Oral Cancer

Definition

Oral cancer is cancer of the mouth and oropharynx.

Description

Oral cancer also may be called oral and oropharyngeal cancer to include the oropharynx region. Oral cancer can occur in the oropharynx or the oral cavity. The oral cavity is the area that includes the lining of the lips and cheeks, the hard palate, the floor of the mouth, the teeth, gums, the bony roof of the mouth, the area behind the wisdom teeth and the front two-thirds of the tongue. The oropharynx includes the tonsils, soft palate, back of the throat, and the back one-third of the tongue.

Oral cancer results from changes to cells that occur in these tissues of the mouth. But not every change or tumor that develops is oral cancer. Some changes that occur are benign, or noncancerous. They don't invade other tissues. And some changes are cancer, but they begin in other parts of the throat, such as the larynx, or voice box. This is laryngeal cancer, not oral and oropharyngeal cancer.

Demographics

More than 34,000 people were diagnosed with oral cancer in 2007 and about 7,550 people in the United States died from the disease. A study in 2008 showed that the incidence of oral cancer on the rise, particularly in younger men. Risk of oral cancer increases as people get older. Many people with oral cancer use tobacco products and about 70% of those also have reported heavy drinking. The median age at diagnosis of the disease between 2000 and 2004 was 62 years. The median age for those who died from the disease was 68. Worldwide, more than 400,000 new cases of oral cancer are diagnosed each year.

Causes and symptoms

Smoking and drinking alcohol are two of the biggest causes of oral cancer. As many as 90% of people with oral cancer use tobacco. Although cigarette smoking is a big factor for oral cancer, as well as for many other cancers, other types of tobacco use can lead to oral cancer. Tobacco smoke from cigars and pipes also can cause cancer in the mouth and throat, as well as in the voice box, lungs, and other organs. Pipe smoking is particularly risky for cancers of the lips, where the lips touch the pipe stem. Chewing tobacco and snuff products are known to cause cancer of the cheek, gums, and insides of the lips. A dip of chewing tobacco can contain up to five times more nicotine than one cigarette and as many as 28 times the carcinogens. People who use snuff for a long period of time are at particularly high risk.

Drinking alcohol increased a smoker's risk of developing oral cancer if the person is a heavy drinker. The American Cancer Society reports that some studies have shown that heavy drinkers and smokers have as much as a 100-fold risk of developing oral cavity and oropharyngeal cancers as people who do not smoke or drink. Frequent exposure to the sun also can cause lip cancer.

Oral cancers may be found early if a person routinely checks his or her mouth for signs or if a doctor, dentist, or dental hygienist notices something wrong. Symptoms of oral cancer include:

• a sore in the mouth that doesn't heal in about 2 weeks
• white or red patches in the mouth
• lumps or thickening in the cheek
• a feeling that something is caught in the throat or a sore throat that won't go away
• painful swallowing
• voice changes
• bad breath that persists
• loose teeth
• numbness of the tongue or in other area of the mouth
• difficulty moving the tongue or jaw

These types of symptoms don't always indicate oral cancer, but they may be signs of the disease and any that persist for more than a few weeks should be checked by a dentist or physician right away.

Diagnosis

As with any cancer, early detection is important. Regular routine examination is key. Seniors should conduct self-examinations, checking their mouths for the symptoms listed above. Regular visits to a dentist provide the chance for dental hygienists and dentists to note any of the symptoms as well. A physician also may notice an early sign in a regular physical check-up.

An oral cancer examination is relatively quick and painless. Removal of dentures or partials may be required so that the health care provider can see all areas of the mouth and gums. The health care provider will feel the jaw and neck area to check for possible lumps and carefully look at the mouth, face, and lips to check for any signs of cancer. He or she also will look at and feel the insides of the cheeks and lips to check for sores or other signs of oral cancer. A thorough examination also includes a check of the tongue, base of the tongue, floor and roof of the mouth, and the throat. In addition to checking for lumps and hard masses, a health care provider is trained to recognize swollen lymph nodes in the neck.

After taking a patient's medical history and performing a head and neck examination, if a health care provider suspects oral cancer, he or she may order one of several tests, including those listed below.

