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Oral Cancer Experts
Each patient is followed closely by a team of experts including oncologists and radiation oncologists and, when necessary, surgeons, dentists and speech pathologists. These specially trained experts customize your care, including the most advanced therapies with the least impact on your body.
Innovative Oral Cancer Treatments Offer Hope
At MD Anderson, your care for oral cancer is personalized and may include surgery, or other treatments such as targeted therapies. If surgery is necessary, you can count on our renowned surgeons, who use the latest, least-invasive techniques.
Oral cancer and its treatment can affect talking, swallowing, eating and breathing. MD Anderson patients with oral cancer receive the expertise of highly skilled head and neck surgeons, medical and radiation oncologists, plastic surgeons, dental oncologists and speech and swallowing specialists, all working together to provide the best chance for successful treatment for oral cancer 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.
Because early diagnosis gives you the best chance for successful treatment, the Oral Cancer Prevention Clinic provides a specialized setting for diagnosis, monitoring and treatment of precancerous lesions of the oral cavity. New optical techniques, less-invasive alternatives to biopsy, may help find some oral cancers earlier.
And at MD Anderson, you're surrounded by the strength of one of the nation's largest and most experienced comprehensive cancer centers, which has all 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.
The American Cancer Society estimates that nearly 30,000 people in the United States were diagnosed with oral cancer in 2015. Oral 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.
Chances of successfully treating oral cancer are highest when it is found early. Our team of experts in the Oral Cancer Prevention Clinic works closely together to detect and diagnose oral cancer in its early stages.
Oral Cancer Types
Almost all cancers of the mouth occur in squamous cells, the type of cells that line the mouth, tongue and lips. These are called squamous cell carcinomas (cancers). Not all tumors in the mouth are cancer. Some are benign (not cancer), and some are precancerous, meaning they may become cancer.
Oral Cancer Risk Factors
Anything that increases your chance of getting oral cancer is a risk factor. The main risk factors and oral cancer causes are:
Tobacco use: Most people with oral cancer use tobacco in some form. The risk increases with the length of the habit and the amount of tobacco used. Specifically, pipe smoking increases the risk for cancer of the lip and the soft palate. People who use chewing tobacco or snuff are more likely to develop cancer of the gums, cheek and lips. Living with a smoker or working in a smoking environment can cause secondhand or passive smoking, which also may increase risk.
Alcohol: Most people with oral cancer are heavy drinkers, consuming more than 21 alcoholic drinks each week. People who drink alcohol and smoke are six times as likely to get oral cancer as people who do not drink. The combination of tobacco and alcohol is particularly dangerous.
Other risk factors include:
- Gender: About two thirds of people with oral cancer are men.
- Race: The risk of oral cancer is higher for African-Americans.
- Age: These cancers are found most often in people over 45.
- Prolonged sun exposure (lip cancer)
- Long-term irritation caused by ill-fitting dentures
- Poor nutrition, especially a diet low in fruits and vegetables
- Immunosuppressive drugs
- Infection with human papillomavirus (HPV oral cancer)
- 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
Not everyone with risk factors gets oral cancer. However, if you have risk factors, you should discuss them with your doctor.
Oral Cancer Prevention
Cancers of the mouth are among the most preventable cancers. One of the most important things you can do is visit a dentist once a year for a complete oral examination.
To minimize your risk of developing oral cancer:
- Avoid tobacco in all forms.
- Drink alcohol in moderation
- Remove your dentures at night and clean them daily
- Have dentures 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
Behavioral and lifestyle changes can help prevent oral cancer. Visit our prevention and screening section to learn how to manage your risk.
In rare cases, oral can be passed down from one generation to the next. Genetic counseling may be right for you. Visit our genetic testing page to learn more.
Did You Know?
Symptoms of oral cancer vary from person to person. Often, symptoms may be caused by other problems that are not dangerous. 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 is a white area or spot in the oral cavity. About 25% of leukoplakias are cancerous or precancerous.
Erythroplakia is a red, raised area or spot that bleeds if scraped. About 70% of erythroplakias are cancerous or precancerous.
Erythroleukoplakia is a spot with both red and white areas.
Other signs of oral cancer include:
- Sore in the mouth or throat that doesn't heal
- Loose teeth
- Lump or thickening in the neck, face, jaw, cheek, tongue or gums
- Dentures that cause discomfort or do not fit well
- Difficulty chewing, swallowing or moving the tongue or jaw
- Persistent bad breath
- Unexplained weight loss
These symptoms usually do not mean you have cancer. However, it is important to discuss any symptoms with your doctor, since a correct diagnosis can help improve your chance for successful treatment. Also, these symptoms may signal other health problems.
Since early diagnosis improves your chances for successful treatment, it’s important for oral (mouth) cancers and pre-cancerous 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 symptoms that may indicate 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 sure way to know if the abnormal area is cancer. A biopsy may be obtained by:
Brush biopsy or 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 all of the tissue where cancer is suspected. Usually, this procedure is completed in the doctor's office or clinic under local anesthesia. But if the tumor is inside the throat, the biopsy may 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 O 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. Healthy cells do not reflect the light; cancerous cells do.
