oral cancer Images (Click to view larger image)
squamous cell cancer of the oral cavity, mouth and throat cancer
Oral cancer is cells that invade and destroy normal tissue cells on the lips and in the mouth and upper throat.
What is going on in the body?
Oral cancer occurs in the top layer of cells lining the mouth and upper throat. The lip, tongue, floor or roof of the mouth, inside of the cheeks, tonsils, and upper throat may be affected. This cancer can start as a sore that is not yet cancerous. Over time, probably years, it can develop into a type of cancer that can spread to other parts of the body through the lymph system and bloodstream.
Oral cancers can grow outward as a wart-like mass. Or they can be ulcers that invade inwardly. The longer that oral cancers are allowed to grow untreated, the more likely they are to spread throughout the body.
What are the signs and symptoms of the disease?
Oral cancer symptoms can include:
What are the causes and risks of the disease?
- a painful or painless growing mass that usually is easily seen when the area is examined
- an ulcer that does not heal
- bleeding or numbness
- difficulty swallowing
- limited tongue movement and speech difficulties
- loose teeth or ill-fitting dentures
- changes in taste or tongue sensation
- a painful, enlarged lymph node in the neck
There are several exposures, lifestyle choices, or other problems can increase a person's risk of developing oral cancer. A person is at risk of developing oral cancer as he or she ages. This risk increases if he or she:
In addition, mouthwashes with high alcohol content, herpes simplex, and the human papilloma virus, or HPV,are being studied for their relationship to oral cancers.
- exposes skin, especially the lips, to the sun
- uses tobacco
- uses alcohol
- has a poor diet
- chronically irritates the mouth and upper throat
- has poor dental hygiene and gum disease
What can be done to prevent the disease?
Avoiding common cancer-causing substances, such as tobacco, can help prevent this disease. The cure rate is highest when sores are diagnosed and treated as early as possible.
How is the disease diagnosed?
To diagnose oral cancer, a sample of tissue is taken from any suspicious mass that can be seen or felt. The tissue sample is sent to a laboratory to be checked for cancer. If cancer is found, the person will need other tests, such as chest and jaw X-rays and, possibly, a CT scan of the neck and entire area that could be affected by oral cancer.
Oral cancers are graded as poorly or well differentiated, a process that looks at the types of cancer cells in the skin lesions. Also taken into account is:
Oral cancer is found in most people before it has spread to distant parts of the body.
- the size of the initial lesion
- any evidence that cancer cells have spread to nearby areas
- whether or not cancer has spread to nearby lymph nodes
What are the long-term effects of the disease?
Early cancers can be cured. In some people, this type of cancer does return. They are also at risk for developing a second oral cancer in the future due to earlier exposure to cancer-causing substances. Oral cancer that spreads to aggressive local neck disease can cause death. Rarely, death occurs from tumours that have developed in distant parts of the body.
What are the risks to others?
Oral cancer is not contagious.
What are the treatments for the disease?
Treatment of oral cancer is complicated and may vary from person to person. It depends upon the size and location of the cancer. The doctor will consider which option will be least disfiguring, yet most likely to stop the cancer.
Very small sores can be removed or treated with radiation. It is unlikely that the cancer will return.
Somewhat larger sores can be treated with surgery or radiation.
If sores are bigger than 2 centimetres and cancer cells have spread to other tissues of the face and jaw or the lymph nodes, surgery, and radiation are required.
In some cases, chemotherapy is used to shrink a locally invasive sore before surgery. This is somewhat controversial and experimental.
Unless a sore is very small, people are usually treated with surgery followed by radiation. Larger sores require extensive removal of lymph nodes on the same side as the tumour.
Chemotherapy drugs that have been used include flurouracil (5-FU), cisplatin, methotrexate, and doxorubicin. At times these drugs are coupled with radiation.
What are the side effects of the treatments?
Surgeons try to minimise deformity and loss of function. Sometimes, in an effort to cure a person, it is difficult to achieve these goals. Surgeons need to remove about 1 to 2 centimetres of cancer-free tissue around the sore in people who may be cured. This can result in lip deformity, scarring or loss of tongue function, difficulty swallowing, scarring of the neck, and difficulty with wound healing.
Radiation to this area will cause:
People who receive neck and throat radiation need to have all of their teeth removed. Teeth cannot survive this treatment and dentures are required.
- loss of salivary gland function and chronic dry mouth
- increased risk of mouth infections
- secondary cancers
- a change in the colour of the skin
Chemotherapy is toxic medication. Its side effects include:
Some people may have difficulty with chewing and swallowing and require feeding through a stomach tube.
- a increased need for transfusions
- hair loss
- irritation of the oesophagus and throat
What happens after treatment for the disease?
People who had had oral cancer must be closely followed to make sure the cancer does not return. The person should also be monitored to make sure no new oral cancers occur. If the person has wide spread disease, careful follow-up will be necessary to make sure supportive care is effective.
How is the disease monitored?
A person is carefully monitored to be sure he or she can eat and that he or she is getting the nutrients the body need. Artificial saliva or salivary stimulation pills may be helpful.
This person will also need frequent mouth examinations to ensure that oral cancer does not return. There may need to be periodic endoscopy. This person will remain at risk for developing other cancers. Chest X-rays and CT scanning may be done to determine whether cancer has spread or developed in other parts of the body.
Author: Thomas Fisher, MD
Reviewer: HealthAnswers Australia Medical Review Panel
Editor: Dr David Taylor, Chief Medical Officer HealthAnswers Australia
Last Updated: 1/10/2001
Potential conflict of interest information for reviewers available on request