Let’s Talk About Jaw Cancer
Unlike some hard-to-diagnose cancers, you can often see tumors of the jaw. If you do, check out these details on what steps to take next.by Stephanie Wood Health Writer
When you feel pain in your jaw, your first thought is to probably call the dentist. It’s a toothache, right? Or maybe you were grinding your teeth in your sleep. There’s a good chance it could be either—but there is also a possibility that the discomfort is caused by a tumor. Cancer in the jaw often spreads there from other areas of the mouth or throat, so the situation could be heading toward serious. And although many jaw growths are benign, they can still do plenty of harm. Start here, to get yourself back on the path to healthy.
Our Pro Panel
We went to some of the nation’s top experts on head and neck cancers to bring you the most up-to-date information possible.
Salvatore M. Caruana, M.D.
Director of the Division of Head and Neck Surgery
New York-Presbyterian Hospital Columbia University Medical Center
New York, NY
Nadia Mohyuddin, M.D.
Head and Neck Surgical Oncologist, Associate Professor of Clinical Otolaryngology
Houston Methodist Hospital
J. Kenneth Byrd, M.D.
Chief of Head and Neck Surgery, Medical Director and Research Director
Georgia Cancer Center at Augusta University
Most cancers that invade the jaw occur in men at least twice as often as they do women, like other head and neck cancers. Benign tumors and cysts may affect men and women equally, or men slightly more than women, depending on the type.
Almost always, yes. Some of these tumors are quite aggressive and can get big enough to affect your ability to chew, swallow, and even talk. In addition, some of them, albeit rarely, can turn into malignancies over time if left untreated.
That’s a tricky question because most of them originate elsewhere and then invade the jaw, so you have to take the original type of cancer and the stage into account as well. When caught early, cancers of the hard palate that start in the gums or oral cavity have five-year survival rates of 81% and 72% respectively. Mandibular cancer that begins in the gums or the floor of the mouth have five-year survival rates of 81% and 73% when caught early.
Generally speaking, a lesion can be almost any abnormal change involving tissue, bone, or organs due to disease or injury. Lesions of the jaw are typically referred to as cysts. They may look similar to a tumor, but cysts contain liquid or semisolid material and are movable when you touch them. A tumor, on the other hand, is a sold mass of tissue that feels firm to the touch. Jaw cysts are usually benign, whereas tumors can be either benign or malignant.
What Is Jaw Cancer, Actually?
If you look in the American Cancer Society’s official A-Z guide of cancer types, you won’t find jaw cancer. This is why: Most cancers that affect the jaw don’t start there. Rather, they are head and neck cancers that usually begin in the mouth, throat, or salivary glands.
Given their proximity to the jaw, it’s not hugely surprising that these cancers spread there but technically speaking, they are still mouth or throat cancer, not “jaw cancer.” It’s like having tumors in your breast that spread to your lungs: Your diagnosis is still breast cancer, no matter where the cancer spreads to. For our purposes here, though, we’ll be using the term “jaw cancer” as a shortcut to talking about cancerous tumors in your jaw, regardless of origin.
Are you with us? Good, there’s more! There are also some bone cancers that can affect the jaw, but these are very rare, representing only 1% of all head and neck cancers. If a cancerous tumor is in the lower portion of the jaw, known as the mandible, it’s called mandibular cancer. If it’s in the upper portion, it may be referred to as hard palate cancer because the upper jaw is part of the hard palate.
And finally, there are several types of tumors and cysts of the jaw that are benign, meaning they are not cancer although they can still grow big enough to threaten your ability to chew, swallow, and talk. Before we dive into the cancerous sort, let’s take a look at benign jaw tumors for a second.
Benign Jaw Tumors
Benign jaw tumors and cysts (lesions that contain liquid or semisolid material) may not threaten your life, but some can certainly hinder the quality of it. They can be aggressive—invading surrounding bone and tissue, displacing teeth, and causing disfigurement in the face and neck. Random fact: While more than 90% of head and neck cancers are squamous cell carcinomas that form in the flat, fish-scale like cells lining inner surfaces of the head and neck, many benign tumors actually originate from the cells and tissues involved in tooth development. (These are called odontogenic tumors.)
Benign jaw tumors and cysts include:
Ameloblastomas: These jaw tumors grow from cells in the enamel that protects your teeth and often form near the wisdom teeth or molars. They can invade local bone and soft tissue and may recur after surgery. Though uncommon, ameloblastomas have been known to become cancerous, particularly if they recur after surgical removal.
