About oral cancer
What is oral cancer?
What is the oral cavity?
The oral cavity and oropharynx have many parts:
- Lining of your cheeks
- Salivary glands (glands that make saliva)
- Roof of your mouth (hard palate)
- Back of your mouth (soft palate and uvula)
- Floor of your mouth (area under the tongue)
- Gums and teeth
What is cancer?
Cancer begins in cells, the building blocks that make up tissues. Tissues make up the organs of the body.
Normally, cells grow and divide to form new cells as the body needs them. When cells grow old, they die, and new cells take their place.
Sometimes this orderly process goes wrong. New cells form when the body does not need them, and old cells do not die when they should. These extra cells can form a mass of tissue called a growth or tumor. The kinds of cells found in the tumor determine how the tumor will behave.
Tumors can be benign or malignant:
- Benign tumors are not cancer:
- Benign tumors are rarely life-threatening.
- Generally, benign tumors can be removed, and they usually do not grow back.
- Cells from benign tumors do not invade the tissues around them.
- Cells from benign tumors do not spread to other parts of the body.
- Malignant tumors are cancer:
- Malignant tumors are generally more serious than benign tumors. They may be life-threatening.
- Malignant tumors often can be removed, but sometimes they grow back.
- Cells from malignant tumors can invade and damage nearby tissues and organs.
- Cells from malignant tumors can spread to other parts of the body. The cells spread by breaking away from the original cancer (primary tumor) and entering the bloodstream or lymphatic system. They invade other organs, forming new tumors and damaging these organs. The spread of cancer is called metastasis.
Oral cancer is part of a group of cancers called head and neck cancers. Oral cancer can develop in any part of the oral cavity or oropharynx. Most oral cancers begin in the tongue and in the floor of the mouth. Almost all oral cancers begin in the flat cells (squamous cells) that cover the surfaces of the mouth, tongue, and lips. These cancers are called squamous cell carcinomas.
When oral cancer spreads (metastasizes), it usually travels through the lymphatic system. Cancer cells that enter the lymphatic system are carried along by lymph, a clear, watery fluid. The cancer cells often appear first in nearby lymph nodes in the neck.
Cancer cells can also spread to other parts of the neck, the lungs, and other parts of the body. When this happens, the new tumor has the same kind of abnormal cells as the primary tumor. For example, if oral cancer spreads to the lungs, the cancer cells in the lungs are actually oral cancer cells. The disease is metastatic oral cancer, not lung cancer. It is treated as oral cancer, not lung cancer. Doctors sometimes call the new tumor "distant" or metastatic disease.
Who's at risk for oral cancer?
Doctors cannot always explain why one person develops oral cancer and another does not. However, we do know that this disease is not contagious. You cannot "catch" oral cancer from another person.
Research has shown that people with certain risk factors are more likely than others to develop oral cancer. A risk factor is anything that increases your chance of developing a disease.
What are the symptoms for oral cancer?
Mouth sore symptom was found in the oral cancer condition
Signs and symptoms of mouth cancer may include:
- A lip or mouth sore that doesn't heal
- A white or reddish patch on the inside of your mouth
- Loose teeth
- A growth or lump inside your mouth
- Mouth pain
- Ear pain
- Difficult or painful swallowing
What are the causes for oral cancer?
Mouth cancers form when cells on the lips or in the mouth develop changes (mutations) in their DNA. A cell's DNA contains the instructions that tell a cell what to do. The mutations changes tell the cells to continue growing and dividing when healthy cells would die. The accumulating abnormal mouth cancer cells can form a tumor. With time they may spread inside the mouth and on to other areas of the head and neck or other parts of the body.
Mouth cancers most commonly begin in the flat, thin cells (squamous cells) that line your lips and the inside of your mouth. Most oral cancers are squamous cell carcinomas.
It's not clear what causes the mutations in squamous cells that lead to mouth cancer. But doctors have identified factors that may increase the risk of mouth cancer.
What are the treatments for oral cancer?
