Oral Cancers

Oral cancer is a cancer that develops in the tissues of the mouth or throat. It belongs to a larger group of cancers called head and neck cancers. Most develop in the squamous cells found in your mouth, tongue, and lips. Oral cancers are most often discovered after they have spread to the lymph nodes of the neck. Early detection is key to surviving oral cancer.

Oral cancers include cancers of the:

• lips
• tongue
• cheek
• gums
• floor of the mouth
• hard and soft palate

Your dentist is often the first healthcare provider to notice signs of oral cancer.

One of the biggest risk factors for oral cancer is tobacco use. This includes smoking cigarettes, cigars, and pipes, as well as chewing tobacco.

People who consume large amounts of alcohol and tobacco are at an even greater risk, especially when both products are used on a regular basis.

Other risk factors include:

• HPV infection (a sexually transmitted virus)
• chronic facial sun exposure
• a previous diagnosis of oral cancer
• a family history of oral or other types of cancer
• being male

Symptoms of oral cancer include:

• a sore on your lip or mouth that won’t heal
• a mass or growth anywhere in your mouth
• bleeding from the mouth
• loose teeth
• pain or difficulty with swallowing
• trouble wearing dentures
• lump in neck
• earache that won’t go away
• dramatic weight loss
• lower lip, face, neck, or chin numbness
• white, red and white, or red patches in mouth or lips

If you notice any of these symptoms, especially if they don’t go away or you have more than one at a time, visit your dentist or doctor as soon as possible.

First, your doctor or dentist will perform a physical exam. This includes closely examining the roof and floor of your mouth, the back of your throat, tongue, and cheeks, and the lymph nodes in your neck. If your doctor cannot determine why you’re having your symptoms, you may be referred to an ear, nose, and throat (ENT) specialist.

If your doctor finds any tumors, growths, or suspicious lesions, they will perform a brush biopsy or a tissue biopsy. A brush biopsy is a painless test that collects cells from the tumor by brushing them onto a slide. A tissue biopsy involves removing a piece of the tissue so it can be examined under a microscope for cancerous cells.

In addition, your doctor may perform one or more of the following tests:

• X-rays to see if cancer cells have spread to the jaw, chest, or lungs
• CT scan to reveal any tumors in your mouth, throat, neck, lungs, or elsewhere in your body
• PET scan to determine if the cancer has traveled to lymph nodes or other organs
• MRI scan to show a more accurate image of the head and neck, and determine the extent or stage of the cancer
• endoscopy to examine the nasal passages, sinuses, inner throat, windpipe, and trachea

There are four stages of oral cancer. Stages 1 and 2 usually involve a small tumor. In these stages, cancer cells have not spread to the lymph nodes.

Stages 3 and 4 are considered advanced stages of cancer. In these stages, tumors are large and the cancer cells have usually spread to the lymph nodes or other parts of the body.

The survival rate after one year for all stages of oral cancer is 81 percent. After five years, the survival rate is 56 percent, and after 10 years it’s 41 percent. The earlier the stage at diagnosis, the higher the chance of survival after treatment. This makes timely diagnosis and treatment all the more important.

Treatment for oral cancer will vary depending on the type, location, and stage of the cancer at diagnosis.

Treatment for early stages usually involves surgery to remove the tumor and cancerous lymph nodes. In addition, other tissue around the mouth and neck may be taken out.

Radiation therapy is another option. This involves a doctor aiming radiation beams at the tumor once or twice a day, five days a week, for two to eight weeks. Treatment for advanced stages will usually involve a combination of chemotherapy and radiation therapy.

Chemotherapy is treatment with drugs that kill cancer cells. The medicine is given to you either orally or through an intravenous (IV) line. Most people get chemotherapy on an outpatient basis, although some require hospitalization.

Targeted therapy is another form of treatment. It can be effective in both early and advanced stages of cancer. Targeted therapy drugs will bind to specific proteins on cancer cells and interfere with their growth.

Nutrition is also an important part of your oral cancer treatment. Many treatments make it difficult or painful to eat and swallow, and poor appetite and weight loss are common. Make sure you discuss your diet with your doctor. Getting the advice of a nutritionist can help you plan a food menu that will be gentle on your mouth and throat, and will provide your body with the calories, vitamins, and minerals it needs.

Finally, keeping your mouth healthy during cancer treatments is a crucial part of treatment. Make sure to keep your mouth moist and your teeth and gums clean.

The recovery from each type of treatment will vary. Post-surgery symptoms can include pain and swelling, but removing small tumors usually has no associated long-term problems.

The removal of larger tumors could possibly affect your ability to chew, swallow, or talk as well as you did before the surgery. You might also need reconstructive surgery to rebuild the bones and tissues in your face removed during surgery.

Radiation therapy can have a negative effect on the body. Some of the side effects of radiation include:

• sore throat or mouth
• dry mouth and loss of salivary gland function
• tooth decay
• nausea and vomiting
• sore or bleeding gums
• skin and mouth infections
• jaw stiffness and pain
• problems wearing dentures
• fatigue
• change in your ability to taste and smell
• changes in skin, including dryness and burning
• weight loss
• thyroid changes

Chemotherapy drugs can be toxic to rapidly growing non-cancerous cells. This can cause side effects such as:

• hair loss
• painful mouth and gums
• bleeding in the mouth
• severe anemia
• weakness
• poor appetite
• nausea
• vomiting
• diarrhea
• mouth and lip sores
• numbness in the hands and feet

Recovering from targeted therapies is usually minimal. The side effects of this treatment can include:

• fever
• headache
• vomiting
• diarrhea
• allergic reaction
• skin rashes

People who are diagnosed with advanced oral cancer will likely need reconstructive surgery and some rehabilitation to assist with eating and speaking during recovery.

Reconstruction can involve dental implants or grafts to repair the missing bones and tissues in the mouth or face. Artificial palates are used to replace any missing tissue or teeth.

Rehabilitation is also necessary for cases of advanced cancer. Speech therapy can be provided from the time you get out of surgery until you reach the maximum level of improvement.

The outlook for oral cancers depends on the specific type and stage of cancer at diagnosis. It also depends on your general health, your age, and your tolerance and response to treatment. Early diagnosis is critical because treating stage 1 and stage 2 cancers may be less involved and have a higher chance of successful treatment.

After treatment, your doctor will want you to get frequent checkups to make sure that you are recovering. Your checkups will usually consist of physical exams, blood tests, X-rays, and CT scans. Make sure to follow up with your dentist or oncologist if you notice anything out of the ordinary.