Oral Cancer
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See also our main information page on Mouth Cancer
Cancer of the lip and oral cavity is a disease in which cancer (malignant) cells are found in the tissues of the lip or mouth. The oral cavity includes the front two thirds of the tongue, the upper and lower gums (the gingiva), the lining of the inside of the cheeks and lips (the buccal mucosa), the bottom (floor) of the mouth under the tongue, the bony top of the mouth (the hard palate), and the small area behind the wisdom teeth (the retromolar trigone).
Cancers of the head and neck are most often found in people who are over the age of 45. Cancer of the lip is more common in men than in women, and is more likely to develop in people with light-coloured skin who have been in the sun a lot. Cancer of the oral cavity is more common in people who chew tobacco or smoke pipes.
A doctor should be seen if a person finds a lump in the lip, mouth, or gums, finds a sore in the mouth that doesn't heal, or has bleeding or pain in the mouth. Another sign of a cancer of the mouth or gums is when dentures no longer fit well. Often lip and oral cavity cancers are found by dentists when examining the teeth.
If there are symptoms, a doctor will examine the mouth using a mirror and lights. The doctor may order x-rays of the mouth. If tissue that is not normal is found, the doctor will need to cut out a small piece and look at it under the microscope to see if there are any cancer cells. This is called a biopsy. The patient will be given a substance to take feeling away from the area for a short time (a local anesthetic) so no pain is felt. The doctor will also feel the throat for lumps.
The chance of recovery (prognosis) depends on where the cancer is in the lip or mouth, whether the cancer is just in the lip or mouth or has spread to other tissues (the stage), and the patient's general state of health.
Once cancer of the lip and oral cavity is found, more tests will be done to find out if cancer cells have spread to other parts of the body. This is called staging. A doctor needs to know the stage of the disease to plan treatment. The following stages are used for cancer of the lip and oral cavity:
The cancer is no more than 2 centimeters (about 1 inch) and has not spread to lymph nodes in the area (lymph nodes are small bean-shaped structures that are found throughout the body; they produce and store infection-fighting cells).
The cancer is more than 2 centimeters, but less than 4 centimeters (less than 2 inches), and has not spread to lymph nodes in the area.
Either of the following may be true:
The cancer is more than 4 centimeters.
The cancer is any size but has spread to only one lymph node on the same side of the neck as the cancer. The lymph node that contains cancer measures no more than 3 centimeters (just over one inch).
Any of the following may be true:
The cancer has spread to tissues around the lip and oral cavity. The lymph nodes in the area may or may not contain cancer.
The cancer is any size and has spread to more than one lymph node on the same side of the neck as the cancer, to lymph nodes on one or both sides of the neck, or to any lymph node that measures more than 6 centimeters (over 2 inches).
The cancer has spread to other parts of the body.
Recurrent disease means that the cancer has come back (recurred) after it has been treated. It may come back in the lip and oral cavity or in another part of the body.
There are treatments for all patients with cancer of the lip and oral cavity. Two kinds of treatment are used:
surgery (taking out the cancer)
radiation therapy (using high-dose x-rays or other high-energy rays to kill cancer cells)
Chemotherapy (using drugs to kill cancer cells) is being tested in clinical trials.
Surgery is a common treatment of cancer of the lip and oral cavity. The doctor may remove the cancer and some of the healthy tissue around the cancer. The doctor may also remove the lymph nodes in the neck (lymph node dissection). A new type of surgery called micrographic surgery is being tested in clinical trials for early cancers of the lip and oral cavity. During this surgery, the doctor removes the cancer and then uses a microscope to look at the area to make sure there are no cancer cells left. As little normal tissue as possible is removed.
Radiation therapy uses high-energy x-rays to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external radiation therapy) or from putting materials that produce radiation (radioisotopes) through thin plastic tubes or needles in the area where the cancer cells are found (internal radiation therapy). If smoking is stopped before radiation therapy is started, the patient has a better chance of surviving longer.
