Oral cancer (mouth cancer) is the most prevalent form of head and neck cancer, typically affecting individuals aged 60 and older. It can impact various parts of the mouth, including the lips, the initial sections of the tongue, and the roof and floor of the mouth. It also affects the oropharynx, encompassing the latter part of the tongue, the roof of the mouth, the tonsils, and the sides and back of the throat.
Overview
What is oral cancer?
Oral cancer (mouth cancer) refers to cancer affecting the inside of the mouth. It can resemble common issues such as white patches or sores that bleed. The key difference is that cancerous changes do not go away. If left untreated, oral cancer can spread throughout the mouth and throat to other areas of the head and neck. Approximately 63% of people diagnosed with oral cavity cancer are alive five years post-diagnosis.
Who is affected by oral cancer?
Approximately 11 out of every 100,000 people will develop oral cancer during their lifetime. Men are more likely than women to develop oral cancer, and white individuals are more likely to develop it than Black individuals.
How does oral cancer affect my body?
Oral cancer can affect both the mouth and the oropharynx, which includes parts of the tongue and the roof of the mouth, and the middle part of the throat visible when the mouth is wide open. Cancer in the oropharynx is referred to as oropharyngeal cancer. This article focuses on oral cancer in the mouth, also known as the oral cavity.
What parts of my body are in my oral cavity?
The oral cavity includes:
- Your lips
- Your gums
- The lining inside your cheeks
- The first two-thirds of your tongue
- The floor of your mouth (under your tongue)
- The initial part of the roof of your mouth
- The area right behind your wisdom teeth
Symptoms and Causes
What causes oral cancer?
Oral cancer starts in the squamous cells of the oral cavity. Squamous cells are flat and resemble fish scales under a microscope. Normal squamous cells become cancerous when their DNA changes and they begin growing and multiplying uncontrollably. Over time, these cancerous cells can spread to other parts of the mouth and other areas of the body.
Are there specific activities that can increase my risk of developing oral cancer?
About 75% of oral cancer cases are linked to certain habits:
- Smoking cigarettes, cigars, or pipes
- Using smokeless tobacco products like chewing tobacco, dip, snuff, or water pipes (hookah or shisha)
- Consuming excessive amounts of alcohol regularly
- Spending a lot of time in the sun without lip protection
- Having human papillomavirus (HPV)
- Having a family history of oral cancer
It is important to note that 25% of oral cancer cases occur in people without any known risk factors.
What are oral cancer symptoms?
Oral cancer can have several signs and symptoms that might be mistaken for common oral issues. You may notice patches in your mouth that do not go away. These patches can be pre-cancerous conditions.
Common symptoms include:
- Sores on your lip or inside your mouth that bleed easily and do not heal within two weeks
- Rough spots or crusty areas on your lips, gums, or inside of your mouth
- Unexplained bleeding in your mouth
- Numbness, pain, or tenderness in your face, neck, or mouth
- Difficulty chewing, swallowing, speaking, or moving your jaw or tongue
- Unintentional weight loss
- Earache
- Chronic bad breath
Diagnosis and Tests
How do healthcare providers diagnose oral cancer?
Dentists may spot potential oral cancer during routine checkups and might refer you to an oral and maxillofacial surgeon or an ENT specialist for further tests.
Oral cancer tests include:
- Physical examination: Examining the entire mouth, head, face, and neck for signs of cancer.
- Brush biopsy: Using a small brush or spatula to scrape the area in question to obtain cells for examination.
- Incisional biopsy: Removing small tissue samples for examination.
- Indirect laryngoscopy and pharyngoscopy: Using a small mirror on a long thin handle to examine the throat, the base of the tongue, and part of the larynx (voice box).
- Direct (flexible) pharyngoscopy and laryngoscopy: Using an endoscope to examine areas of the throat and mouth not visible with mirrors. An endoscope is a thin, flexible tube with an attached light and viewing lens.
Are there oral cancer stages?