Central giant cell granulomas: These lesions usually occur in the front portion of the lower jaw and most require surgery. Some may grow rapidly, causing pain and destroying bone, while others are less aggressive.
Dentigerous cysts: These cysts begin in the tissue that surrounds a tooth before it “erupts” or breaks through the surface. They generally occur near wisdom teeth, but other teeth can also be involved.
Odontomas: This most-common type of odontogenic tumor has the appearance of a misshapen tooth. Odontomas often have no symptoms but may interfere with tooth development or eruption.
Odontogenic keratocyst: This slow-growing, benign cyst most often develops in the lower jaw near the third molars and can be destructive to nearby areas. It frequently recurs and, rarely, may become malignant.
Odontogenic myxomas: This rare, slow growing tumor can be large and aggressive, invading the jaw and surrounding tissue, and displacing teeth. It usually occurs in the lower jaw and may recur after surgery.
Osteoid osteomas: This benign tumor of the bones occurs in the jaw less than 1% of the time, but usually affects the mandible when it does. It can be asymptomatic or cause pain and swelling.
Torus mandibularis: This bony growth develops on the lower jaw, beneath or on the side of the tongue. Although less common, it can occur in the upper jaw, where it is known as torus palatinus. There may be one growth or several, on one side of the mouth or both. Usually no treatment is required unless they become painful, in which case, they can be removed by an oral surgeon.
What Causes Jaw Cancer in the First Place?
Most cancers of the jaw have the same primary culprits as other head and neck cancers: tobacco use and more than a little alcohol consumption. After decades of studies and public service campaigns, it should come as no surprise to anyone that cigarettes, cigars, pipe tobacco, and chewing or smokeless tobacco cause cancer.
Happily, the decline in tobacco use in the U.S. has paralleled the overall decline in head and neck cancers. Alcohol plays the wingman in the cancer-causing process: It acts as an irritant in the mouth and throat, helping the chemicals in tobacco enter the cells more easily, and slowing the body’s ability to break down and get rid of chemicals.
Other possible causes of cancer in the jaw include:
HPV: If your jaw cancer originated in the area of the throat behind the mouth, there’s a good chance that human papillomavirus (HPV) is at work. HPV is a group of more than 200 viruses which are spread through vaginal, anal, and oral sex. It’s responsible for 70% of oropharyngeal cancers in the U.S., which include cancer of the tonsils, the back of the mouth, the base of the tongue, and the walls of the throat.
Paan (betel quid): This chewable combo of betel leaf and areca nut is popular among Southeast Asians for its stimulant and psychoactive effects (think cocaine) and its use has been strongly associated with an increased risk of oral cancer.
Oral health: There’s some evidence that poor oral hygiene and missing teeth may be risk factors for cancers of the oral cavity. Using a mouthwash that has a high alcohol content is also a possible risk factor.
Causes of benign tumors of the jaw are far less obvious. Often, the cause is never known. But some types of benign growths—including odontomas and odontogenic keratocysts—may be related to an inherited genetic syndrome. These growths can also occur in children and young adults. That sets them apart from head and neck cancers with environmental causes, which are usually diagnosed after age 60, and HPV-related cancers of the jaw, which typically occur in people ages 40 to 55.
Do I Have the Symptoms of Jaw Cancer?
Unlike other cancers of the head and neck, which can be maddeningly difficult to identify, mandibular and hard palate cancers stand out: They can typically be seen or felt by you, your doctor, or dentist. And even if you have no symptoms, they will likely appear on routine dental X-rays. Here’s what to watch for:
Painful sores or ulcers in the mouth (most common)
A red or white patch in the mouth
Recurrent bleeding from the mouth
Loose teeth or pain around your teeth
Dentures that no longer fit
Swelling inside the mouth near your jaw or on the side of your face
Difficulty opening the mouth
Numbness in the lower teeth or lower lip and chin area
Pain or difficulty with swallowing
A lump in the neck
Hard Palate Cancer
An ulcer on the roof of the mouth (most common)
A red or white patch on the roof of the mouth
Fullness (swelling) in the roof of the mouth
Loose teeth or pain around your teeth
Dentures that no longer fit
Changes in speech
Difficulty moving your jaw
Numbness in the cheek and upper teeth
A lump in the neck
Benign Jaw Tumors
Swelling or pain in the jaw
Painless, hard, slowly expanding swelling in the jaw or around the teeth
A tooth that does not come in
Difficulty opening and closing the mouth
How Is Jaw Cancer Diagnosed?