Chemotherapy uses drugs to kill cancer cells. Chemotherapy may be taken by pill, or it may be put into the body by a needle in a vein or muscle. Chemotherapy is called a systemic treatment because the drug enters the bloodstream, travels through the body, and can kill cancer cells throughout the body.
If the doctor removes all the cancer that can be seen at the time of the operation, the patient may be given chemotherapy after surgery to kill any cancer cells that are left. Chemotherapy given after an operation to a person who has no cancer cells that can be seen is called adjuvant chemotherapy. Chemotherapy given before surgery to try and shrink the cancer so it can be removed is called neoadjuvant chemotherapy.
Hyperthermia is a new treatment being tested in certain patients. It uses a special machine to heat the body for a certain period of time to kill cancer cells. Because cancer cells are often more sensitive to heat than normal cells, the cancer cells die and the cancer shrinks.
Because the lips and mouth are needed to eat and talk, a patient may need special help adjusting to the side effects of the cancer and its treatment. The doctor will consult with several kinds of doctors who can help determine the best treatment for the patient. Trained medical staff can also help a patient recover from treatment and adjust to new ways of eating and talking. A patient may need plastic surgery or help learning to eat and speak if a large part of the lip or mouth is taken out.
Treatment of cancer of the lip and oral cavity depends on where the cancer is, the stage of the disease, and the patient's age and overall health.
Standard treatment may be considered because of its effectiveness in patients in past studies, or participation in a clinical trial may be considered. Not all patients are cured with standard therapy and some standard treatments may have more side effects than are desired. For these reasons, clinical trials are designed to find better ways to treat cancer patients and are based on the most up-to-date information. Clinical trials are ongoing in many parts of the country for patients with cancer of the lip and oral cavity. To learn more about clinical trials, call the Cancer Information Service at 1-800-4-CANCER (1-800-422-6237); TTY at 1-800-332-8615.
Treatment depends on where the cancer is in the lip or mouth.
If the cancer is in the lip, treatment may be one of the following:
1. Surgery.
2. Radiation therapy.
If the cancer is in the tongue, treatment may be one of the following:
1. Surgery.
2. Surgery followed by radiation therapy to the neck.
3. Radiation therapy to the mouth and the neck.
If the cancer is in the lining of the inside of the cheeks and lips (buccal mucosa), treatment may be one of the following:
1. Surgery.
2. Radiation therapy.
If the cancer is in the bottom (floor) of the mouth, treatment may be one of the following:
1. Surgery.
2. Radiation therapy.
If the cancer is in the lower gums (gingiva), treatment may be one of the following:
1. Surgery.
2. Radiation therapy.
If the cancer is in the small area behind the wisdom teeth, (retromolar trigone), treatment may be one of the following:
1. Surgery to remove part of the jawbone.
2. Radiation therapy followed (if needed) by surgery.
If the cancer is in the upper gums (gingiva) or the top bony part of the mouth (hard palate), treatment may be one of the following:
1. Surgery.
2. Surgery followed by radiation therapy.
For all stage I lip and oral cavity cancers, clinical trials are testing micrographic surgery followed by radiation therapy.
Treatment depends on where the cancer is in the lip or mouth.
If the cancer is in the lip, treatment may be one of the following:
1. Surgery.
2. External and/or internal radiation therapy.
If the cancer is in the tongue, treatment may be one of the following:
1. Radiation therapy.
2. Surgery and radiation therapy.
If the cancer is in the lining of the inside of the cheeks and lips (buccal mucosa), treatment may be one of the following:
1. Radiation therapy.
2. Surgery.
3. Surgery plus radiation therapy.
If the cancer is in the bottom (floor) of the mouth, treatment may be one of the following:
1. Surgery.
2. Radiation therapy.
3. Surgery followed by internal or external radiation therapy.
If the cancer is in the lower gums (gingiva), treatment may be one of the following:
1. Surgery.
2. Radiation therapy.
If the cancer is in the small space behind the wisdom teeth (retromolar trigone), treatment may be one of the following:
1. Surgery to remove part of the jawbone.
2. Radiation therapy followed (if needed) by surgery.
If the cancer is in the upper gums or the top bony part of the mouth (hard palate), treatment will probably be surgery followed by radiation therapy.
