Oral Cancer

The most common type of cancer occurring in the head and neck is squamous cell carcinoma. This tumor makes up the vast majority of cancers that occur in the mouth and when oral cancer is referred to, it is generally synonymous with squamous cell carcinoma.

Oral cancer is more common that many people realize. It is estimated that about 21,000 cases occur each year in the United States, and that does not include cases that involve the pharynx or larynx. The percentage of patients that are cured has only improved a small amount over the years, and that is probably due to the fact that many patients have their cancer diagnosed only after it has reached an advanced stage. Patients who are diagnosed in an early stage generally have a good prognosis, and efforts are needed to identify these problems early.

Oral cancer has few symptoms in the early stages. This makes it difficult to detect. Early signs include ulcers present for more than 2 weeks that are not healing, loosening teeth, difficulty with speech or swallowing, pain the radiates to the ear, or change in a prior white patch. Later stages of disease are usually associated with increased pain and occasional bleeding.

The course of this disease follows a relatively predictable pattern in many cases. The tumor starts in the lining of the mouth and grows relatively slowly. At some time, when it has reached a certain size or depth of invasion, it may spread to a local lymph node in the neck. It may then spread to more lymph nodes, and then to other places in the body – particularly the lungs, liver, and bone.

There are several known risk factors for this cancer. Tobacco and alcohol use, particularly when they are combined, are strong risk factors. Certain viral infections (HPV – Human Papilloma Virus) may play a role, particularly in cancers of the naso-pharynx. Chronic fungal infection and perhaps chronic irritation from poorly fitting prostheses may also have a role. There are patients who develop this cancer who do not have any know risk factors, and research is ongoing to understand the role that different genes play.

Diagnosis of oral cancer is made by a biopsy of a suspicious lesion. Staging is then done by evaluating the size of the cancer, involvement of any lymph nodes, and evaluation of any distant metastasis. Endoscopy may be done to completely evaluate the tongue base, larynx, bronchi, and esophagus to define the exact extent of the cancer and rule out any other lesions. A CT scan is usually done of the neck to further evaluate the lymph nodes. Blood work and chest X-ray are also standard. A PET (positron emission tomography) scan may be considered in certain circumstances, but this isn’t a standard test at the current time.

When staging of the cancer is complete, recommendations can be made on the treatment options. In general, early stage tumors require only one form of treatment –either surgery or radiation. Your doctor will discuss the risks and benefits of each to help you make the right decision in your case. Advanced tumors generally require both surgery and radiation to obtain the best chances for cure. Tumors that can’t be surgically removed, or when such surgery would cause unacceptable loss of function, radiation combined with chemotherapy is frequently the treatment chosen. It is important that every case has its own unique circumstances, so treatment decisions in any one case will be reached after carefully discussing all the options available. Consultations with a radiation oncologist and medical oncologist may be obtained.

Treatment of this cancer has the potential to affect a person’s ability to swallow, speak normally, and can result in facial deformity. These issues will be addressed carefully in the treatment decision process. Procedures to reconstruct the tissues affected by the cancer can help minimize these problems. Please refer to that section of the website for more details. When swallowing problems are anticipated, a feeding tube may be recommended. The most frequently used feeding tube is called a PEG (percutaneous endoscopic gastrostomy). This is a tube that is placed through the skin of the upper abdomen into the stomach. It is relatively convenient and easy to use, and is out of sight. It can be removed when no longer needed. Tracheotomy is another procedure that is considered in certain cases. When swelling of the tongue, breathing, or swallowing difficulties are anticipated, it can help speed recovery. In many cases where tracheotomy is needed, it is temporary, although some patients may require it for longer periods.

The treatment for oral cancer is often complicated and may occur over a period of time. It is important to understand that there are many resources available to help you or your family member through a potentially difficult time. If you have any concerns, please ask a member of your health care team here at Tri-County Oral-Facial Surgeons. There are programs and support available through the cancer center at our hospital and through the American Cancer Society.