After a physical examination of your head and neck, your doctor or dentist is going to want imaging tests to get a better look at the problem area. If something seems suspicious, you’ll likely then have a biopsy of the area. These are some tests and procedures you might receive:
Computed Tomography (CT) Scan
Also called a “CAT” scan, this type of imaging takes detailed pictures inside your body to see if the cancer has spread.
Magnetic Resonance Imaging (MRI)
MRIs use radio waves and strong magnets to take detailed pictures that reveal more about the cancer size. This type of imaging will also reveal additional tumors.
This test uses a very small dose of ionizing radiation to create a two-dimensional picture of the entire mouth, including the full upper and lower jaw, plus the sinuses.
During this traditional form of biopsy, your doctor surgically removes a small piece of the suspected tissue while you’re under general anesthesia for lab analysis.
Your doctor will use a tool called a punch forceps to remove a piece of the suspicious area while you are under local anesthesia.
If it turns out that a jaw tumor is indeed malignant, it will then be staged with the TNM system: How big the tumor is, if it has spread to lymph nodes, and if it has metastasized (spread) to more distant parts of the body. Beyond that, there are four stages, with 1 being the earliest and 4 being the point where other organs or systems are affected. Since most cancers of the jaw originate in other areas of the mouth or throat, a later stage diagnosis is likely.
How Are Jaw Tumors Treated?
Regardless of whether the biopsy was benign or malignant, the first treatment step is almost always complete surgical removal of the tumor. Depending on its location, one of the following procedures may be used:
This procedure removes some of the mandible, or lower jaw. If the tumor has grown up against the jawbone, but not invaded it, a marginal mandibulectomy may be performed, which only removes a portion of the mandible and the bone remains whole.
If the cancer has invaded the bone, a segmental mandibulectomy will be done, during which a cut is made through the entire thickness of the mandible and a section of the bone is removed. This gap will then need to be reconstructed so that the jaw can function and appear normal on the outside. Reconstruction is usually done with bone from another part of the body like the leg, back, forearm, or hip.
This procedure removes some or all of the maxillary bone, or upper jaw. There are five types of maxillectomy—four are partial and depend on where the tumor is located in relation to the eye, nose, teeth, and hard palate. A total maxillectomy removes the entire upper jaw on one side of the face and requires extensive reconstruction. Some maxillectomies may also require a procedure known as orbital exenteration or removal of the eye socket, which is then reconstructed.
Additional procedures may need to be performed if the cancer affects other areas of the mouth or throat, such as a glossectomy (removal of part or all of the tongue) and neck dissection (removal of affected lymph nodes).
Malignancies of the jaw may also require radiation treatment if the tumor was not completely removed, the surgical margins were positive for cancer, the cancer is aggressive, or if it has spread to lymph nodes, nerves, or blood vessels. Chemotherapy is not usually used for cancers of the jaw, but in advanced cases it made be used in combo with radiation if there is concern that surgery did not remove 100% of the cancer.
Benign tumors and cysts often require no follow-up treatment after you’ve recovered from surgery, unless therapy is needed for speech, chewing or swallowing. You can, however, expect to be monitored with annual checkups and imaging tests for a long time to come because they can recur many years later.
Cancers of the Jaw: Thyroid, Head, and Neck Cancer Foundation. (2020). “Thyroid, Head, and Neck Cancer Guide.” thancguide.org/
Bone Cancer and the Jaw: Intechopen.com. (2017). “Osteosarcoma of the Jaw: Classification, Diagnosis and Treatment.” intechopen.com/books/osteosarcoma-biology-behavior-and-mechanisms/osteosarcoma-of-the-jaw-classification-diagnosis-and-treatment
Treatment of Benign Jaw Tumors: Indian Journal of Otolaryngology and Head and Neck Surgery. (2009). “Benign Jaw Tumors.” ncbi.nlm.nih.gov/pmc/articles/PMC3449977/
Ameloblastoma Overview: National Journal of Maxillofacial Surgery. (2014). “Ameloblastoma of the Anterior Mandible.” ncbi.nlm.nih.gov/pmc/articles/PMC4178356/
Odontogenic Keratocyst Overview: Journal of Natural Science, Biology and Medicine. (2013). “Odontogenic Keratocyst: What’s in a Name?” ncbi.nlm.nih.gov/pmc/articles/PMC3783765/