Lip Cancers Health Article

Diagnosis

Dentists frequently identify a suspicious spot, sore, or lump on the lip. A good dental exam includes an examination of the lips and the mouth. X ray and biopsy, the taking of a tissue sample for analysis, can be used to determine whether or not cancer is present.

Because spots and sores on the lips can be short-lived, people should not be alarmed by every change that appears. However, when there is a change that occurs and stays, it should be investigated. If the next scheduled dental visit is several months away, a special appointment with the dentist or a physician should be made. Dentists should tell their patients, particularly older ones, how to undertake a regular self-exam of the lips between check-ups.

Treatment team

A physician who specializes in oncology, the study and treatment of cancer, will probably take the lead on treatment. A surgeon will remove the cancer. Not all oncologists are surgeons, so it is likely that the team will include a medical oncologist, who coordinates treatment, as well as a surgical oncologist, who performs the surgery.

Because surgery on the lip can interfere with eating and talking, most teams include a nutritionist and a speech pathologist. Scars and alterations of facial features can produce changes in body image, and a social worker may participate in the team to help a patient cope with such changes. It is possible that a dentist or oral surgeon will also play a role. Nurses who administer chemotherapy and monitor the status of patients will be involved, as will radiation technicians and a radiation oncologist. If reconstruction of a lip is necessary because of the amount of tissue removed or the size of a scar, a plastic surgeon will be added to the team.

Clinical staging, treatments, and prognosis

The ability to see a suspicious area on the lips and to detect lip cancer early combine to form the staging process. (One inch equals 2.5 centimeters.)

• Stage I: The cancer is less than one inch in diameter and has not spread.
• Stage II: The cancer is up to approximately two inches in diameter and has not spread.
• Stage III: The cancer is either larger than two inches or has spread to a lymph node on the side of the neck that matches the primary location of the lip cancer. The lymph node is enlarged, but not much more than an inch.
• Stage IV: One or more of several things can occur. There may be a spread of cancer to the mouth or to the areas around the lip, more than one lymph node with cancer, or metastasis (spread) to other parts of the body.

The outlook for recovery from lip cancer is very good if it is diagnosed early. For stage I and stage II cancers, surgery to remove the cancer or radiation treatment of the affected area is sometimes all that is required to produce a cure. Decisions about which method to use depend on many factors, but the size of the tumor and the tolerance a patient has for radiation or chemotherapy are particularly important. The larger the tumor, the more urgent is its removal. Smaller tumors can be treated with radiation or other methods in an effort to shrink them before surgery. In some cases, surgery might be avoided. For stage III cancer with lymph node involvement, the cancerous lymph nodes are also removed.

Chemotherapy may be used at any stage, but it is particularly important for stage IV cancer. In some cases, chemotherapy is used before surgery, just as radiation is, to try to eliminate the cancer without cutting, or at least to make it smaller before it is cut out (excised). After surgery, radiation therapy and chemotherapy are both used to treat patients with stage IV lip cancer, sometimes in combination.

There are many new and promising types of treatment for lip cancer. For example, heat kills some cancer cells, and a treatment known as hyperthermia uses heat to eliminate cancer in some patients.

Because lip cancers are well-studied and often successfully treated, the best practices for dealing with the cancer, or a suspected cancer, are specific. In the case of how to extract and study tissue to determine whether a suspicious growth is malignant (biopsy), size is an extremely useful guide.

It is possible to take tissue from a suspected lip cancer for examination, or biopsy, by simply piercing and extracting tissue with a large, hollow needle. The technique is called a punch biopsy. However, the method is not recommended for any tumor that is thicker than about one-sixteenth of an inch. For thicker tumors, a tissue sample is better taken by cutting into the tumor, that is, making an incision.

The success with identifying lip cancer early and eliminating it means that it is not a big killer. Only 4 in 2.5 million people die from lip cancer each year, or about 112 individuals in the entire U.S. population. In contrast, cancers in the oral cavity, including on the tongue, cause more than 8, 000 deaths in the U.S. each year.

Alternative and complementary therapies

Because there seems to be some link between a chronic absence of vitamins A and C in the diet and lip cancer, some complementary therapies promote taking massive amounts of the vitamins, or megavitamins. The value of such therapy has not been demonstrated. In order to avoid possible side effects or harmful interactions with standard cancer treatment, patients should always notify their treatment team of any over-the-counter or herbal remedies that they are taking.