Hard Palate Cancer

What is cancer of the hard palate?

Hard palate cancer is cancer on the roof of your mouth. It’s a relatively rare form of oral cancer. Hard palate cancer includes squamous cell carcinoma and certain types of salivary gland cancer. (In hard palate cancer, squamous cell carcinoma starts in flat cells lining the inside of your mouth.) Healthcare providers treat this condition with surgery. People who have surgery often need reconstructive surgery and extensive post-surgery support to help them eat, swallow and speak.

Is hard palate cancer common?

No, it’s not. Hard palate cancer is a type of oral cancer. Oral cancer makes up about 3% of all cancer cases in the U.S., and experts estimate hard palate cancer accounts for 1% to 5% of oral cancer cases.

What are the symptoms?

One common symptom is a sore on your hard palate. Your hard palate is the bony section of the roof of your mouth. It separates your mouth from the inside of your nose (nasal cavity).

Other symptoms of hard palate cancer may include:

• Bad breath (halitosis).
• Feeling as if your teeth are loose.
• If you wear dentures, it may feel as if they don’t fit as comfortably as they used to.
• Trouble swallowing (dysphagia).
• A lump in your neck.

What causes hard palate cancer?

Medical researchers link hard palate cancer to tobacco use and drinking beverages that contain alcohol.

What are the complications of this condition?

Left untreated, hard palate cancer may spread into lymph nodes in your neck and/or into your nasal passages. Cancer in your lymph nodes can travel through your lymphatic system to create new tumors, called metastases, in other areas of your body.

How is hard palate cancer diagnosed?

Healthcare providers will ask you about your symptoms. For example, they may ask some of the following questions:

• Do you have any pain in the roof of your mouth?
• When did you first notice sores or other changes there?
• Has it gotten bigger?
• Does your sore ever bleed?
• Do you have trouble swallowing?

They may ask you about personal habits. For example, they may ask:

• Do you use tobacco, including smokeless tobacco?
• How often do you drink beverages that contain alcohol?

They’ll look inside your mouth and check lymph nodes in your neck for signs of swelling.

What tests do healthcare providers use?

Providers do biopsies to diagnose hard palate cancer, followed by imaging tests to determine tumor size and whether it’s spread.

Biopsies

Providers use biopsies to obtain tissue samples. Medical pathologists examine tissue samples under microscopes to determine if the tissues contain cancerous cells. (Medical pathologists specialize in examining body tissues and fluids.) In hard palate cancer, they may look for signs of salivary gland tumors, as well as squamous cell carcinoma. Procedures may include:

• Fine needle aspiration biopsy: Providers use a thin hollow needle and syringe to extract tissue from tumors.
• Punch biopsy: They use a special device to punch a small hole in the tumor.
• Incisional biopsy: They use a scalpel to remove tissue from a tumor.

Imaging tests

Imaging tests to diagnose hard palate cancer may include:

• Computed tomography (CT) scan:This test can show tumor size and if it has spread into the bone of your palate or to your lymph nodes.
• Positron emission tomography (PET) scan: PET scans help providers determine if a tumor has spread to lymph nodes in your neck or to other parts of your body, such as your lungs.

What are hard palate cancer stages?

Healthcare providers use information from imaging tests and biopsies to establish cancer stages. Cancer staging describes how tumors are growing or spreading. Providers use the same cancer staging system for all types of oral cancer. They may characterize stages by numbered stages (Stages I through IV) or by tumor designation (T). Providers use the TNM system to stage hard palate cancer:

• T stands for tumor size and location.
• N stands for lymph nodes, specifically whether a tumor has spread to lymph nodes.
• M stands for metastasis. Cancer that spreads from where it started is metastatic cancer.

Stages by tumor designation

Providers designate tumors based on tumor size. They also consider how deep a tumor has spread down into your tissue (depth of invasion).

• Tis: Providers may call this tumor designation carcinoma in situ or very early cancer. In carcinoma in situ, you have cancer cells in one layer of tissue.
• T1: The tumor measures 2 centimeters (cm) or less. It’s also 5 millimeters (mm) deep or less into your tissue.
• T2: The tumor measures more than 2 cm but less than 4 cm. The depth of invasion is between 5 and 10 mm.
• T3: The tumor measures more than 4 cm or has grown more than 10 mm into nearby tissue.
• T4: The tumor is growing into nearby bones.

