Oral Cancers

Oral cancer is a cancer that develops in the tissues of the mouth or throat. 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 this cancer.

Types of Oral Cancers

Did You Know?

According to the Oral Cancer Foundation, more than 45,000 oral cancer cases are diagnosed in the United States every year.

Oral cancers include cancers of the:

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

Your first line of defense against oral cancers is your dentist. They’re often the first healthcare provider to notice signs of oral cancer.

Risk Factors for Developing Oral Cancer

There is no question that certain behaviors can increase your chances of developing oral cancer. One of the biggest risk factors is tobacco use — including smoking cigarettes, cigars, pipes, or the use of 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 type of cancer

The risk for oral cancer increases with age. According to the American Dental Association, adults over the age of 44 are at the greatest risk. The average age of diagnosis is 62. Men are also twice as likely to get oral cancer as compared to women.

What Are Symptoms of Oral Cancer?

The symptoms of oral cancer are similar to other nonthreatening oral problems. However, if you notice any of the below symptoms — especially if you have more than one at a time — you should visit your dentist or doctor as soon as possible.

Symptoms of oral cancer include:

• a sore on your lip or mouth that won’t heal
• 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

How Is Oral Cancer Diagnosed?

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

Your doctor will either perform a brush or tissue biopsy if any tumors or growths are found. 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 checked 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, with or without dye. The scan will show any tumors in your mouth, throat, neck, lungs, or anywhere else in your body.
• MRI will show if cancer has spread to anywhere else in your body.
• Endoscopy is a thin, lighted tube that is placed down your throat to examine the inner throat, windpipe, and lungs.
• PET scan, where the doctor will give you an injection of radioactive sugar. The PET scanner will be able to view where the sugar is collecting. Cancer cells will take up or collect sugar faster than normal cells.

What Are the Stages of Oral Cancer?

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.

After 10 years, it is 41 percent.

This makes timely diagnosis and treatment all the more important.

How Is Oral Cancer Treated?

Treatment for oral cancer will vary depending on what stage you are in.

Early treatment 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 at the tumor once or twice a day, five days a week, for two to eight weeks (depending on your tumor size). An advanced course of treatment 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. A number of 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 cancer cells while interfering with their growth. This form of treatment is usually given through an IV.

Nutrition is an important part of your oral cancer treatment. 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 to your sore mouth and throat and will provide your body with the vitamins and minerals you need.

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.

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Recovering from Oral Cancer Treatment

The recovery from each type of treatment will vary. Recovery from surgery can involve 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 the face.

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

• sore throat or mouth
• dry mouth
• tooth decay
• nausea and vomiting
• sore or bleeding gums
• various infections
• long-term healing after dental care
• 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 cells that aren’t cancerous. Some of the side effects include:

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

Recovering from targeted therapies can be uncomfortable, but the symptoms are much less severe than other forms of treatment. The side effects of this treatment can include:

• fever
• headache
• vomiting
• diarrhea
• allergic reaction

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Reconstruction and Rehabilitation After Oral Cancer Treatment

Individuals 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 (where skin, muscle, and bone are moved from another area, usually the chest, arm, or leg) 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 in advanced cancer cases. Speech therapy can be provided from the time you get out of surgery until you reach maximum level of improvement.

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Outlook and Follow-Up

The outlook for oral cancers depends on when you’re diagnosed, as well as response to treatment. Early diagnosis is critical because it is easier to treat stage 1 and stage 2 cancers. After treatment, your doctor will want you to get frequent checkups to make sure that you are cancer free. Your checkups will usually consist of physical exams, blood tests, X-rays, and/or CT scans. Above all else, follow up with your dentist or oncologist if you notice anything out of the ordinary — doing so could very well save your life.

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