What is Oral Cancer?
Oral cancer is a growth of malignant cells in any part of the oral cavity, which includes the lips, tongue, hard and soft palates, salivary glands, lining of the cheeks, floor of the mouth or under the tongue, gums, and teeth. It is often discussed with oropharyngeal cancer, which pertains to cancer of the throat area at the back of the mouth.
The most common site is the lip, followed by the tongue and then other locations. Symptoms vary depending on the location of the cancer but usually include ulcerations that are initially painless. Bleeding may or may not occur. In more advanced stages, the cancer spreads.
Treatment depends on the location and stage of the malignancy and the age and overall health of the patient, but it usually involves surgery, radiation, chemotherapy or both all three. Prognosis is good if the cancer is detected and treated before it has spread. In most cases lip cancer is very treatable because it is easier to detect, while prognosis for a larger tongue cancer is not as good, particularly if the lesion is near the rear of the mouth and hard to see.
According to the American Cancer Society, 83% of patients who have early-stage cancer of the lip survive five years from the time of diagnosis, and 47% of those with late-stage disease live that long. For mouth cancer found in other places in the oral cavity, the five-year survival rate is 68% for early-stage and 27% for late-stage. For those with oropharyngeal cancer, the survival rate is 57% for early-stage disease and 30% for late-stage.
Who Gets Oral Cancer?
Oral cancers account for about 4% of all cancers. Risk increases with age; the majority of cases occur in people over age 45.
According to the National Cancer Institute, approximately 41,380 cases of oral cancer were diagnosed in the United States in 2013, and about 7,890 people died from oral cancers.
Oral and oropharyngeal cancers are roughly twice as common in men as in women, and the conditions occur more often in African-Americans than Caucasians. Currently, the diagnosis and death rates from oral cancer are dropping in the United States.
- A mucous membrane lesion or ulcerations in some area of the mouth that persist or worsen over time. In early stages such lesions are often painless.
- Difficulty speaking, eating, and swallowing, as well as swollen glands in the neck, especially once the disease has progressed.
- Bad breath.
- Abnormal sense of taste.
- An enlarging growth on the lip that crusts over and bleeds when the crust is removed.
- A sore throat or burning sensation in the mouth during advanced stages, especially when eating or drinking.
- White patches (leukoplakia) or velvety red patches (erythroplakia); these must be watched carefully and biopsied because they may be precancerous.
- The primary risk factor for oral cancers is theuse of tobacco products, including cigarettes, cigars, pipes, chewing tobacco, and dipping snuff. According to the American Cancer Society, 90% of patients who develop mouth cancer use tobacco, and smokers are 6 times more likely to develop oral cancer than nonsmokers. The longer patients use tobacco, the higher the risk. Secondhand smoke is a related risk factor.
- Alcohol use, particularly long-term alcohol consumption, increases oral cancer risk. According to the American Cancer Society, alcohol users account for 75% to 80% of all oral cancer patients. People who use tobacco and alcohol simultaneously run the most serious risk for developing these cancers.
- Sunand ultraviolet light can cause cancer of the lip. In many cases, patients who develop this type of cancer work outside in the direct sun.
- Human papillomavirus infection is associated with both oral cancer and cervical cancer. Oral cancer in nonsmokers is frequently associated with HPV infection.
- Plummer-Vinson syndrome is a rare condition of iron deficiency and abnormalities in the oral cavity.
- Poor diet and nutritional deficiencies, such as low iron, vitamin A, and certain B vitamins, may increase risk.
A diagnosis is made by:
- Taking a patient history and conducting examination of the mouth and neck are necessary on a routine basis.
- Performing a biopsy in which a small sample of affected tissue is removed for microscopic examination of the cells to determine if cancer is present.
- Performing X-rays or CT or MRI scans of the head or chest may be taken to detect if the cancer has spread.
Surgery is recommended often to treat oral and oropharyngeal cancers. Other treatment modalities are radiation therapy and chemotherapy. Treatment depends on the stage and location of the disease, the size of tumor, and if the mouth cancer has spread.
- In a primary tumor resection, the tumor and surrounding tissue are surgically removed. In cases that involve the lip, Mohs micrographic surgery may also be an option. In this procedure, the surgeon slices removes tissue from around the edge of the tumor and examines each piece for microscopic cancer cells. In this way, less surrounding tissue is removed. If cancer has spread to the lymph nodes, a neck dissectionis conducted. Some patients may require reconstructive surgery.
- Radiation therapy is used to treat small tumors or in combination with other types of treatment. There are two main types of radiation therapy:
- External radiation involves a beam of radiation directed at the tumor site. Doctors are careful to use only the amount of radiation necessary to treat the cancer. Radiation usually is administered five times a week for five to seven weeks.
- Internal radiationrequires a hospital stay. In this treatment, radioactive material is placed directly into the cancerous tissue for several days. The material usually is removed before the patient leaves the hospital. While the material is implanted, visits to the patient must be short due to the risk for radiation exposure.
- The U.S. Food and Drug Administration (FDA) has approved the use of cetuximab (Erbitux) to be used with radiation to treat patients with advanced oral cancer. This drug can help slow down the growth and spread of cancer cells. Erlotinib (Tarceva) can help in a similar way. The effectiveness of these drugs is still being investigated.
- Laryngectomyis the surgical removal of the voice box or larynx. Following this procedure, a hole remains in the patient's neck to assist with breathing and talking.
Complications from surgery can include pain, discomfort, swelling, and fatigue. If the tumor is large, parts of the jaw, tongue, or the roof of the mouth may also be removed. In these cases, reconstructive surgery may be performed.
- During recovery, it is important to maintain a healthy diet. However, this is difficult for many patients because treatment can affect appetite, taste, and the ability to chew and swallow. Crunchy, chewy, hot, spicy, or acidic foods should be avoided. Foods high in sugar also should be avoided due to the risk for tooth decay. A dietitian or nutritionistcan teach patients to manage a healthy diet after cancer treatment.
- Avoid all tobacco products.
- Avoid excessive alcohol use.
- Regular dental checkups and periodic self-examination of the mouth may help detect cancer in its early stages.
When To Call A Doctor
See your doctor or dentist if you develop any mouth lesion that fails to heal within two weeks to a month.
Reviewed by Alan Lipkin, M.D., Otolaryngologist, Private Practice, Denver, Colorado. Review provided by VeriMed Healthcare Network.