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Oral cancer

Top questions about oral cancer

What you should know about oral cancer

The incidence of oral cancer is closely tied to excessive alcohol and tobacco use. About 80 percent of people with oral cancer use tobacco, and about 70 percent are heavy drinkers. For people who both smoke and drink heavily, the risk of oral cancer may be twice as high as the risk for people who do not smoke or drink. Other major risk factors for oral cancer include gender—men are twice as likely as women to develop oral cancer—and age, with most patients diagnosed at 55 or older.

Surgery is typically the first-line treatment for oral cancers that are caught early. Other common treatments include chemotherapy, radiation therapy and targeted therapy. Studies have shown that many oral cancer cells contain too many copies of the epidermal growth factor receptor, or EGFR, which allows cancer cells to grow faster and become resistant to radiation and/or chemotherapy. For this reason, treating oral cancer with a drug that targets EGFR may help kill cancer cells without harming normal tissues. Targeted therapy may be used by itself or in combination with other therapies.

Oral cancer and its treatment often cause side effects, including weight loss, fatigue, nausea, diarrhea and constipation. Supportive care services may help patients prevent or manage these symptoms.

What is oral cancer?

Oral cancer develops when cancer cells begin growing out of control in the mouth, which includes the lips, the inside lining of the lips and cheeks, the teeth, the gums, most of the tongue, the bottom of the mouth, and the bony roof of the mouth, or hard palate.

More than 90 percent of oral cancers are squamous cell carcinomas, meaning they form in the flat, thin squamous cells that line the mouth and throat.

What are the symptoms of oral cancer?

Symptoms of oral cancer are commonly mistaken for other, less serious conditions, such as a toothache or mouth sore. If seemingly benign symptoms persist, however, you should call your doctor, who may recommend tests to check for oral cancer.

Symptoms may include:

  • A mouth sore that won’t heal
  • Mouth pain that won’t go away
  • A lump or thickening in the cheek
  • A white or red patch on the gums, tongue, tonsil or lining of the mouth
  • A sore throat or persistent feeling that something is caught in the throat
  • Difficulty swallowing or chewing
  • Pain in the teeth or jaw
  • Voice changes

How is oral cancer typically diagnosed?

A doctor or dentist may find some cancers or pre-cancers of the mouth during an exam, but most oral cancers are detected after the patient experiences signs or symptoms. Diagnosing oral cancer may involve a physical exam, including a complete head and neck exam, biopsy and imaging tests. Sometimes, blood tests and/or a dental exam are performed, as well.

What are the main types of oral cancer?

Almost all oral cancers are squamous cell carcinomas. That’s why treatment is often guided not by the cancer type but by its location. Even though the oral cavity is a small space, it’s made up of many different types of tissue. The most common locations for cancer in the oral cavity are the tongue, tonsils, oropharynx (throat), gums and floor of the mouth.

What type of doctor should I see if I think I have oral cancer?

If you have a symptom of oral cancer that lasts longer than two weeks, consider requesting a diagnostic evaluation with an oncologist or otolaryngologist specifically trained in treating diseases of the mouth and throat. Oral cancer is more treatable when caught early.

Questions about oral cancer treatment

Designing an oral cancer treatment plan is often determined by where the cancer originated, whether it’s spread and how severe the side effects may be. Treatment also may be influenced by the stage of the cancer and the patient’s individual needs and treatment goals.

How is oral cancer typically treated?

Oral cancer may be treated with one therapy or a combination of therapies, depending on where the cancer started and whether the disease has advanced. Surgery is often used to treat oral cancer that hasn’t spread. Surgery also is commonly used to treat advanced-stage and recurrent cancers, often in combination with radiation therapy, chemotherapy and/or targeted therapy.