Special otolaryngology exams

Often, a health care provider will refer a patient to a physician who specializes in oral cancers. The specialist might be identified by one of several names and subspecialties, such as oral and maxillofacial surgeon, head and neck surgeon, otolaryngologist, or ear, nose, and throat doctor. This specialist is trained in the diseases of the head and neck area. He or she can use small mirrors or small fiberoptic tubes that can be inserted through the mouth or nose to observe areas deep within the throat and neck. These procedures are called indirect or direct pharyngoscopy and laryngoscopy, depending on the area the physician observes and the tools used.

A procedure called panendoscopy is used if suspicion of oral cancer is high. The physician uses endoscopes to look at all the areas of the mouth, throat, oropharynx, larynx, esophagus, and passageways to the lungs. It is usually performed under general anesthesia . If the physician finds a tumor, a biopsy of the tissue will be taken at that time.

Imaging examinations

Imaging examinations may be used to help determine if there is a possibility of cancer, and once oral cancer is diagnosed by biopsy, imaging examinations can help physicians determine the stage of the cancer. Dental x-rays can provide early clues about problems in the mouth or throat. Chest x-rays might offer clues concerning the spread of oral cancer. An upper GI series with barium contrast can be used to help determine if oral cancer has spread to the digestive tract. Computed tomography (CT) scans provide detailed, cross-sectional views of organs and tissues. They can provide good images of lymph nodes and other tissues or help determine cancer spread. Magnetic resonance imaging examinations do not use radiation, but take a long time to complete. They are not often used for oral cancer diagnosis and staging. New devices combine CT scanning and positron emission tomography (PET) scanning to better pinpoint cancers and to track tumors' response to treatments.

Blood tests

There are no blood tests to detect oral cancer, but a physician may order blood tests to detect spread of cancer or certain conditions associated with cancer and its treatment.

Biopsy

Biopsy is the only examination that can provide a certain diagnosis of oral cancer. A biopsy is the microscopic evaluation of cells and identification of cancer cells. The tissue sample can be obtained through a variety of techniques. These vary from exfoliative biopsy, which involves scraping a small sample of tissue off and placing the cells onto a slide, to incisional biopsy, which usually involves surgery and general anesthesia for the patient. The type of biopsy used depends on several factors, such as the location of the mass under study. In recent years, many biopsies have been performed with a technique called fine needle aspiration biopsy. Using a thin needle, a physician draws fluid out of a mass and a pathologist examines the tissue in the fluid for cancer.

QUESTIONS TO ASK YOUR DOCTOR

• Is smokeless tobacco as harmful as smoking cigarettes?
• How can I get help quitting tobacco?
• What is the stage of my disease? What is the severity?
• What are the side effects of the treatments you are proposing?

Treatment

A team of health care providers will plan treatment for oral cavity and oropharyngeal cancer. Recommended treatment will depend on factors such as the cancer's stage when diagnosed, location of the tumor, and the patient's age and health condition. The standard treatment for oral cancer generally involves surgery and radiation therapy, but other treatments may be considered. Some patients might receive a combination of treatments.

Surgery

If a patient has surgery for oral cancer, it will involve removal of the cancerous mass, as well as some of the healthy tissue around the mass. This helps ensure that all of the cancerous cells have been removed. Surrounding bone might have to be removed, as well as nearby lymph nodes if they show signs of cancer spread. Surgery for oral cancer can also involve plastic surgery to rebuild areas of the mouth that are removed. A patient might need dental implants , skin grafts, or other plastic surgery to improve appearance after surgery to remove oral cancer masses.

Radiation therapy

Radiation therapy can be used after surgery to kill any remaining cancerous cells. Radiation therapy might also be used as the only treatment for oral cancer. There are several types of radiation therapy, including external beam radiation therapy, which aims high-energy x-ray beams generated by a machine outside the body directly at the cancerous tumor. Another type of radiation therapy is brachytherapy, which is sometimes called internal radiation therapy. A radiation oncologist implants a radioactive material inside or near a tumor for a certain amount of time. The radioactive material kills the tumor cells.

Chemotherapy

More advanced oral cancer can be treated with chemotherapy . Chemotherapy can help shrink tumors and is used in treating cancer that has spread throughout the body. The drugs used in chemotherapy can be injected or taken by mouth.