Diagnostic tests help determine the stage of cancer. Staging describes the cancer’s location, growth, and whether it has spread to other parts of the body. This information helps healthcare providers recommend treatment and predict recovery chances.
Oral cancers are staged using the TNM system: T (size and location of the primary tumor), N (if cancer has spread to lymph nodes), and M (if cancer has metastasized to other areas of the body).
Management and Treatment
How do healthcare providers treat oral (mouth) cancer?
The three main treatment options are surgery, radiation therapy, and chemotherapy. Your healthcare provider will consider several factors before recommending treatment, such as:
- The type of oral cancer
- If the cancer has spread
- Your overall health
- Your age
What surgeries treat oral cancer?
Common surgeries for oral cancer include:
- Primary tumor surgery: Removing tumors through the mouth or neck incision.
- Glossectomy: Partial or total removal of the tongue.
- Mandibulectomy: Surgery for oral cancer in the jawbone.
- Maxillectomy: Removing part or all of the hard palate.
- Sentinel lymph node biopsy: Checking if cancer has spread beyond the original site.
- Neck dissection: Removing lymph nodes from the neck.
- Reconstruction: Reconstructive surgery to fill gaps left by the tumor or replace parts of the lips, tongue, palate, or jaw using healthy bone and tissue from other areas of the body.
What are other ways to treat oral cancer?
Other treatments include:
- Radiation therapy: Using strong energy beams to kill or inhibit cancer cells.
- Targeted therapy: Using drugs or substances to specifically attack cancer cells without harming normal cells.
- Chemotherapy: Using anti-cancer drugs that kill cancer cells.
- Immunotherapy: Engaging the immune system to fight cancer, also known as biological therapy.
Prevention
What can I do to prevent developing oral cancer?
Preventing oral cancer involves:
- Quitting or reducing tobacco use
- Drinking alcohol in moderation
- Using UV-AB-blocking sunscreen on your lips and face
- Getting vaccinated for HPV
- Eating a balanced diet
- Having regular dental check-ups
Can I spot potential oral cancer?
Early detection of oral cancer reduces the chance of its spread. Perform monthly self-examinations and see your dentist regularly. To examine your mouth, throat, and neck for signs of oral cancer:
- Feel your lips, gums, and the roof of your mouth
- Check your neck and under your jaw for lumps
- Use a bright light and a mirror to look inside your mouth
- Examine the top, bottom, and sides of your tongue and the floor of your mouth
Outlook / Prognosis
What can I expect if I have oral cancer?
Early diagnosis and treatment improve the chances of successful treatment. However, approximately 1/3 of people treated for oral cancer develop a new cancer. Regular follow-up examinations are crucial.
Living With
What can I expect after completing my treatment for oral cancer?
Post-treatment, your healthcare provider will inform you about how your treatment might affect your daily life. Regular follow-up appointments with your dentist and other healthcare providers are necessary.
When should I contact my healthcare provider?
Contact your healthcare provider if you notice new persistent sores, rough spots, or other changes in your mouth that do not go away after two weeks.
What questions should I ask my provider?
Consider asking:
- What is the difference between pre-cancerous oral cancer and oral cancer?
- Is my condition likely temporary or chronic?
- What may have caused me to develop cancer?
- What tests will I need, and what do they entail?
- What’s the best course of action?
- What are the alternatives to the primary approach that you’re suggesting?
- If I need surgery, will I need reconstructive surgery?
- Should I see a specialist? What will that cost, and will my insurance cover it?
- What can I do to ease my symptoms?
- What lifestyle changes can I make to help with treatment and recovery?
A Note from Cleveland Clinic:
Oral cancer is a serious illness, but early detection and treatment can lead to successful outcomes. Regular dental check-ups and monthly self-examinations are crucial. Avoiding tobacco products is one of the most important preventive measures. A cancer diagnosis can be frightening, but you don’t have to face it alone. Talk to your healthcare providers about resources to help you communicate with friends and family about your condition.
