Oral Cancer

Definition

Cancer of the lip and oral cavity is a disease in which cancer cells are found in the tissues of the lip or mouth.

The oral cavity includes the front two-thirds of the tongue, the upper and lower gums (the gingiva), the lining of the inside of the cheeks and lips (the buccal mucosa), the bottom (floor) of the mouth under the tongue, the bony top of the mouth (the hard palate), and the small area behind the wisdom teeth (the retromolar trigone).

Description

Cancers of the head and neck are most often found in people who are over the age of 45.

Like most cancers, cancer of the lip and oral cavity is best treated when found early.

Determination of the stage of cancer in the lip or oral cavity is important in order to plan the best course of treatment. There are a number of stages:

Stage I. The cancer is no more than 2 centimeters and has not spread to lymph nodes in the area

Stage II. The cancer is more than 2 centimeters but less than 4 centimeters and has not spread to lymph nodes in the area

Stage III. Either of the following may be true - the cancer is more than 4 centimeters; the cancer is any size but has spread to only one lymph node on the same side of the neck as the cancer.

Stage IV. Any of the following may be true - the cancer has spread to tissues around the lip or oral cavity; the lymph nodes in the area may or may not contain cancer; the cancer is any size and has spread to more than one lymph node on the same side of the neck as the cancer, to lymph nodes on one or both sides of the neck, or to any lymph node that measures more than 6 centimeters.

Recurrent. this means that the cancer has returned after it has been treated. It may come back in the lip and oral cavity or in another part of the body.

Causes and Risk Factors

Cancer of the lip is more common in men than in women and is more likely to develop in people with light-colored skin who have been in the sun a lot.

Cancer of the oral cavity is more common in people who chew tobacco or smoke a pipe.

Symptoms

It is important to see a doctor if you have a lump in the lip, mouth, or gums, or a sore in the mouth that does not heal.

Another sign of a cancer of the mouth or gums is when dentures no longer fit well. Often lip or oral cavity cancers are found by dentists when they examine your teeth.

Diagnosis

Diagnosis is established through a clinical exam and a biopsy of the suspect area.

Treatment

Early cancers (Stages I and II) of the lip and oral cavity are highly curable by surgery or radiation therapy, with the choice depending on the anticipated functional and cosmetic results.

Advanced cancers (Stages III and IV) are usually treated with a combination of surgery and radiotherapy. A few patients with small lesions who have no involved lymph nodes larger than 3/4 inch might receive either surgery or radiation.

Patients with these stages commonly develop recurrences near the primary tumor or metastatic disease after treatment and should be considered for clinical trials involving radiation modifiers or the use of combination chemotherapy in addition to surgery and/or radiation. Patients whose tumors grow into blood vessels have a worse prognosis.

For recurrent cancer, treatment depends on the location and size of the recurrent tumor, as well as the nature of the original treatment. If radiotherapy was used initially, surgery is preferred. If surgery was used initially, radiotherapy or a combination of both will be used.

Because results are poor after using the "other" treatment for a recurrence, clinical trials using chemotherapy or hyperthermia should be considered.

Prevention

To prevent oral cancers, do not use tobacco products of any kind.

Questions to Ask Your Doctor

What is the primary site of the tumor?

How big is it?

What is the staging?

Is there a choice between chemotherapy and radiation?

Will chemotherapy cause nausea?

What are the complications from the treatment?

Will surgery be helpful?