For all stage II lip and oral cavity cancers, clinical trials are testing micrographic surgery followed by radiation therapy.
Treatment depends on where the cancer is in the lip or mouth. In addition to the treatments listed below, a patient will probably have radiation therapy to the neck with or without surgery to remove lymph nodes in the neck (lymph node dissection).
If the cancer is in the lip, treatment may be one of the following:
1. Surgery to remove the cancer plus internal or external radiation therapy.
2. Radiation therapy.
3. A clinical trial of chemotherapy followed by surgery or radiation therapy.
4. A clinical trial of surgery followed by chemotherapy.
5. A clinical trial of surgery, radiation therapy, and chemotherapy.
6. A clinical trial of a new radiation therapy technique (superfractionated).
If the cancer is in the tongue, treatment may be one of the following:
1. External beam with or without internal radiation therapy.
2. Surgery followed by radiation therapy.
If the cancer is in the lining of the inside of the cheeks and lips (buccal mucosa), treatment may be one of the following:
1. Surgery to remove the cancer and the tissue around it.
2. Radiation therapy.
3. Surgery plus radiation therapy.
4. A clinical trial of chemotherapy followed by surgery or radiation therapy.
5. A clinical trial of surgery followed by chemotherapy.
6. A clinical trial of surgery, radiation therapy, and chemotherapy.
If the cancer is in the bottom (floor) of the mouth, treatment may be one of the following:
1. Surgery to remove the cancer and lymph nodes in the neck. Part of the jawbone may also be removed if necessary.
2. External beam therapy with or without internal radiation therapy.
3. A clinical trial of chemotherapy followed by surgery or radiation therapy.
4. A clinical trial of fractionated (smaller doses) radiation therapy.
If the cancer is in the lower gums (gingiva), treatment will probably be radiation therapy given before or after surgery to remove the cancer.
If the cancer is in the small space behind the wisdom teeth (retromolar trigone), treatment may be one of the following:
1. Surgery followed by radiation therapy.
2. A clinical trial of chemotherapy followed by surgery or radiation therapy.
3. A clinical trial of surgery followed by chemotherapy.
4. A clinical trial of fractionated (smaller doses) radiation therapy.
If the cancer is in the top part of the gums (gingiva) or the top bony part of the mouth (the hard palate), treatment may be one of the following:
1. Radiation therapy.
2. Surgery plus radiation therapy.
For all stage III lip and oral cavity cancers, clinical trials are testing chemotherapy combined with radiation therapy.
Treatment depends on where the cancer is in the lip or mouth. In addition to the treatments listed below, a patient will probably have radiation therapy to the neck with or without surgery to remove lymph nodes in the neck (lymph node dissection).
If the cancer is in the lip, treatment may be one of the following:
1. Surgery to remove the cancer plus internal or external radiation therapy.
2. A clinical trial of radiation therapy.
3. A clinical trial of chemotherapy combined with radiation therapy.
4. A clinical trial of fractionated (smaller doses) radiation therapy.
If the cancer is in the tongue, treatment may be one of the following:
1. Surgery to remove the tongue and the voice box (larynx) below it followed by radiation therapy.
2. Radiation therapy to relieve symptoms.
3. A clinical trial of chemotherapy combined with radiation therapy.
4. A clinical trial of fractionated (smaller doses) radiation therapy.
If the cancer is in the lining of the inside of the cheeks and lips (buccal mucosa), treatment may be one of the following:
