Oral cancer (also known as mouth cancer or oral cavity cancer) is most often found in the tongue, the lips and the floor of the mouth.
It also can begin in the gums, the minor salivary glands, the lining of the lips and cheeks, the roof of the mouth or the area behind the wisdom teeth.
Most oral cancers arise in the squamous cells, which line the mouth, tongue, gums and lips. These are called squamous cell carcinomas (cancers).
Salivary gland cancers are not squamous cell carcinoma. These cancers develop deeper in the tissue. Most form from mucoepidermoid cells, which line the minor salivary glands. Learn more about salivary gland cancer.
Cancer can also develop in the bones of the mouth. Learn more about bone cancer.
Not all tumors or growths in the mouth are cancer. Some are benign (not cancer), while others are precancerous, meaning they may become cancer but are not currently cancer.
Oral cancer risk factors
Anything that increases your chances of getting cancer is called a risk factor. Many cases of oral cancers are linked to risk factors. Some patients will develop oral cancers without any known risk factors. The main risk factors for oral cancer are:
Tobacco use: Many people diagnosed with oral cancer use tobacco in some form. These include cigarettes, cigars, pipes and chewing tobacco. The longer people use tobacco and the amount they use increases that risk.
The type of tobacco people use can influence where oral cancer develops. Cigarette smoking can cause oral cancer anywhere in the mouth. People who use chewing tobacco or snuff are more likely to develop cancer of the gums, cheek and lips. Pipe smoking increases the risk for cancer of the lip and the soft palate. Living with a smoker or working in a smoking environment can cause secondhand or passive smoking, which also may increase risk.
Alcohol: Many people diagnosed with oral cancer are heavy drinkers, consuming more than 21 alcoholic drinks each week. The combination of tobacco and alcohol is particularly dangerous. People who drink alcohol and smoke are far more likely to get oral cancer than people who do not drink or smoke.
Other risk factors include:
- Gender: About two-thirds of people diagnosed with oral cancer are men.
- Age: These cancers are found most often in people over 45.
- Prolonged sun exposure, which can lead to lip cancer.
- Long-term irritation caused by poor dental hygiene, including irritation caused by ill-fitting dentures.
- Poor nutrition, especially a diet low in fruits and vegetables.
- Taking immunosuppressive drugs.
- Having a previous head and neck cancer.
- Lichen planus, an auto-immune condition that affects the cells that line the mouth.
- Drinking maté, a beverage made from a type of holly tree common in South America.
- Chewing quids of betel, a stimulant common in Asia.
- Several genetic disorders, including Fanconi’s Anemia and Dyskeratosis Congenita. Learn more about hereditary cancer syndromes.
- Graft vs. Host disease: This is a serious side effect of stem cell transplantation. It can cause immune cells to target tissue in the oral cavity and lead to oral cancer.
Oral cancer prevention
Many oral cancers can be prevented. Some ways to minimize the risk of developing oral cancer include:
- Avoiding tobacco in all forms.
- Visiting a dentist at least once a year for a complete oral examination.
- Drinking alcohol only in moderation.If you have dentures, removing them at night and clean them daily. Have them evaluated by a dentist at least every five years.
- Eating a well-rounded, healthy diet with a variety of fruits and vegetables.
Because early diagnosis gives you the best chance of successful treatment, the Oral Cancer Prevention Clinic provides a specialized setting for diagnosis, monitoring and treatment of precancerous lesions. New optical techniques, which are less-invasive alternatives to biopsy, may help find some oral cancers earlier.
Learn more about oral cancer:
Oral cancer pictures
Leukoplakia, or white patch, of the bottom right side of the tongue. Pre-cancerous growths often present in this way.
Cancer of the lower lip.
A cancer of the tongue.
A cancer of the upper gingiva, or gum.
Cancer of the lower gums, behind the front teeth.
A cancerous lesion on the floor of the mouth, under the tongue.
A cancerous growth behind the last molar.
Oral cancer can develop in almost every structure in the mouth, inclding, the gums, tounge, roof of the mouth and lips.
Tongue cancer survivor thriving after minimally invasive surgery
After Tim Turner began feeling pain in his jaw, doctors discovered an ulcer underneath his tongue. A CT scan and biopsy in early 2023 confirmed he had tongue cancer – again.
Because he’d had radiation therapy and chemotherapy to treat the initial cancer in 2021, Tim’s options were limited. His local doctors suggested surgery. Tim wanted a second opinion.
