Oral cancer is 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.
More than 49,000 cases of oral cancer are diagnosed each year in the United States, occurring most often in people over 40 years old. Oral cancers are most often discovered after they’ve spread to the lymph nodes of the neck. Early detection is key to surviving oral cancer. Learn about what raises your risk, its stages, and more.
Oral cancers include cancers of the:
Your dentist is often the first healthcare provider to notice signs of oral cancer. Getting biannual dental checkups can keep your dentist up to date on the health of your mouth.
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:
- human papillomavirus (HPV) infection
- chronic facial sun exposure
- a previous diagnosis of oral cancer
- a family history of oral or other types of cancer
- a weakened immune system
- poor nutrition
- genetic syndromes
- being male
Men are twice as likely to get oral cancer as women are.
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 your mouth
- loose teeth
- pain or difficulty swallowing
- trouble wearing dentures
- a lump in your neck
- an earache that won’t go away
- dramatic weight loss
- lower lip, face, neck, or chin numbness
- white, red and white, or red patches in or on your mouth or lips
- a sore throat
- jaw pain or stiffness
- tongue pain
Some of these symptoms, such as a sore throat or an earache, may indicate other conditions. However, 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. Find out what mouth cancer looks like here.
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’ll 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
- a CT scan to reveal any tumors in your mouth, throat, neck, lungs, or elsewhere in your body
- a PET scan to determine if the cancer has traveled to lymph nodes or other organs
- a MRI scan to show a more accurate image of the head and neck, and determine the extent or stage of the cancer
- an endoscopy to examine the nasal passages, sinuses, inner throat, windpipe, and trachea
There are four stages of oral cancer.
- Stage 1: The tumor is 2 centimeters (cm) or smaller, and the cancer hasn’t spread to the lymph nodes.
- Stage 2: The tumor is between 2-4 cm, and cancer cells haven’t spread to the lymph nodes.
- Stage 3: The tumor is either larger than 4 cm and hasn’t spread to the lymph nodes, or is any size and has spread to one lymph node, but not to other parts of the body.
- Stage 4: Tumors are any size and the cancer cells have spread to nearby tissues, the lymph nodes, or other parts of the body.
According to the National Cancer Institute, the five-year survival rates for oral cavity and pharynx cancers are as follows:
- 83 percent, for localized cancer (that hasn’t spread)
- 64 percent, for cancer that’s spread to nearby lymph nodes
- 38 percent, for cancer that’s spread to other parts of the body
Overall, 60 percent of all people with oral cancer will survive for five years or more. The earlier the stage at diagnosis, the higher the chance of survival after treatment. In fact, the five-year overall survival rate in those with stage 1 and 2 oral cancers is typically 70 to 90 percent. 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 a 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 to heal.
Keeping your mouth healthy
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. Postsurgery 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:
- a 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
- a change in your ability to taste and smell
- changes in your skin, including dryness and burning
- weight loss
- thyroid changes
Chemotherapy drugs can be toxic to rapidly growing noncancerous cells. This can cause side effects such as:
- hair loss
- painful mouth and gums
- bleeding in the mouth
- severe anemia
- poor appetite
- 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:
- an allergic reaction
- skin rashes
Although these treatments do have side effects, they’re often necessary in beating the cancer. Your doctor will discuss the side effects and help you weigh the pros and cons of your treatment options.
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’re 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.