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The majority of oral cancers arise in the squamous cells, which line the mouth, tongue, gums and lips. These are called squamous cell carcinomas (cancers). Not all tumors or growths in the mouth are cancer, however. 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. 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. 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 six times 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 ill-fitting dentures
- Poor nutrition, especially a diet low in fruits and vegetables
- Immunosuppressive drugs
- Previous head and neck cancer
- Radiation exposure
- Lichen planus, a disease 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 such as Fanconi’s Anemia or Dyskeratosis Congenita
Oral Cancer Prevention
Oral cancers are among the most preventable cancers. Some ways to minimize your risk of developing oral cancer include:
- Avoid tobacco in all forms.
- Visit a dentist at least once a year for a complete oral examination.
- Drink alcohol only in moderation.
- If you have dentures, remove them at night and clean them daily. Have them evaluated by a dentist at least every five years.
- Limit sun exposure; wear a lip balm with sunscreen and a hat with a brim.
- Eat 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, less-invasive alternatives to biopsy, may help find some oral cancers earlier.
Symptoms of oral cancer vary from person to person. But since early detection is important for successful treatment of oral cancer, see your doctor or dentist if you notice abnormal areas in your mouth. These may include the following:
Leukoplakia (literally a “white patch”) is a persistent white area or spot in the oral cavity. About 25% of leukoplakias are cancerous or precancerous.
Erythroplakia (red patch) is a persistent red, raised area or spot in the oral cavity that bleeds if scraped. About 70% of erythroplakias are cancerous or precancerous. Erythroplakia often arises out of an area of leukoplakia, so a mixed red and white appearance is common.
Other potential signs of oral cancer include:
- A sore in the mouth that doesn't heal
- Unexpected loose teeth
- A lump in the neck
- A mass or thickening in the face, jaw, cheek, tongue or gums
- A persistent sore or mass in the mouth that causes pain or a poor fit while wearing dentures
- Difficulty chewing, swallowing or moving the tongue or jaw
- Persistent bad breath
- Unexplained weight loss
These symptoms do not necessarily mean you have cancer. However, it is important to discuss any such symptoms with your doctor, since a correct and early diagnosis can help improve your chance for successful treatment. Also, these symptoms may signal other health problems.
Since early diagnosis dramatically improves your chances for successful treatment, it’s important for oral cancers and pre-cancerous oral lesions to be found as soon as possible. MD Anderson uses the most advanced techniques and technology to determine if a tumor is benign (not cancer), pre-cancer or cancer. In addition, we are working on new less-invasive optical techniques to help detect oral cancers.
Oral Cancer Diagnostic Tests
If you have signs or symptoms of cancer, your dentist or doctor will examine the inside of your cheeks and lips, the floor and roof of the mouth, the tongue and the lymph nodes in your neck. He or she will ask questions about your health and past illnesses and dental problems. Be sure to tell your doctor or dentist if you use or have used tobacco in any form.
If your doctor suspects you may have oral cancer, one or more of the following tests may be used to find out if you have cancer and if it has spread.
If any abnormalities are discovered during the exam, a small tissue sample, or biopsy, usually is taken. This biopsy is important, as it is the only way to know if the abnormal area is cancer. A properly done biopsy does not cause the cancer to spread. A biopsy may be obtained by:
Brush biopsy (exfoliative cytology): This relatively new type of biopsy is painless and does not require anesthetic. The dentist or doctor rotates a small stiff-bristled brush on the area, causing abrasion or pinpoint bleeding. Cells from the area are collected and examined under a microscope by a pathologist. If results are inconclusive or show cancer, an incisional biopsy will be completed.
Incisional biopsy: This is the traditional, most frequently used type of biopsy. The doctor or dentist surgically removes part or, rarely, all of the tissue where cancer is suspected. Usually, this procedure is completed in the doctor's office or clinic using local anesthesia. Occasionally, a biopsy in the mouth may need to be done in an operating room with general anesthesia.
Fine-needle-aspiration biopsy (FNA): This type of biopsy often is used if a patient has a lump in the neck that can be felt. In this procedure, a thin needle is inserted into the area. Then cells are withdrawn and examined under a microscope.
Mucosal staining: A blue dye called toluidine blue is applied to the area where cancer is suspected. If any blue areas remain after rinsing, they probably will be investigated with a biopsy.
Chemiluminescent light: After you rinse your mouth with a mild acid solution, your mouth will be examined with a special light to highlight suspicious areas. Healthy cells usually do not reflect the light; cancerous cells usually do.
Imaging tests, which may include:
- CT or CAT (computed axial tomography) scans
- PET (positron emission tomography) scans
- MRI (magnetic resonance imaging) scans
- Ultrasound is often used to examine and/or direct needle aspiration of suspicious lumps in the neck
- Chest and dental X-rays
- Barium swallow: Also called an upper GI (gastrointestinal) series, this set of X-rays of the esophagus and stomach may be used to look for other cancers and determine how well you swallow.
Oral Cancer Staging
If you are diagnosed with oral (mouth) cancer, your doctor will determine the stage of the disease. Staging is a way of classifying cancer by how much disease is in the body and where it has spread when it is diagnosed. This information helps the doctor treat the cancer. Once the staging classification is determined, the stage stays the same even if treatment is successful or the cancer spreads.
Disease stage is determined by the size of the primary tumor, how much it has invaded the tissues and whether the cancer has spread to the lymph nodes.