Many people with oral cancer want to take an active part in making decisions about their medical care. It is natural to want to learn all you can about your disease and your treatment choices. However, shock and stress after the diagnosis can make it hard to think of everything you want to ask the doctor. It often helps to make a list of questions before an appointment. To help remember what the doctor says, you may take notes or ask whether you may use a tape recorder. You may also want to have a family member or friend with you when you talk to the doctor - to take part in the discussion, to take notes, or just to listen.
Your doctor may refer you to a specialist, or you may ask for a referral. Specialists who treat oral cancer include oral and maxillofacial surgeons, otolaryngologists (ear, nose, and throat doctors), medical oncologists, radiation oncologists, and plastic surgeons. You may be referred to a team that includes specialists in surgery, radiation therapy, or chemotherapy. Other health care professionals who may work with the specialists as a team include a dentist, speech pathologist, nutritionist, and mental health counselor.
Getting a second opinion
Before starting treatment, you might want a second opinion about the diagnosis and the treatment plan. Some insurance companies require a second opinion; others may cover a second opinion if you or your doctor requests it. Do not be afraid to ask for a second opinion. These are serious conditions and you may want to learn about your diagnosis and treatment options from more than one source. Your doctor should not be offended if you ask for a second opinion, and can help you to arrange it, if asked.
There are a number of ways to find a doctor for a second opinion:
- Your doctor may refer you to one or more specialists. At cancer centers, several specialists often work together as a team.
- The Cancer Information Service, at 1-800-4-CANCER, can tell you about nearby treatment centers.
- A local or state medical or dental society, a nearby hospital, or a medical or dental school can usually provide the names of specialists in your area.
- The American Board of Medical Specialties (ABMS) has a list of doctors who have had training and exams in their specialty. You can find this list in the Official ABMS Directory of Board Certified Medical Specialists. The directory is available in most public libraries. Or you can look up doctors at http://www.abms.org. (Click on Who's Certified.)
- The American Dental Association (ADA) Web site provides a list of dentists by specialty and location. The ADA Member Directory is available on the Internet at http://www.ada.org.
- The NCI provides a helpful fact sheet on how to find a doctor called "How To Find a Doctor or Treatment Facility If You Have Cancer." It is available on the Internet at http://cancer.gov/publications.
You may want to ask the doctor these questions before treatment begins:
- What is the stage of the disease? Has the cancer spread? If so, where?
- What are my treatment choices? Which do you recommend for me? Will I have more than one kind of treatment?
- What are the expected benefits of each kind of treatment?
- What are the risks and possible side effects of each treatment? How will treatment affect my normal activities? Will I be given anything to control side effects?
- How long will treatment last?
- Will I have to stay in the hospital?
- What is the treatment likely to cost? Is this treatment covered by my insurance plan?
- Would a clinical trial (research study) be appropriate for me? (See "The Promise of Cancer Research" for more information about clinical trials.)
- Should I try to quit smoking?
Preparing for treatment
The choice of treatment depends mainly on your general health, where in your mouth or oropharynx the cancer began, the size of the tumor, and whether the cancer has spread. Your doctor can describe your treatment choices and the expected results. You will want to consider how treatment may affect normal activities such as swallowing and talking, and whether it will change the way you look. You and your doctor can work together to develop a treatment plan that meets your needs and personal values.
You do not need to ask all your questions or understand all the answers at once. You will have other chances to ask your doctor to explain things that are not clear and to ask for more information.
Methods of treatment
Oral cancer treatment may include surgery, radiation therapy, or chemotherapy. Some patients have a combination of treatments.
At any stage of disease, people with oral cancer may have treatment to control pain and other symptoms, to relieve the side effects of therapy, and to ease emotional and practical problems. This kind of treatment is called supportive care, symptom management, or palliative care. Information about supportive care is available on NCI's Web site at http://cancer.gov and from NCI's Cancer Information Service at 1-800-4-CANCER.
You may want to talk to the doctor about taking part in a clinical trial, a research study of new treatment methods. The section on "The Promise of Cancer Research" has more information about clinical trials.
Surgery to remove the tumor in the mouth or throat is a common treatment for oral cancer. Sometimes the surgeon also removes lymph nodes in the neck. Other tissues in the mouth and neck may be removed as well. Patients may have surgery alone or in combination with radiation therapy.
You may want to ask the doctor these questions before having surgery:
- What kind of operation do you recommend for me?
