Oral Cancer

What is oral cancer?

Oral cancer (mouth cancer) is the broad term for cancer that affects the inside of your mouth. Oral cancer can look like a common problem with your lips or in your mouth, like white patches or sores that bleed. The difference between a common problem and potential cancer is these changes don’t go away. Left untreated, oral cancer can spread throughout your mouth and throat to other areas of your head and neck. Approximately 63% of people with oral cavity cancer are alive five years after diagnosis.

Who is affected by oral cancer?

Overall, about 11 people in 100,000 will develop oral cancer during their lifetime. Men are more likely than women to develop oral cancer. People who are white are more likely to develop oral cancer than people who are Black.

How does oral cancer affect my body?

Oral cancer can affect your mouth and your oropharynx. Your oropharynx includes parts of your tongue and the roof of your mouth and the middle part of your throat that’s visible when your mouth is wide open. Cancer in your oropharynx is called oropharyngeal cancer. This article focuses on oral cancer in your mouth, or oral cavity.

What parts of my body are in my oral cavity?

Your oral cavity includes:

• Your lips.
• Your gums.
• The lining of the inside of your cheeks.
• The first two-thirds of your tongue.
• The floor of your mouth (the part under your tongue).
• The first part of the roof of your mouth.
• The area right behind your wisdom teeth.

What causes oral cancer?

Oral cancer starts in the squamous cells in your oral cavity. Squamous cells are flat and, when viewed under a microscope, look like a fish scale.

Normal squamous cells become cancerous when their DNA changes and cells begin growing and multiplying. Over time, these cancerous cells can spread to other areas inside of your mouth and then to other areas of your head and neck or other areas of your body.

Are there specific activities that can increase my risk of developing oral cancer?

About 75% of people who develop oral cancer have the following habits:

• Smoke cigarettes, cigars or pipes.
• Use smokeless tobacco products such as chewing tobacco, dip, snuff or water pipes (hookah or shush).
• Regularly drink excessive amounts of alcohol.
• Spend a lot of time in the sun without protecting their lips with sunblock.
• Have human papillomavirus (HPV).
• Have a family history of oral cancer.

It’s important to note that 25% of people who develop oral cancer don’t smoke or have other known risk factors.

What are oral cancer symptoms?

Oral cancer has several signs and symptoms that may be mistaken for common problems or changes in your mouth. For example, you may notice patches inside of your mouth that you can’t scrape away. These patches may be pre-cancerous conditions.

The following conditions all appear as patches in your mouth and throat, but they’re different colors:

• Leukoplakia: These are flat white or gray patches in your mouth or throat.
• Erythroplakia: These are slightly raised or flat red patches. These patches might bleed when scraped.
• Erythroleukoplakia: These patches are red and white.

Common signs and symptoms of oral cancer include:

• Sores on your lip or inside your mouth that bleed easily and don’t heal within two weeks.
• Rough spots or crusty areas on your lips, gums or inside of your mouth.
• Areas in your mouth that bleed for no obvious reason.
• Numbness, pain or tenderness on your face and neck or in your mouth that occur without apparent cause.
• Difficulty chewing or swallowing, speaking or moving your jaw or tongue.
• Unintentional weight loss.
• Earache.
• Chronic bad breath.

How do healthcare providers diagnose oral cancer?

Your dentist may spot potential oral cancer during one of your regular checkups. They may follow up with preliminary tests or refer you to an oral and maxillofacial surgeon, or head and neck surgeon. These specialists are also called ear, nose and throat (ENT) specialists.

Oral cancer tests include:

• Physical examination: Your healthcare provider will look at the entire inside of your mouth and might feel around your mouth. They’ll also examine your head, face and neck for potential signs of pre-cancer or cancer.
• Brush biopsy also called scrape biopsy or exfoliative cytology: Healthcare providers use a small brush or spatula to gently scrape the area in question to obtain cells examined for cancer.
• Incisional biopsy: Your healthcare provider will remove small pieces of tissue to get cells to be examined for cancer.
• Indirect laryngoscopy and pharyngoscopy: Your healthcare provider uses a small mirror on a long thin handle to look at your throat, the base of your tongue and part of your larynx (voice box).
• Direct (flexible) pharyngoscopy and laryngoscopy: They may use an endoscope to look at areas of your throat and mouth that can’t be seen 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 a cancer’s stage. A stage describes a cancer’s location, if a cancer has grown, or penetrated the surface of the area where it was found. Tests also check to see if the cancer has moved to other areas in your body.

Healthcare providers use staging information to recommend treatment and help predict chances of recovery.

Oral cancers are staged using the TNM system. T stands for the size and location of the primary tumor. N indicates if the tumor has spread to your lymph nodes. M indicates if the tumor has metastasized, or spread to other areas of your body.

The stages for oral cavity cancer are:

• TI: The tumor in your mouth measures 2 centimeters or less.
• T2: The tumor is 2 centimeters or smaller but isn’t larger than 4 centimeters.
• T3: The tumor is larger than 4 centimeters.

