Oral Cancer

Oral and oral cavity cancers refer to cancer that develops in any of the parts that make up the mouth. Oral cancer can occur on the lips, gums, tongue, inside lining of the cheeks, roof of the mouth, or floor of the mouth, but most oral cancers begin in the tongue and in the floor of the mouth. Oral cancer accounts for roughly 2% of all cancers diagnosed annually in the United States. Approximately 42,000 people will be diagnosed with oral cancer each year and about 8,000 will die from the disease. Anyone can get oral cancer, but the risk is higher if you are male, over age 40, use tobacco or alcohol, or have a history of head or neck cancer. Frequent sun exposure is also a risk for lip cancer.

Oral cancer is one of several types of cancer grouped in a category called head and neck cancers. Oral cancer and other head and neck cancers are often treated similarly, usually with combinations of surgery, radiation therapy, or chemotherapy.

Signs and symptoms of oral cancer may include:

• a sore that does not heal
• a lump or thickening of the skin or lining of your mouth
• a white or reddish patch on the inside of your mouth
• bleeding in the mouth
• loose teeth
• poorly fitting dentures
• tongue pain
• jaw pain or stiffness
• ear ache without hearing loss
• difficult or painful chewing
• difficult or painful swallowing
• numbness in the tongue or other areas of the mouth
• sore throat

The exact cause of oral cancer is not known. In general, cancer begins when a series of genetic mutations occur within a cell, causing the cell to grow and multiply out of control. It is not clear what causes the initial genetic mutations that lead to oral cancers, but several risk factors have been identified factors that may increase your chances of developing oral cancer, including:

• tobacco use of any kind, including cigarettes, cigars, pipes, chewing tobacco and snuff, among others
• heavy alcohol use
• excessive sun exposure to your lips
• a sexually transmitted virus called human papillomavirus (HPV)

An oral cancer examination can detect early signs of cancer. The exam is painless and takes only a few minutes. It may be completed during your regular dental check-up. During the exam, your dentist or dental hygienist will check your face, neck, lips, and entire mouth for possible signs of cancer.

If you have signs or symptoms that suggest you may have oral cancer, your doctor will conduct a comprehensive physical exam and take a medical history. A biopsy of suspicious tissue is the only way to conclusively diagnose cancer.

A diagnosis of oral cancer can be stressful for you and for your family and friends. There are several steps you can take to maintain control of your health and well-being.

Learn enough about oral cancer in order to make decisions about your care. Write down questions to ask your doctor. Ask your health care team for information to help you better understand your disease.

Surround yourself with a support network. Close friends or family can help you with everyday tasks, such as getting you to appointments or treatment. If you have trouble asking for help, learn to be honest with yourself and accept help when you need it.

Seek out other people with cancer. Ask your health care team about cancer support groups in your community. Sometimes there are questions that can only be answered by other people with cancer. Support groups offer a chance to ask these questions and receive support from people who understand your situation.

Take time for yourself. Eat well, relax, and respect the limits that you may feel. Continue to work and engage in hobbies as you are able.

The main treatment options for people with oral and oral cavity cancers are:

• surgery
• radiation therapy
• chemotherapy
• targeted therapy

These may be used either alone or in combination, depending on the stage and location of the tumor. In general, surgery is the first treatment for cancers of the oral cavity, and may be followed by radiation or combined chemotherapy and radiation. Oral and oral cavity cancers are usually treated with a combination of chemotherapy and radiation.

Surgery. Surgery is used in the treatment of oral cancers to remove the tumor, remove lymph nodes to which the cancer has spread, and to reconstruct the mouth after cancer-removal surgery.

Radiation therapy. Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing.

Chemotherapy. Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. Some of the chemotherapy drugs used to treat oral cancer include:

• Carboplatin
• Cisplatin
• 5-fluorouracil (5-FU)
• Docetaxel (Taxotere)
• Paclitaxel (Taxol)
• Ifosfamide (Ifex)
• Bleomycin
• Methotrexate (Trexall)

Targeted therapy. Targeted drugs treat oral cancer by altering specific aspects of cancer cells that fuel their growth. Cetuximab (Erbitux) is one targeted therapy approved for treating some head and neck cancers in certain situations.