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Oral Cancer

What Is It?

Oral cancer is cancer anywhere in the mouth. Oral cancer can include any cancer on the lip, tongue, inside surface of the cheeks, hard palate (the front part of the roof of the mouth) or the gums. Cancers that are far back in the mouth, such as cancers on the soft palate (the back part of the roof of the mouth) or throat, are not considered oral cancer.

Usually, oral cancer is a type of cancer called squamous cell carcinoma, in which surface cells grow and divide in an uncontrolled way.

Oral cancer occurs more often in men than in women. The American Cancer Society estimates that 29,370 new cases of oral cancer will be diagnosed in 2005 in the United States, and less than 10,270 of them will be in women. The number of new cases of oral cancer has decreasing slowly over the past two decades.

Oral cancer is strongly associated with smoking or chewing tobacco: About 90% of people with oral cancers use tobacco. The risk increases with the amount and length of tobacco use. Alcohol use and exposure to sunlight also increase the risk of oral cavity cancer.

People with oral cancer are more likely to develop cancer of the larynx (voice box), esophagus or lung. Fifteen percent of people diagnosed with oral cancer are diagnosed at the same time with one of these cancers. Between 10% and 40% of people with oral cancer will later develop either one of these other cancers or a new oral cancer.

Symptoms

Possible symptoms of oral cancer include:

  • A mouth sore that doesn't heal (This is the most common symptom of oral cancer.)

  • An area in your mouth that becomes discolored and remains that way

  • A persistent lump or thickening in your cheek

  • A persistent sore throat

  • Voice changes

  • Difficulty chewing or swallowing

  • Difficulty moving your jaw or tongue

  • Loose teeth

  • Numbness of the tongue or other area of the mouth

  • Pain around the teeth or jaw

  • Pain or irritation in the mouth that doesn't go away

  • Unexplained weight loss

  • Swelling in your jaw — This may cause dentures to fit poorly or become uncomfortable.

  • A lump or mass in your neck

  • A persistent feeling that something is caught in your throat

Most of the symptoms of oral cancers can be caused by other, less serious disorders. But if any symptoms last for two weeks or longer, they deserve a doctor's attention.

Diagnosis

Diagnosis starts with a physical exam. Whether you have symptoms or not, a routine visit to a doctor or dentist should include an oral exam to look for abnormalities. Your doctor may feel for any lumps or masses. If your doctor suspects anything abnormal, he or she will do further examinations.

The next step may be a referral to an oral surgeon or an ear, nose and throat surgeon. Diagnostic tests usually are done in the office or as same-day procedures in a hospital operating room. To test for cancer, the surgeon will do a biopsy, which involves removing a small piece of tissue from the abnormal area to be examined in a laboratory.

Because oral cancer is closely related to other cancers, diagnosis is commonly followed by close examination of the larynx, esophagus and lungs using a fiber-optic scope (a thin tube with a tiny camera).

Expected Duration

The likelihood and speed of recovery varies considerably depending on many factors, including where the cancer is found, how far it has spread, and your general health. After the cancer has been treated, you may need training or further treatment to regain the ability to speak and swallow as you did before.

Prevention

The greatest risk factors for oral cancer are smoking or use of smokeless tobacco (chewing tobacco). Drinking alcohol is another significant risk factor. If you both smoke or chew tobacco and drink alcohol, your risk is even higher. If you smoke or use smokeless tobacco, get the help you need to stop immediately. If you currently smoke or chew tobacco or have done so in the past, be sure to watch for symptoms. You should have your doctor or dentist inspect your mouth at least once a year for areas that appear abnormal so that cancer can be found at an early stage.

Cancer of the lip is associated with exposure to sunlight. If you are exposed to sunlight, especially as part of your job, try to avoid the sun during the midday hours, wear a wide-brimmed hat, and use sunscreen and lip balm that protect against ultraviolet light.

