What is oral cancer?
Cancer is defined as the uncontrollable growth of cells that invade and cause damage to surrounding tissue. Oral cancer appears as a growth or sore that does not go away. Oral cancer — which includes cancers of the lips, tongue, cheek, floor of the mouth, hard and soft palate, sinuses, and pharynx (throat) — can be life-threatening if not diagnosed and treated early.
Who gets oral cancer and what are the risk factors for oral cancer?
According to the American Cancer Society, men face twice the risk of developing oral cancer as women, and men who are over age 50 face the greatest risk. The rate of development of cancer of the oral cavity and pharynx began to decline in the late 1970s and has continued to decline throughout the 1990s in both African Americans, and white males and females.
Risk factors for the development of oral cancer include:
- Cigarette, cigar, or pipe smoking — Smokers are six times more likely than non-smokers to develop oral cancers.
- Use of smokeless tobacco products (for example, dip, snuff, or chewing tobacco) — Use of these products increase the risk of cancers of the cheek, gums, and lining of the lips.
- Excessive consumption of alcohol — Oral cancers are about six times more common in drinkers than in non-drinkers.
- Family history of cancer.
- Excessive exposure to the sun — especially at a young age.
It is important to note that more than 25% of all oral cancers occur in people who do not smoke and who only drink alcohol occasionally.
Other Oral Cancer Facts
Oral cancer is the sixth most common cancer among men.
About 75% to 80% of people with oral cavity and pharynx cancer consume alcohol.
People who smoke and drink alcohol have an even higher risk of cancer than those who only drink or only use tobacco products.
The risk of developing oral cavity and pharynx cancers increases both with the amount as well as the length of time tobacco and alcohol products are used.
Symptoms and Causes
What are the signs and symptoms of oral cancer?
The following are the common signs and symptoms:
- Swellings/thickenings, lumps or bumps, rough spots/crusts/or eroded areas on the lips, gums, or other areas inside the mouth
- The development of velvety white, red, or speckled (white and red) patches in the mouth
- Unexplained bleeding in the mouth
- Unexplained numbness, loss of feeling, or pain/tenderness in any area of the face, mouth, or neck
- Persistent sores on the face, neck, or mouth that bleed easily and do not heal within two weeks
- A soreness or feeling that something is caught in the back of the throat
- Difficulty chewing or swallowing, speaking, or moving the jaw or tongue
- Hoarseness, chronic sore throat, or changes in the voice
- Ear pain
- A change in the way your teeth or dentures fit together – a change in your "bite"
- Dramatic weight loss
If you notice any of these changes, contact your dentist immediately for a professional examination.
Diagnosis and Tests
I recently noticed a whitish patch in my mouth. Is this oral cancer?
This whitish patch could be leukoplakia. Leukoplakia, a condition caused by excess cell growth, can form on the cheeks, gums, or tongue. Leukoplakia is commonly seen in tobacco users, in people with ill-fitting dentures, and in those who have a habit of chewing on their cheek. This condition can progress to cancer. Red patches in the mouth (called erythroplakia) are less common than leukoplakia but have an even greater potential for being cancerous. Any white or red lesion in your mouth should be evaluated by your dentist.
How is oral cancer diagnosed?
Your dentist will conduct an oral cancer screening exam, which is a routine part of a comprehensive dental examination. More specifically, your dentist will feel for any lumps or irregular tissue changes in your neck, head, face, and oral cavity. When examining your mouth, your dentist will look for any sores or discolored tissue, as well as check for or ask you about the signs and symptoms mentioned above.
Your dentist might perform an oral brush biopsy if he or she sees tissue in your mouth that looks suspicious. This test is painless and involves taking a small sample of the tissue and analyzing it for abnormal cells. Alternatively, if the tissue looks even more suspicious, your dentist might recommend a scalpel biopsy. This procedure usually requires local anesthesia and might be performed by your dentist or a specialist referred by your dentist. These tests are necessary to detect oral cancer early, before it has had a chance to progress and spread.
Management and Treatment
How is oral cancer treated?
Oral cancer is treated the same way many other cancers are treated; that is with surgery to remove the cancerous growth followed by radiation therapy and/or chemotherapy (drug treatments) to destroy any remaining cancer cells.
What can I do to prevent oral cancer?
You can take an active role in preventing oral cancer or detecting it early, should it occur.
- Conduct a self exam at least once a month. Using a bright light and a mirror, look and feel your lips and front of your gums. Tilt your head back and look at and feel the roof of your mouth. Pull your checks out to view the inside of your mouth, the lining of your cheeks, and the back gums. Pull out your tongue and look at all surfaces. Examine the floor of your mouth. Look at the back of your throat. Feel for lumps or enlarged lymph nodes in both sides of your neck and under your lower jaw. Call your dentist’s office immediately if you notice any changes in the appearance of your mouth or any of the signs and symptoms mentioned above.
- See your dentist on a regular schedule. Even though you might be conducting frequent self exams, sometimes dangerous spots or sores in the mouth can be very tiny and difficult to see on your own. The American Cancer Society recommends oral cancer screening exams every three years for people over age 20 and annually for those over age 40. During your next dental appointment, ask your dentist to perform an oral exam. Early detection can improve the chance of successful treatment.
- Don’t smoke or use any tobacco products and drink alcohol in moderation. (Refrain from binge drinking.)
- Eat a well balanced diet.
- Limit your exposure to the sun. Repeated exposure increases the risk of cancer on the lip, especially the lower lip. When in the sun, use UV-A/B-blocking sun protective lotions on your skin as well as your lips.
Outlook / Prognosis
The overall 1-year survival rate for patients with all stages of oral cavity and pharynx cancers is 81%. The 5 & 10-year survival rates are 56% and 41%, respectively.