Oral Cancers: Risk Factors, Diagnosis, and Treatment

Oral Cancer - Mouth Cancer

Oral cancer (mouth cancer) is the most common form of head and neck cancer. It typically affects people aged 60 and older. Oral cancer affects your lips and the first parts of your tongue, mouth, roof, and floor. It also affects your oropharynx — the last part of your tongue and roof of your mouth, your tonsils, and the sides and back of your throat.

More than 49,000 cases of oral cancer are diagnosed each year in the United States, occurring most often in people over 40 years old. Oral cancers are most often discovered after they’ve spread to the lymph nodes of the neck. Early detection is key to surviving oral cancer. Learn about what raises your risk, its stages, and more. [1]

Overview

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.

Signs, Symptoms, and Causes

What causes oral cancer?

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

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 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 much 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. [2]

What are the symptoms of oral cancer?

Symptoms of oral cancer include:

a sore on your lip or mouth that won’t heal
a mass or growth anywhere in your mouth
bleeding from your mouth
loose teeth
pain or difficulty swallowing
trouble wearing dentures
a lump in your neck
an earache that won’t go away
dramatic weight loss
lower lip, face, neck, or chin numbness
white, red and white, or red patches in or on your mouth or lips
a sore throat
jaw pain or stiffness
tongue pain

Some of these symptoms, such as a sore throat or an earache, may indicate other conditions. However, if you notice any of these symptoms, especially if they don’t go away or you have more than one at a time, visit your dentist or doctor as soon as possible.

Risk factors for developing oral cancer

One of the biggest risk factors for oral cancer is tobacco use. This includes smoking cigarettes, cigars, pipes, and chewing tobacco.

People who consume large amounts of alcohol and tobacco are at even greater risk, especially when both products are used regularly.

Other risk factors include:

human papillomavirus (HPV) infection
chronic facial sun exposure
a previous diagnosis of oral cancer
a family history of oral or other types of cancer
a weakened immune system
poor nutrition
genetic syndromes
being male

Men are twice as likely to get oral cancer as women. [3]

Diagnosis and Tests

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 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. [4]

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
a CT scan to reveal any tumors in your mouth, throat, neck, lungs, or elsewhere in your body
a PET scan to determine if cancer has traveled to lymph nodes or other organs
an MRI scan to show a more accurate image of the head and neck and determine the extent or stage of the cancer
an endoscopy to examine the nasal passages, sinuses, inner throat, windpipe, and trachea

What are the stages of oral cancer?

There are four stages of oral cancer.

Stage 1: The tumor is 2 centimeters (cm) or smaller, and the cancer hasn’t spread to the lymph nodes.
Stage 2: The tumor is 2-4 cm, and cancer cells haven’t spread to the lymph nodes.
Stage 3: The tumor is either larger than 4 cm and hasn’t spread to the lymph nodes or is any size and has spread to one lymph node but not to other parts of the body.
Stage 4: Tumors are any size, and the cancer cells have spread to nearby tissues, the lymph nodes, or other body parts.

According to the National Cancer Institute, the five-year survival rates for oral cavity and pharynx cancers are as follows:

83 percent for localized cancer (that hasn’t spread)
64 percent for cancer that’s spread to nearby lymph nodes
38 percent for cancer that’s spread to other parts of the body

Overall, 60 percent of all people with oral cancer will survive for five years or more. The earlier the stage at diagnosis, the higher the chance of survival after treatment. The five-year overall survival rate in those with stage 1 and 2 oral cancers is typically 70 to 90 percent. This makes timely diagnosis and treatment all the more important. [5]

Management and Treatment

How do healthcare providers treat oral (mouth) cancer?

The three main treatment options for oral (mouth) are surgery, radiation therapy, and chemotherapy. Could you 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 oral cancer has spread from the original site to other parts of your mouth, throat, or body.
Your general health.
Your age.

What are other ways to treat oral cancer?

Healthcare providers may combine surgery with other treatments, including:

Radiation therapy: Radiation therapy uses strong energy beams 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 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 body parts.
Immunotherapy: Immunotherapy is a cancer treatment that engages your immune system to fight the disease. The treatment is sometimes called biological therapy. [6]

Recovering from oral cancer treatment

The recovery from each type of treatment will vary. Postsurgery symptoms can include pain and swelling, but removing small tumors usually has no associated long-term problems.

The removal of larger tumors could 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 your face removed during surgery.

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

a sore throat or mouth
dry mouth and loss of salivary gland function
tooth decay
nausea and vomiting
sore or bleeding gums
skin and mouth infections
jaw stiffness and pain
problems wearing dentures
fatigue
a change in your ability to taste and smell
changes in your skin, including dryness and burning
weight loss
thyroid changes

Chemotherapy drugs can be toxic to rapidly growing noncancerous cells. This can cause side effects such as:

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

Recovering from targeted therapies is usually minimal. The side effects of this treatment can include:

fever
headache
vomiting
diarrhea
an allergic reaction
skin rashes

Although these treatments have side effects, they’re often necessary to beat cancer. Your doctor will discuss the side effects and help you weigh the pros and cons of your treatment options. [7]

Prevention

There's no proven way to prevent mouth cancer. However, you can reduce your risk of mouth cancer if you:

Stop using tobacco, or don't start. If you use tobacco, stop. If you don't use tobacco, don't start. Using tobacco, whether smoked or chewed, exposes the cells in your mouth to dangerous cancer-causing chemicals.
Drink alcohol only in moderation, if at all. Chronic excessive alcohol use can irritate the cells in your mouth, making them vulnerable to mouth cancer. If you choose to drink alcohol, do so in moderation. For healthy adults, that means up to one drink a day for women of all ages and men older than 65 and up to two drinks a day for men 65 and younger.
Avoid excessive sun exposure to your lips. Protect the skin on your lips from the sun by staying in the shade when possible. Wear a broad-brimmed hat that effectively shades your entire face and mouth. Apply a sunscreen lip product as part of your routine sun protection regimen.
See your dentist regularly. As part of a routine dental exam, ask your dentist to inspect your entire mouth for abnormal areas that may indicate mouth cancer or precancerous changes. [8]

Outlook - Prognosis

What can I expect if I have oral cancer?

The outlook for oral cancers depends on the specific type and stage of cancer at diagnosis. It also depends on your general health, age, tolerance, and response to treatment. Early diagnosis is critical because treating stage 1 and 2 cancers may be less involved and have a higher chance of successful treatment.

After treatment, your doctor will want you to get frequent checkups to ensure you’re recovering. Your checkups usually include physical exams, blood tests, X-rays, and CT scans. Follow up with your dentist or oncologist if you notice anything unusual.

Living With

When to see a doctor

Could you make an appointment with your doctor or dentist if you have any persistent signs and symptoms that bother you and last more than two weeks? Your doctor will likely investigate other common causes for your signs and symptoms, such as an infection.