1. Surgery to remove the cancer and the tissue around it.
2. Radiation therapy.
3. Surgery plus radiation therapy.
4. A clinical trial of chemotherapy combined with radiation therapy.
5. A clinical trial of fractionated (smaller doses) radiation therapy.
If the cancer is in the bottom (floor) of the mouth, treatment may be one of the following:
1. Surgery to remove the cancer followed by radiation therapy.
2. Radiation therapy followed by surgery.
3. A clinical trial of chemotherapy combined with radiation therapy.
4. A clinical trial of fractionated (smaller doses) radiation therapy.
If the cancer is in the lower gums (gingiva), treatment may be one of the following:
1. Surgery, radiation therapy, or both.
2. A clinical trial of chemotherapy combined with radiation therapy.
3. A clinical trial of fractionated (smaller doses) radiation therapy.
If the cancer is in the small space behind the wisdom teeth (retromolar trigone), treatment may be one of the following:
1. Surgery followed by radiation therapy.
2. A clinical trial of chemotherapy combined with radiation therapy.
3. A clinical trial of fractionated (smaller doses) radiation therapy.
If the cancer is in the top part of the gums (gingiva) or the top bony part of the mouth, treatment may be one of the following:
1. Surgery plus radiation therapy.
2. A clinical trial of chemotherapy combined with radiation therapy.
3. A clinical trial of fractionated (smaller doses) radiation therapy.
Treatment depends on the type of treatment the patient had before. If radiation therapy was given, the patient may have surgery when the cancer comes back. If surgery was used, the patient may have more surgery, radiation therapy, or both. Patients may want to consider taking part in a clinical trial of chemotherapy or hyperthermia.
For more information, call the National Cancer Institute's Cancer Information Service at 1-800-4-CANCER (1-800-422-6237); TTY at 1-800-332-8615. The call is free and a trained information specialist is available to answer your questions.
The National Cancer Institute has booklets and other materials for patients, health professionals, and the public. These publications discuss types of cancer, methods of cancer treatment, coping with cancer, and clinical trials. Some publications provide information on tests for cancer, cancer causes and prevention, cancer statistics, and NCI research activities. NCI materials on these and other topics may be ordered online from the NCI Publications Locator Service at Http: //publications.nci.nih.gov or by telephone from the Cancer Information Service toll free at 1-800-4-CANCER.
There are many other places where people can get materials and information about cancer treatment and services. Local hospitals may have information on local and regional agencies that offer information about finances, getting to and from treatment, receiving care at home, and dealing with problems associated with cancer treatment.
For more information from the National Cancer Institute, please write to this address:
National Cancer Institute
Office of Cancer Communications
31 Center Drive, MSC 2580
Bethesda, MD 20892-2580
PDQ is a computer system that gives up-to-date information on cancer and its prevention, detection, treatment, and supportive care. It is a service of the National Cancer Institute (NCI) for people with cancer and their families and for doctors, nurses, and other health care professionals.
To ensure that it remains current, the information in PDQ is reviewed and updated each month by experts in the fields of cancer treatment, prevention, screening, and supportive care. PDQ also provides information about research on new treatments (clinical trials), doctors who treat cancer, and hospitals with cancer programs. The treatment information in this summary is based on information in the PDQ summary for health professionals on this cancer.
PDQ can be used to learn more about current treatment of different kinds of cancer. You may find it helpful to discuss this information with your doctor, who knows you and has the facts about your disease. PDQ can also provide the names of additional health care professionals who specialize in treating patients with cancer.
Before you start treatment, you also may want to think about taking part in a clinical trial. PDQ can be used to learn more about these trials. A clinical trial is a research study that attempts to improve current treatments or finds information on new treatments for patients with cancer. Clinical trials are based on past studies and information discovered in the laboratory. Each trial answers certain scientific questions in order to find new and better ways to help patients with cancer. Information is collected about new treatments, their risks, and how well they do or do not work. When clinical trials show that a new treatment is better than the treatment currently used as "standard" treatment, the new treatment may become the standard treatment. Listings of current clinical trials are available on PDQ. Many cancer doctors who take part in clinical trials are listed in PDQ.