Imaging tests, which may include:
- CT or CAT (computed axial tomography) scans
- PET (positron emission tomography) scans
- MRI (magnetic resonance imaging) scans
- 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)
Stage 0: Cancer is "in situ," meaning it is isolated and has not traveled into a deeper layer of tissue or the lymph nodes, small almond-shape glands that help fight infection or trap tumor cells.
- Tumor is 2 centimeters (about ¾ inch) or smaller
- Tumor has not spread to lymph nodes or other parts of the body
- Tumor is between 2 and 4 centimeters (from ¾ to 1½ inches)
- Tumor has not spread to lymph nodes or other parts of the body
Stage 3: Tumor is either:
- Larger than 4 centimeters (1½ inches) or
- Any size and has traveled to one lymph node on the same side of the head or neck. The lymph node with cancer measures 3 centimeters or less
- Tumor has not spread to other parts of the body
Stage 4: Tumor is any size and has invaded deeply into muscle or facial skin or the jaws and has spread to:
- More than one lymph node on the same side of the head or neck as the main tumor
- Lymph nodes on one or both sides of the neck
- Any lymph node that measures more than 6 centimeters (2½ inches)
- 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 to include the most advanced therapies with the least impact on your body.
Your care is followed closely by a team of health care professionals, led by a doctor who specializes in treating oral cancers. Other members of your team may include:
- Head and neck surgeons, medical oncologists and radiation oncologists
- Plastic and reconstructive surgeons
- Speech pathologists
- Speech, occupational and physical therapists
We specialize in minimally invasive techniques and innovative treatments, including tumor growth factor inhibitors. 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.
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 treatment for oral cancer. The type of surgery depends on the type and stage of the tumor. Surgical techniques to treat oral cancer and deal with the side effects of treatment include:
- Removal of the tumor or a larger area to remove the tumor and surrounding healthy tissue
- Removal of part or all of the jaw
- Maxillectomy (removal of bone in the roof of the mouth)
- Removal of lymph nodes and other tissue in the neck
- Plastic surgery, including skin grafts, tissue flaps or dental implants to restore tissues removed from the mouth or neck
- Tracheotomy, or placing a hole in the windpipe, to assist in breathing for patients with large tumors or after surgical removal of the tumor
- Dental surgery to remove teeth or assist with reconstruction
In cancer of the mouth, radiation therapy may be used alone to treat small or early-stage tumors. More often, radiation therapy is used after surgery, either alone or with chemotherapy for more advanced tumors. 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.
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.
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.
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.
Tumor Growth Factor Inhibitors
Tumor growth factors are hormone-like substances that occur naturally in the body and cause cell growth. An epidermal growth factor (EGF) receptor on the surface of some oral cancer cells can bind to certain substances that stimulate tumor growth. New drugs are being tested that target EGF receptors and may stop cancer cells from growing.
After Treatment: Reconstruction and Rehabilitation
Oral cancer and its treatment often cause difficulty in speaking, swallowing and breathing. We work with you, defining your needs and making sure you receive the care you need. This may include speech, occupational and physical therapies and other methods.
After treatment, some patients with oral cancer need plastic or reconstructive surgery to help restore their appearance or regain the ability to speak or swallow. MD Anderson’s plastic and reconstructive surgeons are among the most skilled and experienced in the world.
Sometimes the surgeon can perform reconstructive surgery at the same time as your cancer surgery; in other cases it is best to wait. Your doctor will recommend the method that is best for you. If reconstructive surgery isn’t possible, 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.
BY India Ogazi
Each year more than 30,000 people are diagnosed with oral cancer. This type of tumor can occur on the tongue, lips, gums, cheek, palate or floor of the mouth. When caught early, oral cancer is highly treatable, so it’s important to know what to look for.
Ann Gillenwater, M.D., director of MD Anderson’s Oral Cancer Prevention Clinic, recently answered a few questions to help patients and families facing oral cancer, as well as those worried about oral cancer symptoms.
Here’s what she had to say.
What are common oral cancer symptoms and precursors?
Common symptoms include a sore in the mouth that doesn’t heal, loose
teeth, difficulty chewing, swallowing or moving the jaw, persistent
bad breath, a lump or red patch in the mouth and unexplained weight
Some oral cancers begin as precancerous lesions, which need to be closely monitored. The most common type is leukoplakia, which is a white area or spot in the mouth. The other types are:
- erythroplakia, a red, raised area or spot that can bleed if scraped
- erythroleukoplakia, a spot with both red and white areas in the mouth.
Are certain people more likely to develop oral cancer?
Yes. Those more likely to develop oral cancer include tobacco users and people who drink alcohol in excess, as well as those with:
- lichen planus
- graft vs. host disease
- fanconi anemia
Many of my patients ask me if their oral cancer came from the human papillomavirus (HPV), and the answer is almost always no. That’s a common misconception. It’s extremely rare for HPV cancers to occur in the mouth, although it does commonly occur in the throat, which leads to this confusion.
What can people do to lower their risk of oral cancer?