Numbered stages

Providers combine tumor designation (T1 through T3) and TNM information to establish hard palate cancer stages:

• Stage I: The tumor is T1, meaning it measures 2 cm or less and has grown 5 mm or less into your tissue.
• Stage II: The tumor has grown and spread deeper into the tissue, but it hasn’t spread to your lymph nodes or other areas of your body.
• Stage III: The tumor measures more than 4 cm or has grown more than 10 mm deep into your tissue. The tumor also affects nearby lymph nodes.
• Stage IVa: The tumor is in nearby lymph nodes but hasn’t spread from your hard palate into your nasal passages.
• Stage IVb: The tumor has grown outside your lymph nodes or into nearby soft tissues, like muscles and tendons.
• Stage IVc: The tumor has spread from your hard palate to other areas of your body beyond the lymph nodes in your neck.

Cancer staging systems help providers map out the most effective way to treat the condition. Cancer staging is a complicated process to complete, much less explain. If you’re confused or concerned by what you’re hearing, ask your provider to explain how the cancer staging system works in your situation.

How do healthcare providers treat hard palate cancer?

Providers typically treat this condition with surgery to remove the tumor. If cancer has spread from your hard palate to lymph nodes in your neck, they may remove those lymph nodes. Hard palate cancer surgery may include:

• Maxillectomy: In this treatment, surgeons remove tumors from the roof of your mouth. They may be able to do this by making a hole in the roof of your mouth. They may need to remove larger parts or all of your hard palate. Providers may use a prosthetic device (palatal plate) to fill the gap. Palatal plates are acrylic plates that fit into the roof of your mouth and are held in place with orthodontic wire. Providers may also use flaps or pieces of soft tissue from other parts of your body to fill the gap.
• Neck dissection: Hard palate cancer may spread to lymph nodes in your neck. Cancer in your lymph nodes can spread throughout your body. To prevent this, providers may remove some or all of your lymph nodes.

Treatment complications and side effects

Surgery to remove cancerous tumors in your hard palate may cause complications, including:

• Difficulty speaking, swallowing and eating: Surgery to remove hard palate cancer may affect your ability to chew and swallow food. You may need additional surgery and speech therapy to manage these side effects.
• Nerve damage: Surgery to remove lymph nodes in your neck may damage several different nerves.

Can I prevent hard palate cancer?

You may not be able to prevent hard palate cancer. However, you may be able to reduce your risk by avoiding certain activities that increase your risk of developing the condition:

• If you smoke cigarettes or use smokeless tobacco, try to quit. Talk to a healthcare provider about programs to help you stop using tobacco.
• If you regularly drink beverages that contain alcohol, try to limit how much and how often you drink. If you think you may have an issue with alcohol, ask a provider for help.
• Eat a healthy diet that includes fruit and vegetables.
• Have regular dental checkups. People between 20 and 40 should have oral cancer screenings every three years and annual exams after age 40.

Is there a cure for hard palate cancer?

Yes, surgery to remove small tumors may cure hard palate cancer. Larger tumors are more difficult to treat, and hard palate cancer can come back years after you’ve finished treatment.

How do I take care of myself?

If you have hard palate cancer, you may need help managing treatment side effects, such as eating and swallowing issues. Hard palate cancer may come back (recur), so you should plan on regular checkups so healthcare providers can monitor your overall health and watch for new cancer.

When should I see my healthcare provider?

The National Comprehensive Cancer Network (NCCN) recommends continual follow-ups for at least 10 years after you complete treatment. The NCCN recommends the following schedule:

• First year: Checkups every one to three months.
• Second year: Checkups every two to six months.
• Fifth through 10th year: Annual checkups.

What questions should I ask my healthcare provider?

You may want to ask the following questions:

• Can you treat this tumor with surgery?
• How will surgery affect me?
• Will surgery cure me?
• Will I need more than one surgery?
• What other treatments will I need?

A note from Cleveland Clinic

Hard palate cancer is cancer in the roof of your mouth. It’s a rare type of oral cancer. Healthcare providers can treat and possibly cure hard palate cancer with surgery to remove tumors from the roof of your mouth. But not everyone is able to have surgery for hard palate cancer, and surgery comes with side effects that can affect your quality of life. You may not be able to avoid hard palate cancer, but you can reduce your risk. Risk factors for hard palate cancer include tobacco use and drinking beverages that contain alcohol. If you use tobacco, ask a healthcare provider about quitting smoking.