI describes treatment by stage. Stage I and II disease is generally handled with a single approach, either radiation therapy or surgery. Stage III and IV disease usually calls for concurrent chemoradiation, meaning chemotherapy given at the same time as radiation, or surgery followed by radiation, or chemotherapy given first to shrink the tumor.

For cancer that has spread or returned, NCI lists surgical removal, further radiation, and immunotherapy, which uses drugs that help the immune system recognize cancer.

None of this is easy on the body. The oropharynx is where swallowing, tasting, and speaking all happen at once, so treatment there routinely affects all three. Ask before treatment starts about a swallowing evaluation, a dental review, and a nutrition plan, because those are far easier to arrange in advance than in the middle of radiation.

The survival picture

The American Cancer Society projects 60,480 new cases of oral cavity and pharynx cancer and 13,150 deaths in the United States for 2026, and SEER, the federal cancer surveillance program, reprints those numbers. That is 2.9 percent of all new cancers, at a rate of 11.7 per 100,000 people per year.

Five-year relative survival across all stages is 69.9 percent, using cases from 2016 through 2022. By stage, SEER lists 88.7 percent for localized disease, 69.7 percent for regional spread, and 36.0 percent once the cancer has reached distant sites. Only about 26 percent are found while still localized.

The median age at diagnosis is 65. Men are affected far more often, at 17.5 new cases per 100,000 compared with 6.6 for women. All of these are group figures, and none of them forecasts what happens to an individual.

Prevention that actually exists

Two levers work. Not using tobacco and limiting alcohol addresses the risk factors NCI ranks highest.

The second lever did not exist in any era before this one. NCI notes that the FDA has approved Gardasil 9 to prevent cancers caused by HPV in people aged 9 through 45. Vaccination works best before exposure, which is why it is offered in early adolescence.

Grant had access to neither. That is the difference a century and a half makes.

Sources

• https://www.nps.gov/gegr/learn/historyculture/index.htm
• https://www.smithsonianmag.com/history/war-and-peace-of-mind-for-ulysses-s-grant-1882227/
• https://www.cancer.gov/types/head-and-neck/hp/adult/oropharyngeal-treatment-pdq
• https://www.cancer.gov/types/head-and-neck/head-neck-fact-sheet
• https://seer.cancer.gov/statfacts/html/oralcav.html