Category Archives: Oral Cancer

Oral Cancer

Throat Anatomy
Throat Anatomy

Oral cancer is cancer of the mouth.  Alternative names used are “Cancer – mouth”; “Mouth cancer”; “Head and neck cancer”; “Squamous cell cancer – mouth”.  In the U.S. there are 8,000 new cases of oral cancer diagnosed each year, killing roughly one person per hour.

Causes

Oral cancer most commonly involves the tissue of the lips or the tongue. It may also occur on the floor of the mouth, cheek lining, gums (gingiva), or roof of the mouth (palate).

Most oral cancers look very similar under the microscope and are called squamous cell carcinomas. These are malignant and tend to spread rapidly.

Smoking and other tobacco use are associated with 70 – 80% of oral cancer cases. Smoke and heat from cigarettes, cigars, and pipes irritate the mucous membranes of the mouth. Use of chewing tobacco or snuff causes irritation from direct contact with the mucous membranes. Heavy alcohol use is another activity associated with increased risk for oral cancer.

Other factors that increase the risk of oral cancer include poor dental and oral hygiene and chronic irritation (such as from rough teeth, dentures, or fillings). Some oral cancers begin as a white plaque ( leukoplakia) or as a mouth ulcer. Recently, infection with HPV (human papilloma virus) has been shown to be a risk factor.

Oral cancer accounts for about 8% of all malignant growths. Men get oral cancer twice as often as women do, particularly men older than 40.

Symptoms

Mucous membrane lesion, lump, or ulcer:

  • May be a deep, hard-edged crack in the tissue
  • Most often pale colored, may be dark or discolored
  • On the tongue, lip, or other mouth area
  • Usually painless at first (may develop a burning sensation or pain when the tumor is advanced)
  • Usually small

Additional symptoms that may be associated with this disease:

  • Abnormal taste in the mouth
  • Mouth sores
  • Swallowing difficulty
  • Tongue problems

Tests & Diagnosis

An examination of the mouth by the health care provider or dentist shows a visible or palpable (can be felt) lesion of the lip, tongue, or other mouth area. As the tumor enlarges, it may become an ulcer and bleed. Speech difficulties, chewing problems, or swallowing difficulties may develop, particularly if the cancer is on the tongue.

Currently, there are several ways to test for oral cancer.  Commonly, a tongue biopsy, gum biopsy, and microscopic examination of the lesion confirm the diagnosis of oral cancer.  However, researchers in the U.S. and the United Kingdom are developing a new test to detect oral cancer.  The new test would involve no scalpels, biopsies, or off-site laboratories.  Instead, it can be performed by collecting cells from a patient’s mouth with a simple brush, placing the cells on a chip, and inserting the chip into an analyzer, leading to a result in 8-10 minutes.

Treatment

Surgical removal of the tumor is usually recommended if the tumor is small enough. Radiation therapy and chemotherapy would likely be used when the tumor is larger or has spread to lymph nodes in the neck. Surgery may be necessary for large tumors.

Rehabilitation may include speech therapy or other therapy to improve movement, chewing, swallowing, and speech.  There is an encouraging news in the fight against cancer.  Doctors are developing a new treatment at the Institute of Cancer and Research and The Royal Marsden NHS Foundation Trust in the U.K. Seventeen patients suffering from mouth, neck, and head cancer were given injections of genetically engineered version of the herpes virus, as well as chemotherapy and radiotherapy treatments.  The virus, known as OncoVex, was modified to multiply only inside cancer cells and not in healthy ones.  The virus bursts and kills the cancerous cells, as well as releasing a human protein to help stimulate patients’ immune system.  Results showed tumor shrinkage in 14 of the 17 patients. 

Prognosis

Approximately half of people with oral cancer will live more than 5 years after diagnosis and treatment. If the cancer is detected early, before it has spread to other tissues, the cure rate is nearly 75%.  Unfortunately, more than half of oral cancers are advanced at the time the cancer is detected. Most have spread to the throat or neck.  Approximately 25% of people with oral cancer die because of delayed diagnosis and treatment.

Complications

  • Complications of radiation therapy, including dry mouth and difficulty swallowing
  • Other metastasis (spread) of the cancer
  • Postoperative disfigurement of the face, head, and neck

When to contact a doctor

Oral cancer may be discovered when the dentist performs a routine cleaning and examination.

Call for an appointment with your health care provider if you have a lesion of the mouth or lip or a lump in the neck that does not go away within 1 month. Early diagnosis and treatment of oral cancer greatly increases the chances of survival.

Prevention

You should have the soft tissue of the mouth examined once a year. Many oral cancers are discovered by routine dental examination.

Other tips:

  • Have dental problems corrected
  • Minimize or avoid alcohol use
  • Minimize or avoid smoking or other tobacco use
  • Practice good oral hygiene

 

References

National Comprehensive Cancer Network Clinical Practice Guidelines in Oncology: Head and Neck Cancers. National Comprehensive Cancer Network; 2008. Version 2.2008.

Posner M. Head and neck cancer. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007: chap 200.