Oral cancer

Alternative names
Cancer - mouth; Mouth cancer; Head and neck cancer; Squamous cell cancer - mouth

Definition
Oral cancer involves abnormal, malignant tissue growth in the mouth.

Causes, incidence, and risk factors

Oral or mouth cancer most commonly involves the tissue of the lips or the tongue. It may also occur on the floor of the mouth, cheek lining, gingiva (gums), or palate (roof of the mouth). Most oral cancers look very similar under the microscope and are called squamous cell carcinomas. These are malignant and tend to spread rapidly.

Smoking and other tobacco use are associated with 70-80% of oral cancer cases. Smoke and heat from cigarettes, cigars, and pipes irritate the mucous membranes of the mouth. Use of chewing tobacco or snuff causes irritation from direct contact with the mucous membranes. Heavy alcohol use is another high-risk activity associated with oral cancer.

Other risks include poor dental and oral hygiene and chronic irritation (such as that from rough teeth, dentures, or fillings). Some oral cancers begin as leukoplakia or mouth ulcers. Oral cancer accounts for about 8% of all malignant growths. Men are affected twice as often as women, particularly men older than 40.

Symptoms

Skin lesion, lump, or ulcer:

• On the tongue, lip, or other mouth area
  
• Usually small
  
• Most often pale colored, may be dark or discolored
  
• May be a deep, hard edged crack in the tissue
  
• Usually painless initially
  
• May develop a burning sensation or pain when the tumor is advanced

Additional symptoms that may be associated with this disease:

• Tongue problems
  
• Swallowing difficulty
  
• Mouth sores
  
• Abnormal taste

Signs and tests
An examination of the mouth by the health care provider or dentist shows a visible or palpable (can be felt) lesion of the lip, tongue, or other mouth area. As the tumor enlarges, it may become an ulcer and bleed. Speech difficulties, chewing problems, or swallowing difficulties may develop, particularly if the cancer is on the tongue.

A tongue biopsy, gum biopsy, and microscopic examination of the lesion confirm the diagnosis of oral cancer.

Treatment

Surgical excision (removal) of the tumor is usually recommended if the tumor is small enough. Radiation therapy and chemotherapy would likely be used when the tumor is larger or has spread to lymph nodes in the neck. Surgery may be necessary for large tumors.

Rehabilitation may include speech therapy or other therapy to improve movement, chewing, swallowing, and speech.

Support Groups
The stress of illness can often be eased by joining a support group of people who share common experiences and problems. See cancer - support group.

Expectations (prognosis)

Approximately 50% of people with oral cancer will live more than 5 years after diagnosis and treatment. If the cancer is detected early, before it has spread to other tissues, the cure rate is nearly 75%. Unfortunately, more than 50% of oral cancers are advanced at the time the cancer is detected. Most have spread to the throat or neck.

Approximately 25% of people with oral cancer die because of delayed diagnosis and treatment.

Complications

• Postoperative disfigurement of the face, head and neck
  
• Complications of radiation therapy, including dry mouth and difficulty swallowing
  
• Other metastasis (spread) of the cancer

Calling your health care provider
This disorder may be discovered when the dentist performs a routine cleaning and examination.

Call for an appointment with your health care provider if a lesion of the mouth or lip or a lump in the neck are present and do not clear within 1 month. Early diagnosis and treatment of oral cancer greatly increases the chances of survival.

Prevention

• Minimize or avoid smoking or other tobacco use.
  
• Minimize or avoid alcohol use.
  
• Practice good oral hygiene.
  
• Have dental problems corrected.
  
• Have the soft tissue of the mouth examined once a year. Many oral cancers are discovered by routine dental examination.

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