Nutrition/Dietetic concerns

Treatments for oral cancer can affect how a senior eats. Surgery can cause temporary pain that interferes with eating or the complication of infection, which also can affect ability to eat. Radiation therapy for oral cancer might cause soreness in the mouth and throat, making it difficult to eat following treatment. Radiation therapy for oral cancer can also affect the salivary glands, causing dry mouth . Chemotherapy can cause loss of appetite, nausea and vomiting, which can lead to changes in diet or the need for drugs to combat nausea. A dietitian can advise a senior on proper nutrition after treatment for oral cancer. People with oral cancer will need to consider giving up smoking and drinking alcohol.

Therapy

A dentist and related health professionals can help a senior with oral cancer to overcome possible complications of the cancer and treatment. For example, a dentist can help prevent serious mouth problems that can occur from jaw stiffness by demonstrating jaw muscle exercises. Dental hygiene needs can change as a result of treatment and more regular dental visits may be needed. Other health professionals can be involved in helping a senior learn to use certain muscles and for functions such as speech and chewing. Occupational and physical therapists, speech pathologists, nurses, social workers, and dental assistants are often involved in therapy and health care instruction.

KEY TERMS

Biopsy —Removal and microscopic examination of living tissue to diagnose disease.

Carcinogen —A substance or agent capable of causing cancer.

Oropharyngeal —Pertaining to the oropharynx, the area of the head and neck that includes the tonsils, soft palate, back of the throat, and the back one-third of the tongue.

Prognosis

The prognosis for seniors with oral cancer depends on the location and stage of the cancer and the patient's overall health. Age is a factor for risk of dying from oral cancer. In 2000–2004, approximately 58% of all U.S. deaths from oral cancer occurred in men and women age 65 and older. Another 22.8%occurred in people age 55–64. Trends in deaths from oral cancer have improved slightly since about 1980. Those who quit smoking or using other tobacco products usually improve their prognoses.

Prevention

Not all risk factors for oral cancer can be prevented, but the two largest risk factors can be modified to lower risk of oral cancer. Since tobacco use is responsible for most cases or oral cancer, not smoking cigarettes or using other forms of tobacco helps prevent oral cavity and oropharyngeal cancer. People who use tobacco and also drink beer and hard liquor increase their risk more, so avoiding these alcoholic beverages can help decrease risk. Minimizing exposure to sunlight can also lower risk of lip cancer. People who have had oral cancer once and use tobacco can develop a second cancer in the oral cavity or nearby. Chemoprevention can help prevent such second cancers. This is the use of drugs, vitamins , or other agents to help prevent the spread of the cancer cells or to help keep them from coming back. There is a possible link between the human papillomavirus (HPV) and oral cancer, so avoiding infection with HPV might help prevent oral cancer.

Caregiver concerns

After treatment for oral cancer, there can be short-term and long-term side effects and disabilities that a patient can experience. A care giver might have to provide care when a patient returns home following surgery, or simply provide emotional support if a treatment causes altered appearance or disability. Care givers might also have to help patients with more advanced stages of oral cancer make difficult decisions concerning treatment and end-of-life choices.

Resources

BOOKS

Santhanam, Kausalya. Oral Cancers. Gale Encyclopedia of Cancer Ed. Ellen Thackery. Vol. 2, 795–801. Detroit MI: Gale, 2002.

PERIODICALS

Baldauf, Sarah. “Stopping Oral Cancer.” U.S. News & World Report 144.6(Feb. 25, 2008): p.58.

OTHER

All About Oral Cavity and Oropharyngeal Cancer. http://www.cancer.org/docroot/CRI/CRI_2x.asp?sitear-ea=& dt=60 American Cancer Society, 2007.

Oropharyngeal Cancer Treatment. http://www.cancer.gov/cancertopics/pdq/treatment/oropharyngeal/patient- National Cancer Institute, 2007.

The Oral Cancer Exam. http://www.nidcr.nih.gov National Institute of Dental and Craniofacial Research, 2005.

ORGANIZATIONS

American Cancer Society, 1599 Clifton Rd. NE, Atlanta, GA, 30329, (800)866-228-4327, www.cancer.org.

The Oral Cancer Foundation, 3419 Via Lido #205, Newport Beach, CA, 92663, (949) 646-8000, (949) 496-3331, [email protected], www.oralcancerfoundation.org.

Teresa G. Odle

Oral Cancer

Definition

Oral cancer refers to malignancies in the oral cavity (mouth) and the oropharynx. The oral cavity includes the lips, buccal mucosa (lining of the lips and cheeks), the hard palate, floor of the mouth, teeth, front two-thirds of the tongue, and gingiva (gums). The oropharynx includes the tonsils, soft palate, back third of the tongue, and the back of the throat.

