If you’re experiencing symptoms in your mouth, such as a lump that won’t go away or sores that are painful, it can be worrisome.
Is it a minor oral problem or is it something more serious?
The head and neck cancer specialists at the OSUCCC – James are experts at identifying oral cancer, also known as mouth cancer, and will work to get an accurate diagnosis of what might be causing your troubling symptoms. If you or a loved one are diagnosed with oral cancer, our experts will walk with you every step of your personalized treatment plan and recovery.
Early detection of oral cancer is key to successful treatment outcomes. Your oral cancer care at the OSUCCC – James will be multidisciplinary, involving many specialties, and include the latest technologies and the most advanced tools to get you back to living and enjoying your life.
What is oral cancer?
Oral cancer occurs when malignant, abnormal, cells form in the mouth, or oral cavity. It’s the most common type of head and neck cancer. Parts of the mouth where oral cancer can develop include:
- Red part (inside) of lip
- Gums and teeth
- Front section of the tongue
- Roof of the mouth (hard palate)
- Floor of mouth, underneath the tongue
- Inner lining of the cheeks and lips (buccal mucosa)
- Area behind the wisdom teeth (retromolar trigone)
Cancers that develop in the oral cavity are usually squamous cell carcinomas. Tumors of the minor salivary glands in the mouth — like adenoid cystic carcinomas, mucoepidermoid carcinomas and sarcomas — are rarer.
Causes and risk factors of oral cancer
A risk factor for oral cancer is anything that increases your risk of developing it. Risk factors may be environmental, behavioral or genetic. While several risk factors are associated with oral cancer, tobacco use — cigarettes, pipes, cigars and chewing tobacco — is the leading cause of oral cancer.
Additional oral cancer risk factors include:
- Alcohol consumption
- Sun exposure (lip cancer)
Oral cancer is more often diagnosed in older adults, the majority of whom are males assigned at birth, but we’re increasingly seeing cases of oral cancer in younger people of unknown cause.
Not everyone with risk factors will develop the disease, but if you have any of the common risks listed above, you should consult with a lip and oral cavity cancer specialist.
Oral cancer prevention
Although there is no definitive way to prevent oral cancer, there are steps you can take to reduce your risk. This is especially important if you’re aware of a family history of oral cancer or a smoker.
The following steps may help to lower your risk of oral cancer:
- Use proper protection around hazardous chemicals
- Reduce alcohol consumption
- Don’t use tobacco or smoke
- Eat a healthy diet full of antioxidants and vitamins
Oral cancer symptoms
The signs and symptoms of oral cancer can vary based on the type, stage of cancer and precise location of the tumor. In the beginning stages, people may not have any noticeable symptoms, and instead, cancer is potentially discovered during a regular dental exam.
When symptoms do occur, they may begin as a small spot, lesion or ulcer that may or may not be painful but persists for two weeks or more. Additional symptoms of oral cancer may include:
- A lump or thickening on the lips, gums, mouth or neck
- A white or red patch on the gums, tongue, tonsils or lining of the mouth
- Bleeding from the lip, mouth, chin or cheek
- Pain or numbness in the lip, mouth, chin or cheek
- Loose teeth or dentures that no longer fit well
- Trouble chewing, swallowing or moving the tongue or jaw
- Sore throat or feeling that something is caught in the throat
- Swelling of the jaw or neck
- Change in voice
- Weight loss
Having these symptoms doesn’t necessarily mean you have cancer. But if you have one or a combination of these symptoms lasting more than a few weeks, you should talk to your doctor, dentist, or ear, nose and throat (ENT) specialist.
Diagnosis of oral cancer
Depending on your symptoms, our experts will do a physical exam to check overall health and look for signs of disease. We’ll also discuss health habits, past illnesses and treatments as well as perform a comprehensive exam of the lips, mouth, tongue, throat and neck.
After a thorough exam, your doctor may also recommend additional tests including:
- Endoscopy
- Magnetic resonance imaging (MRI) scan
- Computed tomography (CT) scan
- Positron emission tomography (PET) scan
- Incisional biopsy
- Pharyngoscopy
- Laryngoscopy
These tests may uncover an abnormal growth, mass or lesion, as well as alert your doctor to possible causes and help tailor your individualized treatment plan. The diagnostic tools can also be used to stage the cancer. Stage refers to the extent to which the disease has spread.
Oral cancer stages
The staging system most often used for oral cancer and other oropharyngeal cancers is the American Joint Committee on Cancer (AJCC) TNM system, which is based on three key pieces of information:
- The extent of the tumor (T): How large is the main (primary) tumor and which, if any, tissues of the oral cavity or oropharynx have been affected?
- The spread to nearby lymph nodes (N): Has cancer spread to nearby lymph nodes? If so, how many, are they on the same side where cancer started and how large are they?
- Metastasis to other areas of the body (M): Has cancer spread to distant organs such as the lungs?
Numbers or letters after T, N and M provide more details about each of these factors. Higher numbers indicate that a patient’s cancer is more advanced. Once a person’s T, N and M categories have been determined, this information is combined in a process called stage grouping to assign an overall stage.
The stages of oral cavity cancer are typically categorized as:
- Stage 0: There may not be a tumor yet, but abnormal cells have been found.
- T1: The tumor is 2 centimeters or less in size.
- T2: The tumor is at least 2 centimeters but isn’t larger than 4 centimeters in size.
- T3: The tumor is larger than 4 centimeters.
- T4: The tumor is invading the jaw, skin or deep tongue.
If a tumor invades deeply, it can be staged higher even though it is small. It’s important to remember that cancer staging can be complex, especially because every person and case of cancer is different, and it doesn’t always accurately predict the outlook of your cancer. Sometimes staging can change, too, depending on whether treatments work. Ask your doctor to explain stages and the staging process in a way that you understand.
Oral cancer treatment
As experts at one of the highest-volume cancer centers in the nation, the OSUCCC – James head and neck oncology team is exceptionally experienced in treating all forms of head and neck cancer, including the most complex and rarest tumors. These nationally and internationally recognized experts meet with you to discuss your specific cancer and its genetic makeup, as well as its location and stage.
We have various treatment options available, and we’ll determine the most effective course of treatment with the fewest side effects, preserving function and your quality of life. To accomplish this goal, you may receive one or a combination of the following therapies:
- Surgery
- Glossectomy (removal of all or part of tongue)
- Maxillectomy (removal of all or part of upper jawbone)
- Mandibulectomy (removal of part of lower jawbone)
- Neck dissection (removal of lymph nodes in neck)
- Sentinel lymph node biopsy (removal of select lymph nodes in neck)
- Reconstruction of defect
- Chemotherapy
- Radiation therapy
- External beam radiation therapy (EBRT)
- Internal radiation (brachytherapy)
- Proton therapy
- Immunotherapy or targeted drug therapy
- Cetuximab (Erbitux™), a targeted cancer drug
- Nivolumab (Opdivo™), an immunotherapy drug
- Pembrolizumab (Keytruda™), an immunotherapy drug
- Oral cancer clinical trials