About 34,000 people are diagnosed with cancers of the mouth and oropharynx in the United States each year. Oral cancers are much more common in other countries, especially Hungary and France, and some 480,000 cases are diagnosed annually worldwide. Almost all oral cancers occur in squamous cells, which line the mouth and oropharynx. These are called squamous cell carcinomas.
Mouth cancer occurs most commonly in the tongue, the floor of the mouth and the lips. It can also begin in the gums, teeth, salivary glands, the lining of the lips and cheeks, the roof of the mouth and behind the wisdom teeth.
Oropharynx cancer, also known as oropharyngeal cancer, starts in the area just behind the mouth (oropharynx), but can also occur in the back of the tongue, the back of the mouth and the uvula, the tonsils and the back and side walls of the throat.
More than half of patients are diagnosed after the cancer has spread to other areas of the body. The chances of successful treatment of oral cancers are highest when it is found early.
Many of the oral cancer symptoms may be caused by other problems that are not dangerous. But since early detection is important for successful treatment of oral cancer, see your doctor or dentist if you notice abnormal areas in the mouth or throat or other symptoms.
Leukoplakia is a white area or spot in the oral cavity. About 25% of leukoplakias are cancerous or precancerous.
Erythroplakia is a red, raised area or spot that bleeds if scraped. About 70% of erythroplakias are cancerous or precancerous.
Erythroleukoplakia is a spot with both red and white areas.
Other oral cancer symptoms include:
Although the exact causes of oral cancers are unknown, alcohol and tobacco use are major risk factors. Recently, the human papillomavirus has been found to cause cancers of the tonsil and the back portion of the tongue.
Ninety percent of people with mouth and oropharynx cancer use tobacco in some form. The risk increases with the length of the habit and the amount of tobacco used.
Specifically, pipe smoking increases the risk for cancer of the lip and the soft palate. People who use chewing tobacco or snuff are more likely to develop cancer of the gums, cheek and lips. Living with a smoker or working in a smoking environment can cause secondhand or passive smoking, which may also increase risk.
About 80% of people with oral cancers are heavy drinkers, consuming more than 21 alcoholic drinks each week. People who drink alcohol and smoke are six times as likely to get mouth and oropharynx cancer as people who do not drink. The combination of tobacco and alcohol is particularly dangerous.
Other risk factors include:
Your doctor or dentist will examine the tongue, roof of the mouth, back of the throat and the insides of the cheeks and lips. The floor of the mouth and the lymph nodes will also be examined.
Any abnormalities are discovered during the exam, it is typical for a small tissue sample, or biopsy, to be taken. A pathologist will examine the tissue sample under a microscope to check for cancer cells. This biopsy is important, as it is the only sure way to know if the abnormal area is cancerous.
If the biopsy indicates the presence of cancer, the next step is to determine the stage (extent) of the disease, in order for the doctor to plan the most suitable treatment. Staging also provides information about the prognosis (expected outcome) of your cancer. Tumor stage is determined by the size of the primary tumor, how much it has invaded the tissues and whether the cancer has spread to lymph nodes.
Stage 0: Abnormal cells are found in the lining of the lips and oral cavity. These abnormal cells may become cancer and spread into nearby normal tissue. Stage 0 is also called carcinoma in situ.
Stage I: Cancer has formed and the tumor is two centimeters or smaller. Cancer has not spread to the lymph nodes.
Stage II: The tumor is larger than two centimeters but not larger than four centimeters, and cancer has not spread to the lymph nodes.
Stage III: The tumor may be any size and has spread to a single lymph node that is three centimeters or smaller, on the same side of the neck as the cancer. Or, the tumor is larger than four centimeters.
Stage IVA: The tumor has spread to nearby tissues in the lip and oral cavity. Or, the cancer has spread to one or more lymph nodes on one or both sides of the neck, and the involved lymph nodes are six centimeters or smaller.
Stage IVB: The tumor may be any size and has spread to one or more lymph nodes that are larger than six centimeters. Or, the tumor has spread to the muscles or bones in the oral cavity, or to the base of the skull and/or the carotid artery. Cancer may have spread to one or more lymph nodes on one or both sides of the neck.
Stage IVC: The tumor has spread beyond the lip and oral cavity to other parts of the body. The tumor may be any size and may have spread to the lymph nodes.