To learn more about cancer and how it is treated, or to learn more about clinical trials for your kind of cancer, call the National Cancer Institute's Cancer Information Service. The number is 1-800-4-CANCER (1-800-422-6237); TTY at 1-800-332-8615. The call is free and a trained information specialist will be available to answer cancer-related questions.
PDQ is updated whenever there is new information. Check with the Cancer Information Service to be sure that you have the most up-to-date information.
Smoking is by far the major risk factor for developing oral cancer. The use of alcohol and smoking further increases the risk of cancer of the larynx, oral cavity, and esophagus. According the the American Cancer Society statistics, there were 28,000 new cases and 7,400 deaths from Oral cavity and pharynx cancer in the United States in 2002.
Patients
with head and neck cancer that smoke are more likely to develop spread of the
cancer to their lymph nodes and once in the nodes the cancer is more likely to
spread into the soft tissues.
View Article's Abstract The picture on the right shows a cancer of the
uvula in a patient that had a 75 pack year history of smoking and consumed
alcohol. Both smoking and alcohol are risk factors for oral cancer. This
patient also had a second cancer in his lungs and eventually developed spread of
the cancer to his brain. Click on
Pictures to Enlarge
Use of tobacco products produces changes in all of the cells that are exposed.
Thus, the entire oral cavity, lungs are larynx are at risk for developing tumors.
Patients do not just develop one tumor but may develop a second or a third
lesion. Vaamonde found that of 636 patients with head and neck cancer
48 or 7.5% developed a second lesion.
View Article's Abstract
The
picture on the right is from a 22 year old male who has used over 1 can of snuff
for the past 15 years. He has high blood pressure from the
vasoconstrictive (contraction of blood vessels) effect of nicotine and
gastroesphageal reflux disease (stomach acid coming up from the stomach towards
the mouth) which is also made worse from using tobacco products. The picture on
the right shows extensive leukoplakia forming between his gums and lips. This
is a pre-cancerous condition and if it does not resolve with his cessation of
using tobacco products, it will need to be surgically removed.
Click on Pictures to Enlarge
Below is a picture from the New Mexico Dept of Health of a patient who had a "Jaw-Tongue-Neck" procedure. Surgery and radiation therapy or combination of chemotherapy and radiation therapy are the treatments of choice.
The picture on the right shows a patient undergoing a jaw tongue neck operation. The lip is split and the neck skin and cheeks are reflected. The jaw, tongue, neck and part of the soft palate and uvula can then be removed.
*** Click on Picture to Enlarge ***
The picture to the right shows the removed surgical specimen.
*** Click on Picture to Enlarge ***
Even
if treated, many cancers may recur. In this patient, a cancer is recurring in
his neck with a massive slowly growing fungating mass. The mass will slowly
erode into the carotid artery causing massive bleeding and sudden death.
This patient is a 87 year old who used to smoke 1 pack per day many years
ago she was not sure how long she smoked. This patient has a tumor on both her
tongue and right floor of the mouth. The tumor is over her
This patient is a 56 year old who had a 100
pack year
history of smoking. He had a large tumor involving the floor of his mouth and
jaw (see picture on the right). The tumor had eroded through the skin and
produced a large mass over his right jaw and chin (see pictures below). This
patient also had a small cell carcinoma of the lung which was inoperable.
Dentist
Dr David Gilmartin
Postal address
MK Dental Care, 159 Ramsons Avenue, Conniburrow, Milton Keynes, Buckinghamshire, MK14 7BE, England.
Phone
01908 690326
Fax
01908 676880
Electronic mail
The patient below is a 70 year old who smoke 1 pack per day for 50 years he
also drank alcohol heavily. He presented with severe
dysphagia
(trouble swallowing) and on examination was found to have a very small airway.
He underwent an emergency
tracheotomy(breathing hole placed in the neck)
under local anesthesia no IV sedation or analgesia was given. The was then put
to sleep with general anesthesia and had his oral tumor debulked. The pictures
on the right show a large oral tumor in the
hypopharynx with a very small airway under the
epiglottis.
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