What Is It?

Oral cavity cancer occurs when cells divide abnormally in the lip or mouth. The oral cavity includes the gums, lips, inside of the cheeks, teeth, roof and floor of the mouth, the underside of the tongue and the front two-thirds of the tongue.

Oral cavity cancer occurs more often in men than in women. An estimated 27,000 new cases of oral cavity cancer will be diagnosed in 2003 in the United States, and less than 10,000 of them will be in women. The incidence rate has been slowly decreasing over the past two decades. Oral cavity cancer is strongly associated with smoking or chewing tobacco: About 90 percent of people with oral cavity cancers use tobacco. The risk increases with the amount and duration of tobacco use. Alcohol use and exposure to sunlight also increase the risk of oral-cavity cancer.

People with oral cavity cancer have an increased risk for developing cancer of the throat, esophagus or lung. Fifteen percent of people diagnosed with oral- avity cancer are diagnosed at the same time with cancer of the larynx, esophagus or lung. Between 10 percent and 40 percent of people with oral cavity cancer will later develop either one of these cancers or a new oral cavity cancer.

According to the American Cancer Society, the most common symptom of oral cavity cancer is a mouth sore that doesn’t heal. Other common symptoms of oral cavity cancer, as described by the American Cancer Society, include:

• A lump or mass in your neck
• A persistent feeling that something is caught in your throat
• A persistent discoloration in your mouth
• A persistent lump or thickening in your cheek
• A persistent sore throat
• Changes to your voice
• Difficulty chewing or swallowing
• Difficulty moving your jaw or tongue
• Loosening of your teeth
• Numbness of the tongue or other area of the mouth
• Pain around the teeth or jaw
• Pain or irritation in the mouth that doesn’t go away
• Sudden unexplained weight loss
• Swelling in your jaw — this may cause dentures to fit poorly or become uncomfortable

Most of the symptoms of oral cavity cancers can be caused by other, less serious disorders. But if any symptoms persist for two weeks or longer, they deserve immediate attention.

Diagnosis starts with a physical exam. Whether you have symptoms or not, a routine visit to a doctor or dentist should include an oral exam to look for abnormalities. Your doctor may feel for any lumps or masses. If your doctor suspects anything abnormal, he or she will do further examinations.

The next step may be a referral to an oral surgeon or an ear, nose and throat surgeon. Diagnostic tests usually are done in the office or as same-day procedures in a hospital operating room. Small mirrors or a fiberoptic scope (a thin tube with a tiny camera) may be used to get a closer look at structures in the back of your throat, voice box or nose. To test for cancer, the surgeon will do a biopsy, which involves removing a small piece of tissue from the abnormal area to be examined in a laboratory.

Because oral cavity cancer is closely related to other cancers, diagnosis is commonly followed by close examination of the larynx, esophagus and lungs using a fiberoptic scope.

The likelihood and speed of recovery varies considerably depending on many factors, including where the cancer is found, how far it has spread, and your general health. After the cancer has been treated, you may need training or further treatment to regain the ability to speak and swallow as you did before.

The greatest risk factors for oral cavity cancer are smoking or use of smokeless tobacco. Drinking alcohol is another significant risk factor. If you both use tobacco and drink alcohol, your risk is even higher. If you smoke or use smokeless tobacco, get the help you need to stop immediately. If you currently smoke or chew tobacco or have done so in the past, be sure to watch for symptoms.

Cancer of the lip is associated with exposure to sunlight. If you are exposed to sunlight, especially as part of your job, try to avoid the sun during the midday hours, wear a wide-brimmed hat, and use sunscreen and lip balm that protect against ultraviolet light.

Doctors identify a cancer’s development by giving it a numerical “stage.” A stage 0 or stage I tumor has not invaded very far into surrounding tissues, while a stage III or IV tumor may be penetrating throughout and beyond surrounding tissues.

The type of treatment recommended varies depending on the cancer’s origin and its stage of development. The most common treatments for oral cavity cancer are surgery, radiation therapy and chemotherapy.

• Surgery, the most common treatment, involves removing the tumor and some surrounding tissue. In many cases, surgery can be done directly through the mouth, but in other cases, tumors must be reached through the neck or jaw. When cancer cells have spread beyond the oral cavity into the lymph nodes, a surgery called neck dissection removes the cancerous lymph nodes in hopes of containing the cancer before it spreads throughout the body.
• Radiation therapy, which uses high-energy rays to destroy cancer cells, is the primary treatment for some small tumors. It also may be used after surgery to ensure that all cancer cells are destroyed. It also may be used to relieve symptoms such as pain, bleeding, or difficulty swallowing, even when it cannot cure the cancer. This is called palliative care.
• Chemotherapy, the use of cancer-killing drugs, may help to shrink tumors before surgery is performed. Some studies also have shown that instead of surgery, chemotherapy combined with radiation therapy can be effective in treating large cancers confined to the head and neck region.

If cancer is discovered at an earlier stage, the chances for successful treatment are much better. In stage I and II tumors, usually surgery or radiation therapy is required. One treatment might be favored over the other because of the side effects of the therapies. Depending on the location of the cancer, surgery might be preferred to avoid radiation’s effects on surrounding healthy tissue. In other cases, surgery might significantly alter the ability to speak or eat and radiation would then be more desirable. Stage III and IV tumors usually require more extensive surgery, or radiation therapy if surgery would be unable to remove the tumor.

Recovery from oral cavity cancer treatments also may include rehabilitation to recover the ability to speak and eat, as well as cosmetic surgery if extensive surgery is done.

If you discover a lump (an area of thickness or inconsistent texture) or a discolored area in your mouth or on your tongue, make an appointment to see your doctor as soon as possible. If you develop a fever along with a pain or lump in the mouth, you may have an infection. Ask to see your doctor right away.

The earlier oral cavity cancer is discovered, the better the prognosis. As many as 90 percent of people with early-stage cancers survive at least five years after diagnosis. For later-stage cancers, the five-year survival rate is between 20 percent and 50 percent. Even after successful treatment, up to 40 percent of people with oral cavity cancer develop another cancer at a later time, so follow-up examinations are crucial.

Diseases and Conditions Center

All ArmMed Media material is provided for information only and is neither advice nor a substitute for proper medical care. Consult a qualified healthcare professional who understands your particular history for individual concerns.