An Overview of Oral Cancer

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Oral cancer is a type of head and neck cancer that develops when abnormal cells within the lining of the cheeks, gums, roof of the mouth, tongue, or lips grow uncontrollably. Often times, oropharyngeal cancer—that affects the soft palate, side and back walls of the throat, back third of the tongue, and the tonsils—is lumped under this term, too.

Tobacco and alcohol use are the major risk factors for the disease, but there are others, including infection with the human papillomavirus (HPV). The most common symptoms of oral cancer are a non-healing sore or persistent mouth pain. A biopsy is needed to confirm the diagnosis. Depending on the location and spread of the cancer, treatment varies, but generally entails surgery, radiation, and/or chemotherapy. 

The vast majority of oral cancers are squamous cell cancers. Squamous cells are the thin, flat cells that line the mouth and throat. Much less commonly, non-squamous cell oral cancers like salivary gland tumors or lymphoma may develop.

Symptoms

According to the American Cancer Society, the most common symptoms of oral cancer include a sore in the mouth that does not heal or mouth or throat pain that does not go away.

Other potential symptoms of oral cancer include: 

  • White patch (called leukoplakia) or red patch (called erythroplakia) on the inside of the mouth 
  • Non-healing scab on the lip or mouth ulcer
  • Bleeding from the mouth that is unrelated to an injury
  • Pain and/or difficulty chewing 
  • Swollen glands (lymph nodes) or a mass in the neck
  • Jaw pain or swelling
  • Difficulty swallowing, chewing, speaking, or moving the tongue or jaw
  • Numb tongue or area of the mouth
  • Loose teeth or dentures
  • Persistent bad breath

Causes and Risk Factors

While the exact cause of oral cancer is unclear, there are factors that have been consistently found to increase a person's risk for developing it.

Perhaps the most significant risk factor for developing oral cancer is tobacco use. Smoking cigarettes, cigars, and pipes all increase your risk of cancer anywhere in the mouth or throat. Moreover, smokeless or oral tobacco products often called "dip" or "chew," heighten the risk for developing cancers of the cheek, gums, and inner part of the lips. 

Other risk factors linked to the development of oral cancer include: 

  • Heavy alcohol consumption: Risk dramatically increases when a person both smokes and drinks heavily. 
  • Human papillomavirus (HPV), especially HPV type 16, which is transmitted through sexual contact
  • Eating a diet deficient in fruits and vegetables
  • Being exposed to excess sunlight (increases risk for lip cancer)
  • Having a weakened immune system
  • Having certain underlying health problems like graft-versus-host disease or a genetic syndrome like Fanconi anemia
  • Chewing betel quid, a stimulant drug that's ingested like chewing tobacco and often mixed with tobacco

Oral cancer is more common in men, perhaps because men are more likely to use tobacco and alcohol than women. Oral cancer is also more common in adults over age 55, although this is changing as cancers related to HPV infection are increasing in number.

head and neck cancer: newly diagnosed cases
Illustration by Verywell

Diagnosis

Diagnosing oral cancer is a step-wise approach that often begins with a primary care doctor or dentist seeing an abnormality in your mouth or throat after performing a physical exam. In this case, or if you are experiencing one or more symptoms suspicious for oral cancer, your healthcare professional will refer you to someone who specializes in diseases of the mouth and throat, called an ear, nose, and throat (ENT) doctor.

The ENT doctor will perform a thorough head and neck exam, looking for all abnormal areas and/or enlarged lymph nodes. In order to best perform this exam, the ENT may use an endoscope (a flexible tube with a camera and light at the end). 

If suspicious areas are visualized during the exam, a tissue sample (called a biopsy) is removed. If cancer cells are found within the biopsy, the stage of the disease (how far cancer has spread) is then determined. Overall, staging is used to both determine proper treatment and help predict a person's prognosis or outlook.

Some of the tests involved in staging include:

  • HPV testing of the biopsy specimen
  • Magnetic resonance imaging (MRI)
  • Computed tomography (CT) scan of the neck and chest
  • Positron emission tomography (PET) scan 
  • Dental X-rays
  • Barium swallow (gastrointestinal series of X-rays of the esophagus and stomach)

Early stages of oral cancer, in the gums (gingiva) for example, manifest as a white patch or red sore. Stage 2 tumors are larger in size, growing past 2 centimeters. Stage 3 tumors touch on nearby lymph nodes, causing them to swell, and stage 4 tumors into several lymph nodes and other tissue.

Treatment

The treatment regimen you, your ENT doctor, and oncologist choose will depend on the stage and location of cancer, as well as your goals of care. It's wise to discuss all of the options in relation to your case.

Surgery

Surgery (performed by your ENT doctor) to remove cancerous tissue is usually the first method of treating oral cancer and is used most commonly for early-stage oral cancers. During surgery to remove cancer, lymph nodes in the neck may also be taken out since oral cancers commonly spread there. For some people, surgery is the only type of treatment needed; for others, chemotherapy and/or radiation may also be used. 

Radiation Therapy

Radiation therapy uses certain types of high energy beams of radiation to shrink tumors or eliminate cancer cells. Radiation therapy works by damaging a cancer cell's DNA, making it unable to multiply. 

Chemotherapy 

Chemotherapy may be given in lieu of surgery (usually combined with radiation therapy) to treat some oral cancers (called chemoradiation). It may also be given before surgery in order to decrease the size of a cancer (called neoadjuvant chemotherapy) or after surgery combined with radiation (called adjuvant chemoradiation) in order to eliminate any leftover cancer cells. For advanced cancers, chemotherapy may be used to slow tumor growth and ease symptoms. 

Targeted Therapy

The targeted therapy used to treat oral cancer is called Erbitux (cetuximab), and it works by zeroing in on a protein located on cancer cells called epidermal growth factor (EGFR). This protein helps cancers cells grow and duplicate, so by blocking it, cancer growth may be halted. Depending on the stage of the cancer, cetuximab may be combined with radiation or chemotherapy, or even used as a single agent. 

Supportive Therapy

Supportive therapy for oral cancer focuses on symptom management, like controlling pain and optimizing nutrition.

Coping

For many people, being diagnosed with and being treated for oral cancer causes some degree of psychological distress. This stems not only from the physical challenges of living with oral cancer (for example, fatigue, undergoing treatment, or difficulties with eating or drinking) but also the practical, everyday challenges of living with cancer (for example, managing employment or insurance issues or navigating relationships with family and friends).

The good news is that with proper coping strategies (ones that suit your unique needs), you and those close to you can get through the journey ahead. 

A Word From Verywell

The key to curing oral cancer is finding it early, which unfortunately does not happen in close to half of newly diagnosed cases. The good news, though, is that despite the lack of an official screening test or guideline, there is increasing awareness of oral cancer.

This has inspired many doctors and dentists to perform more detailed oral exams during routine appointments. Patients are encouraged, as well, to engage in periodic self-exams and be proactive about scheduling a prompt appointment when a symptom, like a new lump or sore in the mouth or throat, arises.

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Article Sources
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  • American Cancer Society. (2018). Treating Oral Cavity and Oropharyngeal Cancer.https://www.cancer.org/cancer/oral-cavity-and-oropharyngeal-cancer/treating.html
  • Centers for Disease Control and Prevention. (2016). The Link Between HPV and Cancer. www.cdc.gov/hpv/parents/cancer.html.
  • National Cancer Institute. (2017). Head and Neck Cancers. www.cancer.gov/types/head-and-neck/head-neck-fact-sheet.
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