- Do I need any lymph nodes removed? Why?
- How will I feel after the operation? How long will I be in the hospital?
- What are the risks of surgery?
- Will I have trouble speaking, swallowing, or eating?
- Where will the scars be? What will they look like?
- Will I have any long-term effects?
- Will I look different?
- Will I need reconstructive or plastic surgery? When can that be done?
- Will I lose my teeth? Can they be replaced? How soon?
- Will I need to see a specialist for help with my speech?
- When can I get back to my normal activities?
- How often will I need checkups?
- Would a clinical trial be appropriate for me?
Radiation therapy (also called radiotherapy) is a type of local therapy. It affects cells only in the treated area. Radiation therapy is used alone for small tumors or for patients who cannot have surgery. It may be used before surgery to kill cancer cells and shrink the tumor. It also may be used after surgery to destroy cancer cells that may remain in the area.
Radiation therapy uses high-energy rays to kill cancer cells. Doctors use two types of radiation therapy to treat oral cancer:
- External radiation: The radiation comes from a machine. Patients go to the hospital or clinic once or twice a day, generally 5 days a week for several weeks.
- Internal radiation (implant radiation): The radiation comes from radioactive material placed in seeds, needles, or thin plastic tubes put directly in the tissue. The patient stays in the hospital. The implants remain in place for several days. Usually they are removed before the patient goes home.
Some people with oral cancer have both kinds of radiation therapy.
You may want to ask the doctor these questions before having radiation therapy:
- Which type of radiation therapy do you recommend for me? Why do I need this treatment?
- When will the treatments begin? When will they end?
- Should I see my dentist before I start treatment? If I need dental treatment, how much time does my mouth need to heal before radiation therapy starts?
- What are the risks and side effects of this treatment? What can I do about them?
- How will I feel during therapy?
- What can I do to take care of myself during therapy?
- How will my mouth and face look afterward?
- Are there any long-term effects?
- Can I continue my normal activities?
- Will I need a special diet? For how long?
- How often will I need checkups?
- Would a clinical trial be appropriate for me?
Chemotherapy uses anticancer drugs to kill cancer cells. It is called systemic therapy because it enters the bloodstream and can affect cancer cells throughout the body. A new targeted therapy called cetuximab, which blocks a growth factor upon which cancer cells may depend, is being used today, either alone or in combination with radiation and older chemotherapy drugs.
Chemotherapy is usually given by injection. It may be given in an outpatient part of the hospital, at the doctor's office, or at home. Rarely, a hospital stay may be needed.
You may want to ask the doctor these questions before having chemotherapy:
- Why do I need this treatment?
- Which drug or drugs will I have?
- How do the drugs work?
- Should I see my dentist before I start chemotherapy? If I need dental treatment, how much time does my mouth need to heal before the chemotherapy begins?
- What are the expected benefits of the treatment?
- What are the risks and possible side effects of treatment? What can I do about them?
- When will treatment start? When will it end?
- Will I need to stay in the hospital? How long?
- How will treatment affect my normal activities?
- Would a clinical trial be appropriate for me?
What are the side effects of treatment for oral cancer?
Because treatment often damages healthy cells and tissues, unwanted side effects are common. These side effects depend mainly on the location of the tumor and the type and extent of the treatment. Side effects may not be the same for each person, and they may even change from one treatment session to the next. Before treatment starts, your health care team will explain possible side effects and suggest ways to help you manage them.
The NCI provides helpful booklets about cancer treatments and coping with side effects. Booklets such as Radiation Therapy and You, Chemotherapy and You, and Eating Hints for Cancer Patients may be viewed, downloaded, and ordered from http://cancer.gov/publications. These materials also may be ordered by calling the Cancer Information Service at 1-800-4-CANCER.
The National Institute of Dental and Craniofacial Research (NIDCR) also provides helpful materials. Head and Neck Radiation Treatment and Your Mouth, Chemotherapy and Your Mouth, and other booklets are available from NIDCR. See "National Institute of Dental and Craniofacial Research Information Resources" for a list of publications.
What are the risk factors for oral cancer?
Factors that can increase your risk of mouth cancer include:
- 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)
- A weakened immune system