“My wife asked the radiologist where he would go for a second opinion if his wife had cancer,” Tim recalls. “He said, ‘MD Anderson.’”
Choosing MD Anderson for tongue cancer surgery
Tim requested an appointment online and received a call from MD Anderson within 30 minutes. He had an appointment a couple of weeks later with a multidisciplinary team led by head and neck surgeon Neil Gross, M.D. During the initial visit, Gross and the team laid out a plan that included undergoing a few rounds of chemotherapy and immunotherapy to shrink the tumor before surgery. Tim and his wife, Michele, discussed the plan and decided it was the best option.
Starting that March, Tim underwent three sessions of immunotherapy and chemotherapy. The tumor shrank, and as a result, he had less of his tongue removed during his surgery in May 2023.
Transoral single-port robotic surgery for tongue cancer
Tim underwent single-port robotic surgery, a minimally invasive approach through the mouth that helps patients recover faster.
“For selected patients with cancers of the tonsil or the base of the tongue, transoral single-port robotic surgery is better,” Gross says. “Using the robot allows us to avoid the old-fashioned approach of splitting the jaw.” During Tim’s 13-hour surgery, Gross used a single port robot to remove the tumor from the base of his tongue before plastic surgeon Z-Hye Lee, M.D., performed reconstructive microsurgery.
Tim stayed in the hospital for about a week after surgery. He used a feeding tube for three months, re-learning how to swallow, because of the prior radiation. A nurse ensured he knew how to set up his feeding tube when he returned home. Tim says learning how to eat and swallow again was the most difficult part after surgery.
“The feeding tube was a bit of a struggle and more boring than anything,” he says. “But at this point, I can eat just about anything I want to, and other than that, I don't have a complaint.”
Thriving after tongue cancer treatment
Today, Tim is back to work as a professional artist and enjoying his favorite activities like working out, hiking and visiting his grandchildren in Washington, D.C., and Switzerland. He created a series of paintings called “Songs of Celebration” that showcases collage work with teapots, flowers and wine cups – items that he associates with celebration.
“Making art has been good for me in many ways,” says Tim, who works in his studio every day. “It takes my mind off things as it did to get me through cancer treatment.”
Tim is grateful for his care team and that he chose MD Anderson for surgery.
“It absolutely could not be any better,” he says. “Everyone at MD Anderson is very informative, very compassionate. We couldn’t ask for a better team.”
Request an appointment at MD Anderson online or call 1-877-632-6789.
Proton therapy saved my ability to taste during treatment for tongue cancer
For Carlos Morera, the only symptom of oral cancer was a small lump beneath his jaw when shaving.
With a history of cancer, he knew that a swollen lymph node or a painless lump in the neck was among the most common symptoms of oral cancer.
“My first reaction was fear,” says Carlos. “I had undergone surgery for thyroid cancer the year before and was told the cancer was gone.”
His ENT told him not to worry but recommended a CT scan and a biopsy from a local surgeon near his home in Miami, Florida. That’s when he received the news that it was HPV-related tongue cancer, specifically squamous cell carcinoma of the right base of the tongue.
“I felt very nervous after receiving the news,” recalls Carlos. “I did not feel comfortable with the treatment plan I initially received. I wanted to explore other options because of the anticipated side effects.”
After talking it over with his wife, Edleen, he decided to look for a second opinion. He wanted to go to MD Anderson because of its reputation as the top cancer hospital in the nation and its expertise in proton therapy. Carlos knew about this advanced type of radiation therapy, which minimizes the impact of treatment on healthy surrounding tissues.
Settling in at MD Anderson for head and neck cancer treatment
In October 2023, Carlos traveled to Houston for his first appointment at MD Anderson to see head and neck surgeon Ryan Goepfert, M.D.
“Dr. Goepfert reassured me that I was at the best place for my care, and that made me feel comfortable,” says Carlos. Goepfert did not recommend surgery. Instead, he referred Carlos to radiation oncologist Steven Frank, M.D., who specializes in proton therapy, along with head and neck medical oncologist Renata Ferrarotto, M.D., for chemotherapy.
After meeting with Dr. Frank, Carlos felt better about his upcoming treatment. “I knew I was being treated by the best of the best and felt thankful for proton therapy,” says Carlos.