Description

In the United States, oral cancer is diagnosed in approximately 30,000 patients each year and is responsible for about 8,000 deaths. Oral cancer is the sixth most frequently occurring cancer, and the most common sites of oral cavity cancers are the floor of the mouth and the tongue. In the oropharynx the most common sites of cancerous tumors are the tonsils and base of the tongue.

The economic and social impact of this disease is great. Oral cancer may result in serious long-term disabilities such as loss of speech, hearing, salivary, and chewing functions, as well as pain and disfigurement resulting from head and neck surgery.

Causes and symptoms

Nearly three-quarters of all oral cancers are related to tobacco use—either cigarette, pipe, or cigar smoking, or the use of smokeless tobacco products such as snuff. Tobacco-specific nitrosamines are the carcinogens (cancer-causing substances) implicated in the development of oral cancers. Chronic alcohol consumption is linked to oral cancers, and the use of alcohol and tobacco together poses a greater risk than using either one alone.

Exposure to asbestos or radiation increases the risk of developing oral cancers, and exposure to sunlight is a risk factor for cancer of the lips. A high-fat diet that is also low in fruits, vegetables, and other sources of vitamins A and C has been linked to development of oral cancers.

Age, gender, and race affect the risk of developing oral cancers. Oral cancer usually occurs among older adults because they have longer exposure to lifestyle and environmental risk factors. Oral cancer occurs 2.5 times more often in males than females, and blacks are affected more often than whites. The higher rate of oral cancer among black men is attributed to lifestyle, such as nutritional status, tobacco, and alcohol use, rather than genetic differences. Recent research controlling for tobacco and alcohol use has demonstrated comparable rates of oral cancer among blacks and whites.

The signs and symptoms of oral cancer depend on the site of the tumor. Certain types of lesions in the oral cavity have the potential to become cancerous. Leukoplakias (white lesions) and erythroplakia (red lesions) that do not resolve within two weeks should be evaluated by a healthcare professional. Other possible signs or symptoms include:

• sore throat, hoarseness, or sensation that something is caught in the throat
• lump or thickening in the oral cavity
• difficulty chewing, eating, or swallowing
• difficulty moving the tongue or jaw
• numbness, weakness, or altered sensation in the mouth or tongue
• swelling of the jaw, mouth, or tongue
• changes in hearing, smell, or taste
• changes in the fit or feel of dentures or dental appliances
• abnormal odor or discharge from nose, ears, or mouth
• lesions, sores, or thickened patches that do not readily heal or resolve

Diagnosis

An examination to screen for oral cancer may be made by a physician, dentist, or dental hygienist. Though regular self-examination—with attention to lumps, thickenings, whitish patches, or sores—may detect some oral cancers, it is not a substitute for a thorough professional examination. An oral examination, performed by a physician or dentist using a mirror and lights, identifies abnormalities in the oral cavity. The physician will also palpate the throat, neck, and head for lumps or thickenings. X rays of the mouth, performed by a radiological technologist, may be used to examine suspicious areas.

When an abnormal area is detected in the oral cavity, the definitive diagnostic technique is biopsy—removal of all or part of the suspicious area for examination under the microscope by a pathologist. Biopsy is usually performed by an oral surgeon or an ear, nose, and throat specialist, also known as an otolaryngologist. Since squamous cells line the oral cavity, nearly all oral cancers are squamous cell carcinomas.

Staging

Staging refers to the process of determining the extent to which the cancer has metastasized (spread). Since treatment depends upon the stage of the oral cancer, additional diagnostic tests may be performed. These include imaging studies such as dental x rays and CT scans, and lymph node biopsy. Cancers of the oral cavity are identified as Stages I through IV and recurrent. Stage I cancers are less than 0.75 inch (2 cm) in size and have not spread to local lymph nodes. Stage II cancers are between 0.75 and 1.5 inches (2-4 cm) and have not metastasized to local lymph nodes. Stage III cancers are larger than 1.5 inches (4 cm), or are cancers of any size that have spread to a single lymph node on the same side of the neck as the cancer. Stage IV cancers have one or more of the following characteristics:

• spread to surrounding oral cavity tissue
• metastasized to more than one lymph node on the same side of the neck as the cancer
• metastasized to lymph nodes on both sides of the neck
• widespread metastasis throughout the body

Recurrent oral cancers are those that have returned following treatment. Recurrences may present in the oral cavity or elsewhere on the body.

