What Is It?
Oral cancer is cancer anywhere in the mouth. Oral cancer can include any cancer on the lip, the tongue, the inside surface of the cheeks, the hard palate (the front part of the roof of the mouth), or the gums. Cancers that are far back in the mouth area, such as cancers on the soft palate (the back part of the roof of the mouth) or back of the throat, are not considered oral cancer.
Usually, oral cancer is a type of cancer named 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 36,540 new cases of oral cancer will be diagnosed in 2010 in the United States, and 11,120 of them will be in women. The number of new cases of oral cancer has been slowly decreasing over the past 3 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 1 of these other cancers. Between 10% and 40% of people with oral cancer will later develop either one of these other cancers or a new oral cancer.
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 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.
After the diagnosis is made, you will need tests to determine if the cancer has spread beyond the oral cavity. This information is needed to decide on the treatment. The tests often include:
- MRI of the head and neck
- CT scan of the chest to look for lymph node involvement
- PET scan to determine cancer activity in more distant parts of the body
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).
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.
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.
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 yet 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 your cancer. If surgery isn't likely to interfere with your ability to speak and swallow, it is usually preferred. Radiation can cause irritation of the healthy tissues in your mouth or throat, but it is a better choice of treatment for 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 of these treatments.
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. Ask to see your doctor right away.
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.
American Cancer Society (ACS)
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National Cancer Institute (NCI)
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