Treatment

Doctors identify a cancer's development by giving it a numerical "stage." A stage 0 or stage I tumor has not invaded very far into surrounding tissues, while a stage III or IV tumor may be penetrating throughout and beyond surrounding tissues.

The type of treatment recommended varies depending on the cancer's origin and its stage of development. The most common treatments for oral cancer are surgery, radiation therapy and chemotherapy.

  • Surgery, the most common treatment, involves removing the tumor and some surrounding tissue. In many cases, surgery can be done directly through the mouth, but in other cases, tumors must be reached through the neck or jaw. When cancer cells have spread beyond the oral cavity into the lymph nodes, a surgery called neck dissection removes the cancerous lymph nodes in hopes of containing the cancer before it spreads throughout the body.

  • Radiation therapy which uses high-energy rays to destroy cancer cells, is the primary treatment for some small tumors. It also may be used after surgery to make sure that all cancer cells are destroyed. It also may be used to relieve symptoms such as pain, bleeding and difficulty swallowing, even when it cannot cure the cancer. This is called palliative care.

  • Chemotherapy the use of cancer-killing drugs, may help to shrink tumors before surgery. When a cancer is too large to be treated with surgery, chemotherapy combined with radiation therapy can improve symptoms by reducing the size of the tumor. The two most commonly used chemotherapy drugs for oral cancers are cisplatin and 5-fluorouracil (5-FU).

If cancer is discovered at an earlier stage, the chances for successful treatment are much better. In stage I and II tumors, the cancer is less than 4 centimeters at its widest point, and it has not spread to lymph nodes. Oral cancers in this stage can be treated with a good chance of cure, using either surgery or radiation therapy. Which treatment your doctor chooses may depend on the location of the cancer. If surgery isn't likely to interfere with your ability to speak and swallow, it usually is preferred. Radiation can irritate healthy tissues in your mouth or throat, but it is a better choice for treatment of some cancers. Stage III and IV tumors are cancers that are more advanced. These tumors are large, involve more than one part of the mouth, or have spread to a lymph node. These cancers usually are treated with more extensive surgery, and radiation therapy, chemotherapy, or both radiation and chemotherapy.

Recovery from oral cancer treatments also may include rehabilitation to recover the ability to speak and eat, as well as cosmetic surgery if extensive surgery is done.

 

When To Call A Professional

If you discover a lump (an area of thickness or inconsistent texture) or a discolored area in your mouth or on your tongue, make an appointment to see your doctor or dentist as soon as possible.

Prognosis

The earlier oral cancer is discovered, the better the prognosis. As many as 90% of people with early stage cancers survive at least 5 years after diagnosis. For people with cancers in stage III or IV who have received all recommended treatments, the chance of remaining cancer-free for the next 5 years is between 20% and 50%. Even after small cancers are treated and fully cured, up to 40% of people with oral cancer develop a brand new cancer in the mouth, head or neck at a later time, so follow-up examinations are crucial.

Additional Info

American Cancer Society (ACS)

1599 Clifton Road, NE

Atlanta, GA 30329-4251

Toll-Free: (800) 227-2345

http://www.cancer.org/

Cancer Research Institute

681 Fifth Ave.

New York, NY 10022

Toll-Free: (800) 992-2623

E-Mail: info@cancerresearch.org

http://www.cancerresearch.org/

National Cancer Institute (NCI)

U.S. National Institutes of Health

Public Inquiries Office

Building 31, Room 10A03

31 Center Drive, MSC 8322

Bethesda, MD 20892-2580

Phone: (301) 435-3848

Toll-Free: (800) 422-6237

TTY: (800) 332-8615

E-Mail: cancergovstaff@mail.nih.gov

http://www.nci.nih.gov/

Online Medical Reviewer: Pickett, Mary E. MD
Date Last Reviewed: 7/4/2005
Copyright by Harvard University. All rights reserved. Content Licensing by Belvoir Media Group
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