Treatment

Treatment depends upon the location and stage of the cancer, as well as the age and overall health of the patient. It generally consists of a combination of surgery to remove as much of the cancer as possible and radiation and/or adjuvant chemotherapy (anticancer drugs) to kill any remaining cancer cells. Drugs called radiosensitizers are sometimes used to render cancer cells more sensitive to radiation. Most oral cancers are treated with surgery and fractionated (small, measured doses) radiation therapy. Another treatment that is presently being tested is hyperthermia. Since cancer cells are more sensitive to heat than normal cells, hyperthermia treatment involves heating the body in order to kill cancer cells.

Surgical treatment and radiation of the lips and oral cavity may produce disfigurement and difficulty with activities such as eating and talking. Patients recovering from treatment may benefit from rehabilitation with a speech therapist and support from social workers or other mental health professionals.

Prognosis

The prognosis for patients with oral cancer depends, again, upon the location and stage of the cancer, as well as the patient's age, overall health and effectiveness of treatment. Generally, oral cancers detected early, such as Stage I cancers, have the best prognoses. Patients who have had oral cancers are at increased risk for developing another cancer of the mouth, head, or neck; for this reason, all patients require vigilant, regular follow up. Patients who stop smoking or using tobacco products and alcohol also have better outlooks than those who do not.

Health care team roles

Patients with oral cancers may be cared for by oral surgeons, otolarynogologists, oncologists, surgical and oncology nurses, laboratory and radiological technologists, speech therapists, and mental health professionals. Health educators and behavior modification specialists may be involved in assisting patients with smoking cessation or recovery from alcohol dependency.

Patient education

The objectives of education are to prevent patients from smoking or using tobacco products, and to encourage smokers to quit. Participation in smoking cessation programs should be encouraged, and patients should be informed about the health risks of excessive alcohol consumption. Patient teaching also should describe the role of environmental carcinogens such as asbestos, radiation, and sun exposure in the development of oral cancers.

Prevention

Since tobacco products and alcohol abuse are associated with more than 75% of oral cancers, health education efforts to prevent their use could sharply reduce the incidence of oral cancers. Regular examinations by a dentist or physician are vital for early detection of oral cancers.

KEY TERMS

Adjuvant therapy— Treatment involving radiation, chemotherapy (anticancer drug treatment), or a combination of both.

Biopsy— Surgical removal and microscopic examination of living tissue for diagnostic purposes.

Carcinogen— Any substance or agent capable of causing cancer.

Chemotherapy— Systemic treatment of cancer with synthetic drugs that destroy the tumor either by inhibiting the growth of cancerous cells or by killing them.

Malignant— Cancerous.

Metastasize— The spread of cancer cells from a primary site to distant parts of the body.

Oncologist— A physician who specializes in cancer medicine.

Pathologist— A person who specializes in the diagnosis of disease by studying cells and tissues under a microscope.

Radiation therapy— Treatment using high energy radiation from X-ray machines, cobalt, radium, or other sources.

Stage— A term used to describe the size and extent of spread of cancer.

Resources

BOOKS

Murphy, Gerald P. et al. American Cancer Society Textbook of Clinical Oncology, 2nd ed. Atlanta: The American Cancer Society, Inc. 1995, pp. 5, 15, 369-370.

Otto, Shirley E. Oncology Nursing. St. Louis: Mosby, 1997, pp. 230-231.

PERIODICALS

Hall, Stephen, et al. "Time to First Relapse as an Outcome and Predictor of Survival in Patients with Squamous Cell Carcinoma of the Head and Neck." The Laryngoscope (December 2000): 2041-2046.

Scully, Crispian, and Stephen Porter. "Oral Cancer [Clinical Review: ABC of Oral Health]." British Medical Journal (July 8, 2000): 97-100.

Tankere, Frederic, et al. "Prognostic Value of Lymph Node Involvement in Oral Cancers: A Study of 137 Cases." The Laryngoscope (December 2000): 2061-2065.

ORGANIZATIONS

American Cancer Society. (800) ACS-2345. 〈http://www.cancer.org〉.