Surgical procedures for oral cancer include:

  • Tumor resection, or the removal of the entire tumor and some surrounding tissue
  • Mohs micrographic surgery, which removes thin slices of a tumor at a time, recommended to treat some cases of lip cancer
  • Mandibulectomy, the removal of all or part of the lower jawbone
  • Glossectomy, the removal of all or part of the tongue
  • Maxillectomy, the removal of all or part of the hard palate
  • Neck dissection, the removal of a few, most or almost all of the lymph nodes on one side of the neck, in cases when cancer has spread to this area

Because oral cancer surgery may affect patients’ physical appearance and ability to perform everyday activities, such as eating and swallowing, several surgical techniques have become available to help restore those features and function. For example, it may be possible to reconstruct the tongue by using tissues from other areas of the body. Also, a tracheoesophageal puncture, or TEP, may be an option for patients who undergo a laryngectomy. With a TEP, the surgeon inserts a small, one-way valve between the trachea and the esophagus to help the patient. A feeding tube is another option that may be recommended for patients who experience difficulty with eating and swallowing.

What are the potential side effects of oral cancer treatment?

Aside from side effects that may affect appearance and function, oral cancer treatment may also cause weight loss, fatigue, nausea, diarrhea, taste changes, dry mouth and constipation.

How long do side effects last?

The length of time patients experience side effects from oral cancer treatment generally varies depending on the stage of the disease and the type of treatment or treatments. Some side effects may last a few weeks or months, but others may last for the rest of the patient’s life. If a feeding tube is required after treatment, for instance, it may be removed once the patient is able to eat without assistance. But some speech challenges may be permanent.

Can treatment-related side effects be managed?

Even if a patient experiences permanent side effects related to oral cancer and its treatment, supportive care services may help. Because nutrition is a common concern for oral cancer patients, registered dietitians may recommend certain foods to help support healthy digestion and nutrition, and help manage certain side effects. Naturopathic providers also may suggest supplements to prevent and treat nausea, and reduce acid reflux, heartburn, bloating, gas and diarrhea. Naturopathic providers also may monitor your supplement and vitamin intake to help you avoid potential drug-herb and drug-nutrient interactions, while speech therapists may help address problems with dry mouth, difficulty swallowing, loss of voice and cognitive changes.

Questions to ask your doctor

Because symptoms of oral cancer may mimic those of less serious conditions, awareness is important. If you have persistent pain in your mouth, or a sore that won’t go away, a diagnostic evaluation may rule out, or confirm, whether you have cancer. A doctor experienced in treating cancers of the oral cavity may help determine whether an evaluation is necessary, and which diagnostic tests should be performed.

Do I have oral cancer?

Delayed or mistaken diagnoses are a significant concern in catching oral cancer early, largely because early symptoms don’t seem serious. A primary care physician may recommend an antibiotic for a mouth sore, for example, and by the time it becomes clear that the antibiotic isn’t working, it may be several weeks before the doctor recommends a visit with a specialist. That’s why experts urge patients to consider asking their primary care physicians about the possibility that such symptoms may be oral cancer, and to request a referral to a specialist if they are concerned.

A physical exam and a biopsy are often used to diagnose oral cancer.

How long will treatment last?

The length of oral cancer treatments depends on a number of factors, such as the stage of the cancer, the type of treatment and its goals. A small cancer on the lip, for example, may be removed with surgery, but if cancer cells are later discovered to have spread to nearby areas or lymph nodes, other treatments may be recommended. Also, surgical treatments that affect the patient’s physical appearance or ability to perform basic functions may be followed by reconstructive surgeries at a later date.

What should I expect after treatment is complete?

After treatment ends, your doctor will likely give you a schedule for follow-up appointments and tests, which are typically spaced further and further apart as time passes.

If your treatment includes surgery, your doctor may recommend radiation and/or chemotherapy treatment afterward to kill any remaining cancer cells.

Also, even though treatment has ended, you may still experience certain side effects. You may continue regular visits with a speech therapist, for example, to help re-learn how to speak and swallow following surgery, or see a dietitian to help you manage nutritional deficits that may have developed during treatment.

Is there a chance my cancer could come back?

Cancer recurrence is always a possibility. That’s why regular follow-up visits are recommended, so your doctor can monitor you closely after treatment ends, especially in the first two years, when the risk of recurrence is highest. Oral cancer patients are also at risk for developing a secondary cancer, which may develop during cancer treatment or after treatment ends. Because smoking and alcohol use increases the risk for secondary cancers, while also reducing the effects of certain treatments, oral cancer patients are advised to avoid tobacco and alcohol products altogether.