His care team talked to him about all the extra things that could help during treatment, such as yoga and acupuncture. “It’s not just about MD Anderson being the best. It’s how they treated us – it was phenomenal,” says Edleen. “From the time we got there, attention to detail was impeccable.”
Carlos and Edleen rented a house in Houston from November until his last treatment in January 2024. Their four children remained in Miami and joined them in Houston for the holidays. “It was a relief to know they did not have to see me go through treatment,” recalls Carlos.
Managing side effects from treatment
In November, Carlos began 33 daily proton therapy treatments, concurrent with six rounds of weekly doses of cisplatin, a type of chemotherapy. “I was expecting to feel bad from the chemotherapy medication, but I never did,” says Carlos. “My nurse, Shef Ghandi, and nurse practitioner, Ian Moore, kept me informed about preventive medicine to help me stay ahead of side effects.”
Carlos did not develop mouth sores, but his care team asked every day to make sure they only gave him the medication he needed and nothing unnecessary. To avoid losing weight, he made every effort to keep his diet the same. He maintained his normal exercise routine of walking twice a day for 15 minutes, along with doing yoga a few times a week.
Carlos feared losing his sense of taste from the radiation, but he only lost his taste for sweet foods. “My wife and I got to experience the different types of food at restaurants in Houston,” he says. He scheduled his treatments in the morning and would look forward to eating after treatment.
“Treating Carlos with proton therapy gave us the ability to reduce the radiation dose to the anterior tongue, which then allowed him to maintain his taste,” says Frank.
Carlos remembers the worst part of proton therapy was the anxiety he would feel before each treatment. His care team prescribed anti-anxiety medication. That helped prepare him for wearing the mask and mouthpiece needed to protect his teeth and jaw.
Doing the recommended exercises not only helped keep side effects to a minimum but also helped him manage his mental health. “Once you let your mind take over with worry, it makes it hard,” he says. “I kept getting mentally stronger with each week, as I found out it wasn’t as bad as I anticipated.”
Life after tongue cancer treatment
Almost a year has gone by since Carlos completed treatment. He is back to his normal routine with no major side effects, except for a change of perspective. “Now, when my kids drive me crazy, I appreciate them and everything we have so much more,” says Carlos. “I’m so thankful to be back to everyday life.”
Carlos met a fellow patient of Dr. Frank who was undergoing the same type of treatment he was. They talked every week. “Having a peer to talk to helped me prepare for what to expect throughout the process,” recalls Carlos.
Carlos also credits Edleen for being with him every step of the way. “She is my rock and the reason I did so well throughout treatment,” he says. “Her faith and support made me stronger every day.”
Carlos encourages others to do their research and understand their treatment options. “Take it day by day. It is hard not to worry, but stay positive and do not think the worst,” he says. “Be patient, pray and have a lot of faith. I was blessed to have found MD Anderson and the right team of doctors.”
Request an appointment at MD Anderson online or call 1-877-632-6789.
Why choose MD Anderson for oral cancer treatment?
Where you go first for cancer treatment matters.
At MD Anderson, your care for oral cancer is personalized. Your care team in the Head and Neck Center will include a surgeon, medical oncologist and radiation oncologist. They will work together, and with you, to develop a care plan customized to your specific needs and wishes. They can offer the most advanced therapies and pay special attention to minimizing side effects.
Treatments may include advanced surgical and reconstructive surgery techniques; cutting-edge cancer drugs like immunotherapy and targeted therapy; and highly targeted radiation treatments including proton therapy. As a top-ranked cancer center, MD Anderson also has multiple clinical trials covering all stages of oral cancer. Some of these trials may not be available anywhere else.
Oral cancer care teams also include specialists who can help improve your quality of life during and after treatment. These include speech pathologists who can help you maximize your ability to speak, chew and swallow.
MD Anderson also has dentists who specialize in caring for cancer patients. They evaluate patients with oral cancer and conduct any pre-treatment procedures necessary for their long-term oral health. Dental care after oral cancer treatment can be particularly challenging, so these treatments are essential to your quality of life. Our dental team also crafts custom-made prosthetics for patients who have portions of their jaw or other bones removed as part of cancer treatment.
And at MD Anderson, you're surrounded by the strength of the nation's largest and most experienced comprehensive cancer center. From support groups to integrative medicine services to social work counseling, we have the services needed to treat the whole person – not just the disease.
Cancer changed me. I see the beauty in all of this. I see life in a different perspective.
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