Cancer Care, Inc. (800) 813-HOPE. 〈http://www.cancercareinc.org〉.

Cancer Information Service of the NCI. (800) 4-CANCER. 〈http://wwwicic.nci.nih.gov〉.

Cancer Research Institute. 681 Fifth Avenue, New York, NY 10022. (800) 992-2623.

Centers for Disease Control. 〈http://www.cdc.gov〉.

National Cancer Institute (National Institutes of Health). 9000 Rockville Pike, Bethesda, MD 20892. (800) 422-6237 〈http://www.nci.nih.gov〉.

National Coalition for Cancer Survivorship. 1010 Wayne Ave., 5th Floor, Silver Spring, MD 20910. (301) 650-8868.

Mouth Cancer

What Is Mouth Cancer?

How Is Mouth Cancer Diagnosed and Treated?

Life after Mouth Cancer

How Is Mouth Cancer Prevented?

Resources

Mouth cancer, also called oral cancer, occurs when cells in the tissues of the mouth or throat divide without control or order, forming abnormal growths.

KEYWORDS

for searching the Internet and other reference sources

Cancer

What Is Mouth Cancer?

Mouth cancer usually begins in the tissues that make up the lips, tongue, or cheek lining, but it also can affect the gums, the floor or the roof of the mouth, or the salivary glands*. In almost all cases, it is caused by the use of substances that irritate the mucous membranes* in the mouth: spit tobacco (also called chewing tobacco or snuff), cigarettes, cigars, pipes, or alcohol. Over time, this constant irritation takes its toll, and some of the tissue takes on an abnormal appearance and eventually turns cancerous. Mouth cancer most commonly appears in men over the age of 45 who have been longtime users of tobacco and alcohol.

*salivary glands

(SAL-i-var-ee glands) are the three pairs of glands that produce the liquid called saliva, which aids in the digestion of food.

*mucous membranes

are thin sheets of tissue that line the inside of the mouth, throat and other passages within the body.

Many mouth cancers begin as whitish or reddish patches in the mouth, called leukoplakia (loo-ko-PLAY-kee-a) or erythroplakia (e-rith-row-PLAY-kee-a). Other symptoms may include:

• a sore on the lip or in the mouth that does not heal
• a lump on the lip or in the mouth or throat
• unusual bleeding, pain, or numbness in the mouth
• a sore throat that does not go away, or a feeling that something is caught in the throat
• difficulty or pain with chewing or swallowing
• swelling of the jaw
• pain in the ear
• a change in the voice.

Most dentists check for signs of oral cancer as part of the usual dental examination. Early detection is the key to treating it successfully. Otherwise, it can spread throughout the mouth, throat, neck, and even to distant parts of the body through the lymphatic system.*

*The lymphatic system

(lim-FAT-ik system) is a network of vessels, organs, and tissues that produce, store, and carry infection-fighting white blood cells in a colorless, watery fluid called lymph.

A Major League Fight against Spit Tobacco

For many years, baseball great Joe Garagiola waged a one-man battle against the prevalent use of spit tobacco, also called chewing tobacco, snuff, or chew, by major league baseball players. Himself a former user, Garagiola was concerned both about the players’ health and about the effect their behavior was having on young fans. He wanted to convey the message that just because spit tobacco is smokeless does not mean it is safe. To the contrary, it is a major cause of mouth cancer.

In 1996, Garagiola collaborated with a group called Oral Health America to found the National Spit Tobacco Education Program (NSTEP) and get other players involved with the cause. Bill Tuttle, who started using spit tobacco as an outfielder in the 1950s and 1960s, gave talks based on his own experiences with mouth cancer. NSTEP recruited players Lenny Dykstra, Mike Piazza, Tino Martinez, Alex Rodriguez, and Paul Molitorto do anti-tobacco spots that were broadcast during games.

How Is Mouth Cancer Diagnosed and Treated?

When dentists or doctors find a suspicious-looking area in the mouth, they may order a biopsy. During this procedure, a surgeon removes part or all of the suspect tissue. Examination under a microscope will determine whether cancer cells are present. Once oral cancer is diagnosed, doctors then need to find out whether the cancer has spread.

The first course of treatment is to remove the tumor and any cancerous tissue in the mouth. If there is evidence that the cancer has spread, the surgeon may also remove lymph nodes in the neck as well as part or all of the tongue, cheek, or jaw.