Because the mouth and throat are crucial components of eating, breathing and talking, oral cancer treatment and rehabilitation requires a team of healthcare professionals, led by a doctor who specializes in treating oral cancers. Team members may include speech pathologists, dieticians and plastic surgeons, working together to restore physical function as much as possible.
Surgery is the most common treatment for oral cancer. The type of surgery depends on the type and stage of the tumor. Multiple surgeries may be necessary to treat the cancer and restore physical function and appearance. Even if the surgeon removes all the cancer, some patients may need additional treatment to increase the chance of successful outcomes, which may include chemotherapy or radiation therapy.
There are several surgical techniques to treat mouth and oropharynx cancer:
In cancer of the mouth and oropharynx, radiation therapy may be used alone to treat small to intermediate-stage tumors or to kill remaining cancer cells after surgery, or it may be combined with chemotherapy for advanced tumors. The method of radiation treatment used depends on the type and stage of cancer.
External radiation therapy is the most common procedure to treat cancers of the mouth and oropharynx. Known as intensity-modulated radiotherapy (IMRT), these highly focused beams treat the tumor while sparing salivary gland tissue, with the goal of sparing saliva production.
Internal radiation or brachytherapy delivers radiation with tiny seeds, needles or tubes that are implanted into the tumor. After the implants are in place, patients remain in the hospital for several days with limited human contact. The implants will be removed before the patient leaves the hospital.
Chemotherapy may be used to shrink the cancer before surgery or radiation, or it may be combined with radiation to increase the effectiveness of both treatments. Chemotherapy may also be used to shrink tumors that cannot be surgically removed. The most commonly used drugs in mouth and oropharynx cancer are cisplatin and 5-fluorouracil. Carboplatin and paclitaxel are also used in combination.
Tumor Growth Factors
New research on growth factors shows promise in the treatment of mouth and oropharynx cancer. Growth factors are hormone-like substances that occur naturally in the body and cause cell growth. An epidermal growth factor (EGF) receptor on the surface of some mouth and oropharynx cancer cells can bind to certain substances that stimulate tumor growth. New drugs are being tested that target EGF receptors and may stop cancer cells from growing.
Cancer is a journey that no one needs to take alone. There are many forms of support to help you through every stage: diagnosis, treatment and survivorship. Whether you meet with other cancer survivors like yourself, use complementary therapies or individual coping mechanisms, help is available in many forms. Listed below are just some of the ways to find help...and hope.
Getting together with other cancer patients in a support group is a valuable coping tool. Support groups are usually focused on a single disease or topic, such as breast cancer survivors or people coping with life-changing side effects from their cancer or cancer therapy. These groups allow participants to meet others like themselves and seek strength from each other. Most major cities and cancer hospitals offer support groups that meet weekly or monthly. There are also dozens of online support web sites or message boards for those who may not have access to a traditional meeting.
Complementary therapies are used in conjunction with cancer treatment, in an effort to reduce treatment side effects, ease depression and anxiety and help cancer patients take their mind off the negative aspects of their situation. Complementary therapies may include mind-body exercises like yoga, tai chi and Qi gong; visualization or guided imagery; using art or music as therapy and self-expression and traditional Eastern medicine such as acupuncture.
Staying physically active as much as possible during cancer treatment has many positive benefits. Physical activity stimulates the release of endorphins, a hormone that helps elevate mood, as well as decreasing feelings of fatigue.
Exercises for cancer patients can range from simple stretches done in the bed or chair, to more active pursuits such as walking or light gardening work. However, it’s important not to push yourself too hard. Check with your doctor before attempting any physical activity to make sure you are up to it.
Many people find it helpful to keep a journal of their cancer treatment experience. It may be as simple as recording symptoms and side effects into a notebook, or may include personal emotions and opinions about what they may be going through. Journals can be private, like a diary, or shared with loved ones and even strangers.
Increasingly, people are turning to the Internet to share their cancer journey with the world at large and to seek out others with similar experiences. Many cancer patients have begun their own web log, or “blog” to publicize their battle with cancer. Twitter, a mini-blogging technology that limits posts to 140 characters, has also proven to be a helpful tool for cancer patients to keep friends updated and reach out to others.