Oral cancer (patient information)

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 * Assistant Editor-in-Chief: Alexandra M. Palmer

Overview
Oral cancer refers to cancers that develop on the tongue, oral mucosa (tissue lining the mouth and gums), and on the floor of the mouth. There are several types of oral lesions that have the potential to become cancerous. These include white lesions (leukoplakia), the most commonly diagnosed precancerous lesions in the mouth, and red, velvet-like lesions (erythroplakia). Of those lesions that become cancerous, about 90 percent are a type of tumor called squamous cell carcinoma.

What are the symptoms of Oral cancer?
Mucous membrane lesion, lump, or ulcer:
 * May be a deep, hard-edged crack in the tissue
 * Most often pale colored, may be dark or discolored
 * On the tongue, lip, or other mouth area
 * Usually painless at first (may develop a burning sensation or pain when the tumor is advanced)
 * Usually small

Additional symptoms that may be associated with this disease:
 * Abnormal taste in the mouth
 * Mouth sores
 * Swallowing difficulty
 * Tongue problems

What are the causes of Oral cancer?
Oral cancer most commonly involves the tissue of the lips or the tongue. It may also occur on the floor of the mouth, cheek lining, gums (gingiva), or roof of the mouth (palate).

Most oral cancers look very similar under the microscope and are called squamous cell carcinomas. These are malignant and tend to spread rapidly.

Smoking and other tobacco use are associated with 70 - 80% of oral cancer cases. Smoke and heat from cigarettes, cigars, and pipes irritate the mucous membranes of the mouth. Use of chewing tobacco or snuff causes irritation from direct contact with the mucous membranes. Heavy alcohol use is another activity associated with increased risk for oral cancer.

Other factors that increase the risk of oral cancer include poor dental and oral hygiene and chronic irritation (such as from rough teeth, dentures, or fillings). Some oral cancers begin as a white plaque (leukoplakia) or as a mouth ulcer. Recently, infection with HPV (human papilloma virus) has beeen shown to be a risk factor.

Oral cancer accounts for about 8% of all malignant growths. Men get oral cancer twice as often as women do, particularly men older than 40.

Who is at risk for Oral cancer?

 * Smokers
 * People infected with HPV
 * People who practice poor dental and oral hygiene

How to know you have Oral cancer?
An examination of the mouth by the health care provider or dentist shows a visible or palpable (can be felt) lesion of the lip, tongue, or other mouth area. As the tumor enlarges, it may become an ulcer and bleed. Speech difficulties, chewing problems, or swallowing difficulties may develop, particularly if the cancer is on the tongue.

A tongue biopsy, gum biopsy, and microscopic examination of the lesion confirm the diagnosis of oral cancer.

When to seek urgent medical care
Oral cancer may be discovered when the dentist performs a routine cleaning and examination.

Call for an appointment with your health care provider if you have a lesion of the mouth or lip or a lump in the neck that does not go away within 1 month. Early diagnosis and treatment of oral cancer greatly increases the chances of survival.

Treatment options
Surgical removal of the tumor is usually recommended if the tumor is small enough. Radiation therapy and chemotherapy would likely be used when the tumor is larger or has spread to lymph nodes in the neck. Surgery may be necessary for large tumors.

Rehabilitation may include speech therapy or other therapy to improve movement, chewing, swallowing, and speech.

Diseases with similar symptoms

 * Head and neck cancer
 * Laryngeal cancer
 * Thyroid cancer

Where to find medical care for Oral cancer
Directions to Hospitals Treating Oral cancer

Prevention of Oral cancer
You should have the soft tissue of the mouth examined once a year. Many oral cancers are discovered by routine dental examination.

Other tips:
 * Have dental problems corrected
 * Minimize or avoid alcohol use
 * Minimize or avoid smoking or other tobacco use
 * Practice good oral hygiene

What to expect (Outlook/Prognosis)
Approximately half of people with oral cancer will live more than 5 years after diagnosis and treatment. If the cancer is detected early, before it has spread to other tissues, the cure rate is nearly 75%. Unfortunately, more than half of oral cancers are advanced at the time the cancer is detected. Most have spread to the throat or neck.

Approximately 25% of people with oral cancer die because of delayed diagnosis and treatment.