Doctors may also order radiation therapy, either before the surgery to shrink the tumors, or afterward to destroy any remaining cancer cells. In some cases, surgeons may place tiny “seeds” containing radioactive material directly into or near the tumor. Generally, this implant is left in place for several days, and the patient will stay in the hospital.

Chemotherapy is another possible treatment for mouth cancer, especially when it has spread beyond the mouth. It involves taking anticancer drugs by injection or in pill form.

Life after Mouth Cancer

People who are treated for large or widely spread mouth tumors often experience permanent changes that are challenging to deal with, both emotionally and physically. If they lose part of their jaw, tongue, cheek, or palate (the roof of the mouth), they will need reconstructive and plastic surgery. If surgery is not possible, they may need to use an artificial dental or facial part called a prosthesis. In either case, their appearance will be changed permanently.

These people also are likely to have some difficulty chewing and swallowing, and they may lose their sense of taste. For these reasons, weight loss can present a real problem after treatment for mouth cancer.

Many patients have trouble speaking after losing part of their mouth or tongue. Speech therapists will work with them both during and after their hospital stay to help them get back to speaking as normally as possible.

How Is Mouth Cancer Prevented?

People can prevent mouth cancer by not using spit tobacco or smoking cigarettes, cigars, or pipes, or quitting if they already do. If they drink alcohol, they should not have more than one or two drinks per day.

Mouth Cancer and Tobacco

Oral Health America, which runs the National Spit Tobacco Education Program, has compiled these statistics about spit tobacco use, which has increased over the past three decades.

• One out of three adolescents in the United States is using some form of tobacco by age 18.
• Spit tobacco use by adolescents is associated with early indicators of gum disease and unusual lesions in the mouth tissue.
• Each year, 10 to 16 million Americans use smokeless or spit tobacco products. Annual sales of these products in 1998 exceeded $1 billion, or more than triple that of 1972.
• Young men ages 17 to 19 are the most frequent users of spit tobacco. The Department of Health and Human Services estimates that 1 million adolescent boys use spit tobacco.
• The risk of developing oral cancer for long-term spit tobacco users is 50 times greater than for non-users.

See also

Cancer

Tobacco-Related Diseases

Resources

Book

Koppett, Leonard. To Improve Health and Health Care, 1998-1999: The Robert Wood Johnson Foundation Anthology. Edited by Stephen L. Isaacs and James R. Knickman. San Francisco: Jossey-Bass, 1999. See chapter 3, “The National Spit Tobacco Education Program.” Available online at
http://www.rwjf.org/library/oldhealth/anthlgyb.htm

Organizations

U.S. National Cancer Institute, National Institutes of Health, Bethesda, MD. This organization has published Chew or Snuff Is Real Bad Stuff and What You Need to Know About Mouth Cancer.
Telephone 800-4-CANCER
http://rex.nci.nih.gov

See also its fact sheet “What You Need to Know About Oral Cancer”
http://cancernet.nci.nih.gov/wyntk_pubs/index.html

National Oral Health Information Clearinghouse, 1 NOHIC Way, Bethesda, MD 20892-3500. This clearinghouse is a project of the National Institute of Dental Craniofacial Research, National Institutes of Health.
Telephone 301-402-7364
http://www.nidr.nih.gov

Oral Health Education Foundation, P.O. Box 396, Fairburn, GA 30213. This foundation maintains the Oral Cancer Information Center.
Telephone 770-969-7400
http://www.oralcancer.org

ORAL CANCER

Oral cancer is a malignant growth involving the tongue, floor, palate, interior lining of the cheeks or lips, or other parts of the mouth or pharynx. Most oral cancers are squamous cell carcinomas. It is the most common cancer in parts of Southeast Asia and India; in the United States it ranked seventh, most common among blacks and twelfth among whites. Incidence and mortality rates increase with age, though in the United States they have been decreasing among whites and increasing among nonwhites. Tongue cancer incidence and mortality have been increasing since 1970 among the young in the United States. Tobacco and alcohol are major risk factors for oral cancer; used together, they increase the effects of each other.

John C. Greene

(see also: Alcohol Use and Abuse; Cancer; Oral Health; Tobacco Control )

Bibliography

Schottenfeld, D., and Fraumeni, J. F., Jr., eds. (1996). Cancer Epidemiology and Prevention, 2nd edition. New York: Oxford University Press.