Oral Cancer Stages
(Source: National Cancer Institute)
Precancerous stage: Abnormal (dysplastic) cells are found on the surface (in situ) of the lining of the lips and/or oral cavity. These abnormal cells may invade deeper to become cancer.
Early Stage (1-2):
- Tumor is 4 centimeters (about 1 ½ inch) or smaller AND
- Tumor has not spread to lymph nodes or other parts of the body
Advanced Stage (3-4A):
- Tumor is larger than 4 centimeters (1½ inches), invading deep muscle or bone OR
- Tumor has spread to the lymph nodes or other parts of the body
Unresectable/Metastatic (4B-C): The cancer involves tissues that cannot be removed, such as the carotid artery, or has spread to other parts of the body
Recurrent: The oral cancer has reappeared after it was treated. It may reappear in the oral cavity or another part of the body.
The mouth is an important part of eating, breathing and talking, and MD Anderson takes special care to customize your oral cancer treatment so that we maximize the chances of cure while minimizing the impact on your body and lifestyle.
Your care is provided by a team of health care professionals, led by a doctor, typically a head and neck surgeon, who specializes in treating oral cancers. Other members of your team may include:
- Medical oncologists
- Radiation oncologists
- Plastic and reconstructive surgeons
- Speech pathologists
- Speech, occupational and physical therapists
We specialize in minimally invasive techniques and innovative treatments, including the use of new therapies through clinical trials. If reconstruction is needed, our plastic surgeons are among the most experienced in the country. We take special care to work with each patient to restore optimum physical function.
Our Oral Cancer Treatments
If you are diagnosed with oral cancer, your doctor will discuss the best options to treat it. This depends on several factors, including the type and stage of the cancer and your general health.
Your treatment for oral cancer will be customized to your particular needs. One or more of the following therapies may be recommended to treat the cancer or help relieve symptoms.
Surgery is the most frequent first treatment for oral cancer. The type of surgery depends on the type, extent and stage of the cancer. Surgical techniques are designed to remove all of the cancer in the mouth, and if needed, lymph nodes confirmed or suspected to have cancer cells.
During oral cancer surgery, surgeons work closely with pathologists who use special techniques to examine the tissues and make sure the cancer is removed completely. If needed, plastic surgeons reconstruct the surgical site and help restore function.
Radiation therapy may be used after surgery, either alone or with chemotherapy for more advanced tumors. In rare cases, radiation therapy is used instead of surgery or as a first step in treatment. The method of radiation treatment used depends on the type and stage of cancer.
External-beam radiation therapy is the most frequently used method to deliver radiation therapy to the mouth. Intensity-modulated radiotherapy (IMRT) and proton therapy are aimed at treating the tumor while minimizing damage to surrounding normal tissue.
Internal radiation or brachytherapy delivers radiation with tiny seeds, needles or tubes that are implanted into the tumor. It is used sometimes for treating small tumors or with surgery in advanced tumors.
Proton therapy delivers high radiation doses directly into the tumor, sparing nearby healthy tissue and vital organs. For many patients, this results in a higher chance for successful treatment with less impact on the body.
The Proton Therapy Center at MD Anderson is one of the world’s largest and most advanced centers. It’s the only proton therapy facility in the country located within a comprehensive cancer center. This means this cutting-edge therapy is backed by all the expertise and compassionate care for which MD Anderson is famous.
MD Anderson offers the most advanced chemotherapy options. Chemotherapy may be used to shrink the cancer before surgery or radiation, or it may be combined with radiation to increase the effectiveness of both treatments. It also may be used to shrink tumors that cannot be surgically removed.
Cancer cells need specific molecules to survive, multiply and spread. These molecules are usually made by the genes that cause cancer, as well as the cells themselves. Targeted therapies, such as epidermal growth factor (EGF) receptor inhibitors, are designed to interfere with those molecules or the cancer-causing genes that create them.
Cancer cells need to evade the immune system to survive, multiply and spread. A new class of cancer medicines, immunotherapies, work to unmask the cancer to the immune system. These drugs are not currently a standard treatment option for oral cancer outside of a clinical trial, except for patients with unresectable or metastatic cancer.
After Treatment: Reconstruction and Rehabilitation
Oral cancer and its treatment often cause difficulty with speaking, swallowing and breathing. We work with you, defining your needs and making sure you receive the care you need to increase the likelihood of returning to normal speech and function. Therapy may include speech, occupational and physical therapies and other methods.
As part of treatment, some patients with oral cancer need plastic or reconstructive surgery to help regain the ability to speak or swallow and/or restore their appearance.
Usually, reconstruction is performed at the same time as your cancer surgery. In some cases the surgery site is left to heal on its own. Your doctor will recommend the method that is best for you. In some cases, you may be fitted for a dental prosthesis or implant. A therapist will show you how to use the device. Sometimes, grafts of skin, muscle or bone, which are moved from another part of body to the mouth, are used.
Why choose MD Anderson for your oral cancer care?
At MD Anderson, your care for oral cancer is personalized. Your cancer care team, will communicate closely and work together, and with you, to customize your care, including the most advanced therapies with the least impact on your body.
We offer new strategies to maintain dental and oral health treatment. Our highly specialized speech pathologists and therapists are among the most experienced in the nation, particularly in the newest methods of voice restoration and speech.
And at MD Anderson, you're surrounded by the strength of the nation's largest and most experienced comprehensive cancer center, which has all the services needed to treat the whole person – not just the disease.
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