How do healthcare providers treat oral (mouth) cancer?

The three main treatment options for oral (mouth) are surgery, radiation therapy and chemotherapy. Talk to your doctor about the purpose, side effects and ways to manage side effects for all of your options.

Your healthcare provider considers several factors before recommending treatment. Those factors include:

• The kind of oral cancer that you have.
• If the oral cancer you have has spread from the original site to other parts of your mouth and throat or other parts of your body.
• Your general health.
• Your age.

What surgeries treat oral cancer?

The most common surgeries for oral cancer are:

• Primary tumor surgery: Healthcare providers remove tumors through your mouth or an incision in your neck.
• Glossectomy: This is the partial or total removal of your tongue.
• Mandibulectomy: This is surgery for oral cancer in your jawbone.
• Maxillectomy: This surgery removes part or all of the hard palate, which is the bony roof of your mouth.
• Sentinel lymph node biopsy: This test helps healthcare providers know if cancer has spread beyond the original oral cancer.
• Neck dissection: This surgery is done to remove lymph nodes from your neck.
• Reconstruction: Surgery that removes large areas of tissue might be followed by reconstructive surgery to fill gaps left by the tumor or replace part of your lips, tongue, palate or jaw. In some cases, reconstructive surgery is done by taking healthy bone and tissue from other areas of your body.

What are other ways to treat oral cancer?

Healthcare providers may combine surgery with other treatments, including:

• Radiation therapy: Radiation therapy uses strong beams of energy to kill cancer cells or keep them from growing. Your healthcare provider may combine radiation therapy with other treatments.
• Targeted therapy: This cancer treatment uses drugs or other substances to precisely identify and attack certain types of cancer cells without hurting normal cells. Monoclonal antibodies are immune system proteins that are created in the lab and used to treat cancer.
• Chemotherapy: Your healthcare provider may use anti-cancer drugs that kill cancer cells, including treatments that affect most parts of your body.
• Immunotherapy: Immunotherapy is a cancer treatment that engages your immune system to fight the disease. The treatment is sometimes called biological therapy.

What can I do to prevent developing oral cancer?

Oral cancer can be prevented, and you can play an active role in preventing it. You can help prevent oral cancer with the following tips:

• If you’re someone who smokes tobacco, chews tobacco or uses a water pipe, try stopping or cutting back. Talk to your doctor about smoking cessation programs.
• If you’re someone who drinks alcohol, drink in moderation.
• Remember your sunscreen. Use UV-AB-blocking sunscreen on your face and sunblock.
• Get vaccinated for human papillomavirus.
• Eat a well-balanced diet.
• Have regular dental check-ups. People between ages 20 and 40 should have an oral cancer screening every three years and annual exams after age 40.

Can I spot potential oral cancer?

Detecting oral cancer early can reduce the chance the cancer will grow or spread. You can detect oral cancer early by doing a monthly self-examination. If you spot changes or something unusual, contact your dentist immediately. Here’s how to examine your mouth, throat and neck for signs of oral cancer:

• Feel your lips, the front of your gums and the roof of your mouth.
• Feel your neck and under your lower jaw for lumps or enlarged lymph nodes.
• Use a bright light and a mirror to look inside your mouth.
• Tilt your head back and look at the roof of your mouth.
• Pull your cheeks out to view the inside of your mouth, the lining of your cheeks and your back gums.
• Pull your tongue out and look at the top, bottom and sides. Gently push your tongue back so you can see the floor of your mouth.

What can I expect if I have oral cancer?

Oral cancer includes cancer in your mouth. Like most forms of cancer, early diagnosis and treatment improve the chance that oral cancer will spread. Approximately 1/3 of people treated for oral cancer develop new a cancer. If you’ve been treated for oral cancer, talk to your healthcare provider about follow-up examinations.

What can I expect after completing my treatment for oral cancer?

If you’ve been treated for oral cancer, your healthcare provider will share information on how your specific treatment may affect your day-to-day life.

For example, some peoples’ oral cancer is successfully treated by removing the tumor from their lip or mouth. But someone whose oral cancer has spread will have had different and more extensive surgery that may involve reconstructing part of their mouth or jaw.

Regardless of your situation, you may need regular follow-up appointments with your healthcare providers, including your dentist.

When should I contact my healthcare provider?

You should contact your healthcare provider any time you notice changes in your mouth such as new persistent sores or rough spots that don’t go away after two weeks.

What questions should I ask my provider?

Some general questions you might ask your healthcare provider include:

• 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 that if caught early on can be treated successfully. That’s why it’s important you try to see your dentist twice a year and make time to do a monthly self-examination. There are ways to prevent oral cancer, and one of the most important is to avoid using tobacco products. A cancer diagnosis can be scary. Know you don’t have to go it alone, though. Talk to your healthcare providers about resources to help you talk to your friends and family about your oral cancer.