What are Oral & Lip Cancers?
The Oral Cavity is comprised of several parts:
- Front two thirds of the tongue
- Gingiva (gums)
- Buccal mucosa (the lining of the inside of the cheeks)
- Floor (bottom) of the mouth under the tongue
- Hard palate (the roof of the mouth)
- Retromolar trigone (the small area behind the wisdom teeth)
The oral cavity helps you to breathe, talk, eat, chew, and swallow. Minor salivary glands located throughout the oropharynx make saliva that keeps your mouth moist and helps you digest food. And, it is composed of several types of body tissues, which are made up of several types of cells.
Oral cavity cancer starts and develops in the mouth.
Squamous Cell Carcinomas
More than 90% of oral cavity cancers are squamous cell carcinomas, also called squamous cell cancers. Squamous cells are flat, scale-like cells that normally form the lining of the mouth and throat. Squamous cell cancer begins as a collection of abnormal squamous cells.
The earliest form of squamous cell cancer is called carcinoma in situ, meaning that the cancer cells are present only in the outer layer of cells called the epithelium. This is different from invasive squamous cell carcinoma, where the cancer cells have grown into deeper layers of the mouth.
Anything that increases your risk of getting a disease is called a risk factor. Having a risk factor does not mean that you will get cancer; not having risk factors doesn't mean that you will not get cancer. People who think they may be at risk should discuss this with their doctor.
Risk factors for lip and oral cavity cancer include the following:
- Using tobacco products
- Heavy alcohol use
- Being exposed to natural sunlight or artificial sunlight (such as from tanning beds) over long periods of time
- Being infected with human papillomavirus (HPV)
Signs and Symptoms
These and other symptoms may be caused by lip and oral cavity cancer. Other conditions may cause the same symptoms. A doctor should be consulted if any of the following problems occur:
- A sore on the lip or in the mouth that does not heal
- A lump or thickening on the lips or gums or in the mouth
- A white or red patch on the gums, tongue, tonsils, or lining of the mouth
- Bleeding, pain, or numbness in the lip or mouth
- Change in voice
- Loose teeth or dentures that no longer fit well
- Trouble chewing or swallowing or moving the tongue or jaw
- Swelling of jaw
- Sore throat or feeling that something is caught in the throat
Lip and oral cavity cancer may not have any symptoms and is sometimes found during a regular dental exam.
If a patient has symptoms that could indicate oral cavity cancer, the doctor will test for fever and high blood pressure and check general signs of health. The patient will likely have one or more of the following tests:
An exam to check the lips and oral cavity for abnormal areas. The doctor or dentist will feel the entire inside of the mouth with a gloved finger and examine the oral cavity with a small long-handled mirror and lights. This will include checking the insides of the cheeks and lips; the gums; the roof and floor of the mouth; and the top, bottom, and sides of the tongue. The neck will be felt for swollen lymph nodes. A history of the patient’s health habits and past illnesses and medical and dental treatments will also be taken.
A procedure to look at organs and tissues inside the body to check for abnormal areas. An endoscope is inserted through an incision (cut) in the skin or the mouth.
X-Rays of the Head, Neck, and Chest
An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.
The removal of cells or tissues so they can be viewed under a microscope by a pathologist. If leukoplakia is found, cells taken from the patches are also checked under the microscope for signs of cancer.
A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body.
A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly.
A procedure to collect cells from the lip or oral cavity. A piece of cotton, a brush, or a small wooden stick is used to gently scrape cells from the lips, tongue, mouth, or throat. The cells are viewed under a microscope to find out if they are abnormal.
A series of x-rays of the esophagus and stomach. The patient drinks a liquid that contains barium (a silver-white metallic compound). The liquid coats the esophagus and x-rays are taken. This procedure is also called an Upper GI Series.
A procedure to find malignant tumor cells in the body. A small amount of radionuclide glucose (sugar) is injected into a vein. The PET scanner rotates around the body and makes a picture of where glucose is being used in the body. Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells.
If oral cavity cancer is diagnosed, the doctor needs to know the stage, or extent, of the disease to plan the best treatment. Staging is a careful attempt to find out whether the cancer has spread, and if so, to what parts of the body.
Stages of Oral Cancer
The most common system used to describe the extent of oral cavity cancers is the TNM System of the American Joint Committee on Cancer (AJCC). The TNM system for staging describes three key pieces of information:
T - Indicates the size of the primary tumor and which, if any, tissues of the oral cavity or oropharynx it has spread to
N - Describes the extent of spread to nearby lymph nodes.
M - Indicates whether the cancer has metastasized to other organs of the body. (The most common site of spread is to the lungs. The next most common sites are the liver and bones.)
Numbers or letters appear after T, N, and M to provide details about each of these factors. The numbers 0 through 4 indicate increasing severity. The letter X means "cannot be assessed" because the information is not available.
Different types of treatment are available for patients with oral cavity cancer. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. (A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer)
Your treatment options depend on the stage of cancer, your overall health and your preferences about treatment. In metastatic disease, the location and extent of the oral cavity cancer is also an important consideration.
You do not have to rush to make a decision, so consider the options carefully. Ask questions if you do not understand any aspect of treatment or the terms your doctors are using. Research shows that cancer survivors of all educational levels and backgrounds can have a hard time communicating with their health care team. One of the best ways to improve communication with your health care team is to prepare your visits so that you can best make use of the time.
A treatment plan is a way to deal with both the short and long term goals of managing your oral cavity cancer. There are different treatment options depending on the cancer stage and the patient’s age and general health. Patients have time for second opinions and to talk through all of their options with their doctors and develop a treatment plan that best fits their needs.