Oral Cancer

Introduction

Cancer of the oral cavity is the most common type of cancer that develop in the head and neck region, a grouping called head and neck cancer.

 The oral cavity includes the:

  • Lips
  • Lining of the lips and cheeks, called the buccal mucosa
  • Upper and lower gums, called the gingiva
  • Front two-thirds of the tongue
  • Floor of the mouth under the tongue
  • Roof of the mouth, also called the hard palate
  • Retromolar trigone, which is the small area behind the wisdom teeth

Risk Factors and Prevention

The risk of oral cancers is greatly increased by 2 factors:

  • Tobacco use. Using tobacco, including cigarettes, cigars, pipes, chewing tobacco, and snuff, is the single largest risk factor for head and neck cancer. Secondhand smokemay also increase a person’s risk of head and neck cancer.
  • Frequent and heavy consumption of alcohol increases the risk of head and neck cancer. Using alcohol and tobacco together increases this risk even more.

Other factors that can raise a person’s risk of developing oral cancer include:

  • Prolonged sun exposure.High exposure to the sun, without sun protection measures, is linked with cancer in the lip area.
  • Men are more likely to develop oral and oropharyngeal cancers than women.
  • Fair skin.Fair skin is linked to a higher risk of lip cancer.
  • People older than 45 have an increased risk for oral cancer, although this type of cancer can develop in people of any age.
  • Poor oral hygiene.Lack of dental care and not following regular oral hygiene practices may cause an increased risk of oral cavity cancer.
  • Poor diet/nutrition.A diet low in fruits and vegetables and a vitamin A deficiency may increase the risk of oral and oropharyngeal cancer.
  • Weakened immune system
  • Marijuana use.Recent studies have suggested that people who have used marijuana may be at higher-than-average risk for head and neck cancer.

Symptoms and Signs

  • The most common symptom is a sore in the mouth or on the lip that does not heal
  • Red or white patch on the gums, tongue, or lining of the mouth
  • Lump on the lip, mouth, neck, or a feeling of thickening in the cheek
  • Numbness of the mouth or tongue
  • Pain or bleeding in the mouth
  • Difficulty chewing, swallowing, or moving the jaws or tongue
  • Ear and/or jaw pain
  • Chronic bad breath
  • Changes in speech
  • Loosening of teeth or toothache
  • Dentures that no longer fit
  • Unexplained weight loss
  • Fatigue
  • During later stages of the disease, people may experience a loss of appetite

Treatment

There are 3 main treatment options for oral cancer: surgery, radiation therapy, and therapies using medication.

Treatment options and recommendations depend on several factors, including the type and stage of cancer, possible side effects, and the patient’s preferences and overall health. One of these therapies, or a combination of them, may be used.

Surgery

Surgery is the removal of the tumor and some surrounding healthy tissue, known as a margin, during an operation. An important goal of the surgery is the complete removal of the tumor with “negative margins.” Negative margins means that there is no trace of cancer in the margin’s healthy tissue.

Sometimes surgery is followed by radiation therapy, therapies using medication, or both.

The most common surgical procedures for the removal of oral cancer include:

  • Primary tumor surgery.The tumor and a margin of healthy tissue around it are removed to decrease the chance that any cancerous cells will be left behind. The tumor may be removed through the mouth or through an incision in the neck.
  • This is the partial or total removal of the tongue.
  • If the tumor has entered a jawbone but not spread into the bone, then a piece of the jawbone or the whole jawbone will be removed.
  • This surgery removes part or all of the hard palate, which is the bony roof of the mouth.
  • Neck dissection. Cancer of the oral cavity or oropharynx often spreads to lymph nodes in the neck. Preventing the cancer from spreading to the lymph nodes is an important goal of treatment. It may be necessary to remove some or all of these lymph nodes using a surgical procedure called a neck dissection, even if the lymph nodes show no evidence of cancer when examined (see Stages and Grades). A neck dissection may be followed by radiation therapy or a combination of chemotherapy and radiation therapy, called chemoradiation, to make sure there is no cancer remaining in the lymph nodes. Sometimes, for oropharyngeal cancer, a neck dissection will be recommended after radiation therapy or chemoradiation. If a neck dissection is not possible, radiation therapy may be used instead. See “Radiation therapy,” below, for more details on this type of treatment.
  • Transoral robotic surgery and transoral laser microsurgery. Transoral robotic surgery (TORS) and transoral laser microsurgery (TLM) are minimally invasive surgical procedures. This means that they do not require large cuts to get to and remove a tumor. In TORS, an endoscopeis used to see a tumor in the throat, the base of the tongue, and the tonsils. Then 2 small robotic instruments act as the surgeon’s arms to remove the tumor. In TLM, an endoscope connected to a laser is inserted through the mouth. The laser is then used to remove the tumor. A laser is a narrow beam of high-intensity light.

Radiation therapy

Radiation therapy is the use of high-energy x-rays or other particles to destroy cancer cells. A radiation therapy regimen, or schedule, usually consists of a specific number of treatments given over a set period of time.

  • External-beam radiation therapy.This is the most common type of radiation treatment for oral cancer. During external-beam radiation therapy, a radiation beam produced by a machine outside the body is aimed at the tumor. This is generally done as an outpatient procedure.
  • Internal radiation therapy.When radiation treatment is given using implants, it is called internal radiation therapy or brachytherapy.

Radiation therapy may be the main treatment for oral cavity cancer, or it can be used after surgery to destroy small areas of cancer that could not be removed. Radiation therapy can also be used to treat the lymph nodes. Combining radiation therapy with cisplatin (a chemotherapy drug) may be used for this purpose in some cases. This approach is called chemoradiation.

Therapies using medication

Treatments using medication are used to destroy cancer cells. Medication may be given through the bloodstream to reach cancer cells throughout the body. When a drug is given this way, it is called systemic therapy.

The types of medications used for oral cancer include:

  • Chemotherapy
  • Immunotherapy
  • Targeted therapy

A person may receive 1 type of medication at a time or a combination of medications given at the same time. They can also be given as part of a treatment plan that includes surgery and/or radiation therapy.

Chemotherapy

Chemotherapy is the use of drugs to destroy cancer cells, usually by keeping the cancer cells from growing, dividing, and making more cells.

The use of chemotherapy in combination with radiation therapy, called chemoradiation, is often recommended. The combination of these 2 treatments can sometimes control tumor growth, and it often is more effective than giving either of these treatments alone.

Chemotherapy may be used as the initial treatment before surgery, radiation therapy, or both, which is called a neoadjuvant chemotherapy. Or it can be given after surgery, radiation therapy, or both, which is called adjuvant chemotherapy. Chemotherapy for oral cavity cancer is most often given as part of a clinical trial.

Immunotherapy

Immunotherapy, also called biologic therapy, is designed to boost the body’s natural defenses to fight the cancer. It uses materials made either by the body or in a laboratory to improve, target, or restore immune system function.

Immunotherapy in combination with chemotherapy and radiation therapy may also be used in clinical trials.

Targeted therapy

Targeted therapy is a treatment that targets the cancer’s specific genes, proteins, or the tissue environment that contributes to cancer growth and survival. This type of treatment blocks the growth and spread of cancer cells and limits damage to healthy cells.