I tell my patients to not drink alcohol in excess and to stop smoking. It’s also important to maintain a healthy diet that consists of fruits, vegetables, lean meats and unprocessed foods. Routine dental care and good dental hygiene also are essential. Dentists often recognize precancerous lesions during routine dental check-ups.
How are oral cancer and oral precancerous lesions typically treated?
We tailor the treatment plans to fit each patient, but surgery is often required to remove oral cancers. We use minimally invasive surgical techniques to preserve as much healthy tissue as possible.
Surgery is sometimes followed by radiation therapy and chemotherapy. At MD Anderson, we offer two radiation therapies that minimize damage to healthy tissues surrounding the tumor: proton therapy and intensity-modulated radiotherapy (IMRT).
What treatment options are typically offered to patients experiencing an oral cancer recurrence?
The first line of treatment is surgery, followed by radiation therapy.
What side effects do oral cancer patients typically experience after treatment?
Many patients with early oral cancers have minimal side effects. But surgery can often affect the speech and swallowing functioning of those with advanced oral cancers. Radiation can cause dry mouth for both groups.
Our plastic surgeons and dental oncologists can reconstruct portions of the mouth that have been surgically removed. Our speech pathologists also work closely with the patients to help restore their speech and swallowing.
What new oral cancer research is being done at MD Anderson?
For patients with no history of tobacco or alcohol use, we evaluate their lifestyle habits to try to determine what caused this disease. I work closely with engineers at Rice University to advance our diagnostic screening tools and better understand how likely oral lesions are to become cancer.
We also have a clinical trial for advanced oral cancer that uses genomic biomarkers to identify those individuals most likely to respond to chemotherapy. In addition, we will soon open a chemopreventive study investigating a new immunotherapy drug to prevent high-risk patients from developing oral cancer.
What’s your advice for patients who’ve just been diagnosed
with oral cancer or oral precancerous lesions?
Be sure to choose a doctor experienced in oral cancer at a facility that offers a full spectrum of treatment options. It also doesn’t hurt to get a second opinion.
If you have precancerous lesions, they should be examined and monitored by a doctor experienced in oral cancer. At our Oral Cancer Prevention Clinic, we are testing advanced diagnostic tools that give quantitative measurements of lesions, which non-invasively indicate a lesion’s chance of having a high-grade pre-cancer or cancer.
Finally, whether you have oral cancer or precancerous lesions, my number one rule is to stay positive and remember that many patients do quite well.
When Cora “Corky” Hilliard was diagnosed with squamous cell cancer of the tongue for the second time in June 2012, she got to MD Anderson as quickly as she could. She’d had her first tongue cancer occurrence treated near her home in Austin nearly three years earlier. At the time, she’d been told that the disease would never return to its original location.
At MD Anderson, our integrated approach to cancer treatment won her admiration immediately.
“In 2009, I had to go out and find my own radiation oncologist, and I couldn’t get any direction from the doctors about who was driving the bus,” Corky says. “Then I came to MD Anderson and met with Dr. Michael Kupferman and his team, and I realized that I actually had a team. It included an oncologist, a radiologist, a surgeon, a speech therapist, a nutritionist and more, all working together. That gave me immense confidence.”
Tongue cancer treatment at MD Anderson saves speech
Corky’s confidence proved well-founded. During an Aug. 2012 robot-assisted surgery, Kupferman was able to completely remove the golf ball-sized tumor near the base of Corky’s tongue without compromising her ability to speak — a critical concern since she makes her living as a public speaker.
“I’d been told by a different doctor that if I had the surgery, only my close friends and family might eventually be able to understand me,” Corky says. “So I was facing not only the loss of my ability to communicate verbally, but also the loss of my career. MD Anderson literally gave me my voice back.”
Previous radiation exposure requires ongoing vigilance
Today, Corky considers herself lucky. None of the 30 or so lymph nodes surgically removed during the course of her treatment showed evidence of metastasis. So her second tongue cancer treatment didn’t require chemotherapy or radiation.
That was a huge relief to Corky, after the side effects she’d experienced from the high-dose radiation she’d received in 2009 as a part of her first tongue cancer treatment. “It was really painful to eat and drink then, and I had a blister on the end of my tongue for two and a half months,” she says. “I also lost my sense of taste, but eventually it came back.”
Corky is now just six months shy of the coveted five-year mark for remaining tongue cancer-free. But she must watch her body closely for signs of secondary cancers caused by her previous radiation exposure.
“I just had a basal cell cancer removed from my right eyelid,” Corky says. “When I asked Dr. Richard Allen if it could be related to all the radiation I received back in 2009, he said, ‘No doubt.’ So I pay careful attention.”
Why Corky gives back to MD Anderson
Corky also finds great satisfaction in using her voice to give back to the place that helped her to keep it.
She began donating annually to MD Anderson in 2012, and she encourages others to do the same.
“I earmark my donations for Dr. Kupferman’s research,” Corky says. “I know it’s a little self-serving since he’s studying my kind of cancer, but I wanted to feel like I was contributing in some way. State support for government institutions like MD Anderson has been steadily diminishing, and Dr. K. saved my life. This lets me feel like I’m paying my own way and doing my part.”
Make a gift to MD Anderson to support cancer research that benefits patients like Corky.