Oral Cancer: Symptoms, Causes, and Treatment

Oral cancer, or mouth cancer, manifest as a growth or sore in the mouth that does not go away. It can occur anywhere in the mouth, on the surface of the tongue, inside the cheeks, on the lips, in the gums, on the roof or floor of the mouth, in the tonsils, in the salivary glands, or in the throat. It can be life threatening if not diagnosed and treated early.

It is estimated that 10,860 deaths (7,970 men and 2,890 women) from oral or oropharyngeal cancer will occur this year. The overall 5-year survival rate for people with these two diseases is 65%.

Early detection is key for better treatment outcomes. When diagnosed early the overall 5-year survival rate is 84%

What are the symptoms of oral cancer?

There are often no signs or symptoms in the early stages. Smokers and heavy drinkers are advised to have regular checkups with the dentist because they may be able to identify early signs.

The common symptoms for oral cancer include the following:

• Red and/or white patches in the mouth
• Swelling or thickening, lumps or bumps, rough spots or eroded area on the lips, gums, or other areas inside the mouth
• Unexplained pain, tenderness, or numbness in the mouth, lips, face, or neck
• Unexplained bleeding in the mouth
• Sores or irritation that doesn’t heal within 2 weeks
• Difficulty moving the jaw or tongue
• Soreness in the throat or a feeling that something is caught in the back of the throat
• Hoarseness, chronic sore throat, or change in voice
• Difficulty chewing, swallowing, or speaking
• A change in the way your bite feels
• Ear ache
• Dramatic weight loss

If you’ve been feeling any of these symptoms, especially if it has been going on for 2 weeks or more, let your dentist know as soon as possible. They will help you find out what’s going on, or direct you to the right specialist who can.

Remember that early detection is essential for better treatment outcomes.

Who get oral cancer? What are the risk factors?

According to the American Cancer Society, men are twice as likely to develop oral cancer than women. The average age of diagnosis is 62. Only about 25 percent of cases occur in people younger than 55.

A risk factor is anything that increases a person’s chance of developing cancer. The risk of developing oral cancer is greatly increased by two factors.

• Tobacco use – Using tobacco is the single largest risk factor for head and neck cancer. 85 percent of head and neck cancer is linked to tobacco use. Pipe smoking has been linked to cancer in the part of the lips that touch the pipe stem.
• Chewing tobacco or snuff is associated with a 50% increase in the risk of developing cancer in the cheeks, gums, and inner surface of the lips, where the tobacco has the most contact.

• Alcohol – Frequent and heavy consumption of alcohol increases the risk of head and neck cancer. Using alcohol and tobacco together increases this risk even more.

It is important to note that over 25% of all oral cancers occur in people who do not smoke and who only drink alcohol occasionally.

The Human papillomavirus (HPV) has been associated with throat cancers.

It is important to remember that statistics on the survival rates for people with oral and oropharyngeal cancer are an estimate. The estimate comes from annual data based on the number of people with these cancers in the United States. Also, experts measure the survival statistics every 5 years. So the estimate may not show the results of better diagnosis or treatment available for less than 5 years. Talk with your doctor if you have any questions about this information. ~ from cancer.net, approved by the Cancer.Net Editorial Board

How can my dentist detect oral cancer?

If you smoke or drink heavily, it is recommended that you get examined for oral cancer routinely for early detection. But even if you do not drink or smoke, routine checkups can help detect cancer early.

The following tests may be used to diagnose oral cancer:

Physical examination – Often, dentists and doctors find lip and mouth cancers during routine checkups. If they find signs of cancer, they will take a complete medical history. They will evaluate the patient’s symptoms and risk factors. They will feel for any lumps on the neck, lips, gums, cheeks. They will also examine the sinus behind the nose, and even the throat.

This will help them determine if the patient is at risk. If they find something suspicious, they may order more tests such as an endoscopy.

They will also have you come back for a follow up examination to see if any lesion has changed in size, shape, and color.

Endoscopy – An endoscopy will help the doctor see the inside of the mouth and throat. If an area is suspicious, the doctor will take a biopsy.

X-ray – An x-ray may be recommended to look for abnormal findings in the mouth or neck.

Barium swallow / modified barium swallow – This will help check for abnormalities in a patient’s swallowing. During an x-ray exam, the patient is asked to swallow liquid barium. The doctor will then be able to see any changes in the structure of the mouth and throat. The modified barium swallow is used to evaluate difficulties with swallowing.

Biopsy – A biopsy is when a small amount of tissue is removed so it can be examined under a microscope. Other tests can only suggest the presence of cancer. A biopsy can make a definite diagnosis of cancer.

Oral brush biopsy – Some dentists use a newer and simple technique to detect oral cancer. It involves using a small brush to gather the cell samples of a suspicious area. The specimen is then sent to the laboratory for thorough examination and analysis. This procedure is done in the dentist’s chair with little or no pain to the patient. If cancer is found using this method, a traditional biopsy is still recommended to confirm the results. However, if there is no cancer found in this way, the patient did not and will not have to go through the traditional biopsy procedure.

HPV testing – HPV testing may be done on a sample of the tumor removed during the biopsy. Since HPV has been linked to a higher risk of oropharyngeal cancer, knowing if a person has HPV can help with the diagnosis.

Computed tomography (CT or CAT) scan, Magnetic resonance imaging (MRI), Ultrasound, Positron emission tomography (PET) or PET-CT scan – All of these create pictures or images of organs and tissues inside the body. It can help detect tumors. And also help determine if a tumor can be removed safely.

After diagnostic tests are done, your doctor will review all of the results with you. If the diagnosis is cancer, the results from these tests can also help the doctor describe what stage the cancer is in.

How can I prevent oral cancer?

There is no proven way to prevent this type of cancer yet. Routine checkups help with early detection, but it does not help with prevention.

However, there are ways you can lower your risk of developing this disease.

For instance, you can quit drinking alcohol heavily or practice drinking moderately.

Stopping the use of tobacco is very important if you want to reduce your risk of developing oral cancer.

Reducing the risk of HPV infection is also important. You can do this by limiting your number of sexual partners because having many partners increases the risk of HPV infection. It is worth noting that using a condom does not fully protect you from HPV during sex. An HPV vaccination before exposure to the virus can reduce your risk as well. Today, the Centers for Disease Control and Prevention (CDC) recommends HPV vaccination for all preteen boys and girls.

If you have had oral cancer before, you may be more likely to develop it again. So regular visits to the dentist is important to monitor a recurrence.

Talk to your doctor about your risks of developing this disease and how you can lower your risk.

About Dr. Steven Paul, MD, DDS

Dr. Paul is a member of the American Association of Oral & Maxillofacial Surgeons.

He has devoted his profession to all aspects of Oral Surgery with special interests in the treatment and restoration of missing teeth through dental implant procedures including advanced techniques in full mouth rehabilitation (All on 4), bone and soft tissue grafting, restoring both function and aesthetics, as well as extraction of wisdom teeth and associated cysts and tumors of the oral cavity. All this done through anesthetic techniques specific for each individual patient.

NOTE: This article is intended to promote understanding of, and general knowledge about oral cancer. It is not intended to be a substitute for professional advice, diagnosis or treatment. Always seek the advice of your dental care specialist or other qualified healthcare provider with any questions you may have regarding a medical condition or treatment.