Oral Cancer: Mouth, Throat and Neck Cancers

Definition: Head, Neck, Mouth and Throat Cancer

• Head and Neck Cancer - Defined as cancer that arises in the head or neck region (nasal cavity, sinuses, lips, mouth, salivary glands, throat, or larynx (voice box).
• Throat Cancer - Defined as cancerous tumors that develop in your throat (pharynx), voice box (larynx) or tonsils.
• Mouth Cancer - Also called oral cancer or oral cavity cancer, is defined as a cancer that develops in any of the parts that make up the mouth. Mouth cancer is one of several types of cancer grouped in a category called head and neck cancers. Mouth cancer and other head and neck cancers are often treated similarly.

Main Document

'Mouth cancer,' refers to cancer that develops in any portion of a person's mouth. Mouth cancer may occur on a person's lips, tongue, gums, inside lining of their cheeks, the floor or roof of a person's mouth. Cancer that occurs on the inside of the mouth is at times referred to as, 'oral cancer,' or, 'oral cavity cancer.'

Mouth cancer is one of a number of forms of cancer grouped into a category called, 'head and neck cancers.' Mouth cancer and other head and neck cancers are many times treated in a similar fashion. Mouth cancer has a number of symptoms associated with it, such as:

• Sore throat
• Loose teeth
• Tongue pain
• Jaw pain or stiffness
• Poorly fitting dentures
• A sore that does not heal
• Painful or difficult chewing
• Painful or difficult swallowing
• A feeling that something is caught in the throat
• A reddish or white patch on the inside of the mouth
• A thickening or lump of the skin or lining of the mouth

Causes of Mouth Cancer

Mouth cancer occurs when cells on a person's lips or in their mouth develop mutations in their DNA. The mutations allow cancer cells to grow and divide when cells that are healthy would die. The accumulating mouth cancer cells may form a tumor. Over a period of time, they might spread to additional areas of a person's mouth and on to other areas of their neck and head, or other parts of the person's body.

Mouth cancers most often start in the flat and thin cells that line a person's lips and the inside of their mouth. The majority of oral cancers are squamous cell carcinomas. It is not clear what causes the mutations in squamous cells that lead to mouth cancer, yet doctors have identified factors that might increase someone's risk of mouth cancer.

Mouth Cancer Types

'Mouth cancer,' is a general term that applies to cancers that occur on a person's lips and throughout their mouth. Terms for these forms of cancer that are more specific include the following:

• Lip cancer
• Gum cancer
• Tongue cancer
• Hard palate cancer
• Salivary gland cancer
• Floor of mouth cancer
• Cancer affecting the inside portion of the cheeks

Risk Factors for Mouth Cancer

Some different risk factors for mouth cancer exist. These risk factors can increase a person's chance of mouth cancer and include:

• Heavy alcohol use
• Excessive sun exposure to the person's lips
• A sexually transmitted virus known as, 'human papillomavirus (HPV)'
• Tobacco use of any kind such as cigars, cigarettes, chewing tobacco, pipes or snuff

Questions a Doctor May Ask

A doctor is likely to ask a person with mouth cancer several questions. Being ready to answer these questions might allow more time later to cover points an affected person wants to address. For example, a doctor might ask:

• Do you drink alcohol
• How severe are your symptoms
• When did you first start to experience symptoms
• What, if anything, seems to worsen your symptoms
• Have your symptoms been occasional, or continuous
• Do you at this time, or have you ever used tobacco products
• Have you ever received radiation therapy to your neck or head area
• What, if anything, appears to improve the symptoms you experience

It is important to avoid doing things that worsen your signs and symptoms. If you experience pain in your mouth, avoid spicy foods or hard foods that might cause additional irritation. If you are having difficulties with eating due to pain, consider drinking nutritional supplement drinks. The drinks can provide the nutrition you require until you can meet with your doctor or dentist.

Mouth Cancer Tests and Diagnosis

A couple of different tests are available to diagnose mouth cancer. These tests and procedures include the following:

A Physical Examination: A doctor or dentist will examine your lips and mouth to look for things such as sores, areas of irritation, or white patches known as, 'leukoplakia.'

Removal of Tissue for Testing: If a suspicious area is discovered, a doctor or dentist might remove a sample of cells for laboratory testing in a procedure referred to as a, 'biopsy.' Unusual cells may be scraped away with a brush, or cut away using a scalpel. In the laboratory, the cells are analyzed for precancerous changes that indicate a risk of future cancer, or cancer itself.

Stages of Mouth Cancer

After a person has been diagnosed with mouth cancer, a doctor works to determine the stage or extent of the mouth cancer. Mouth cancer staging tests might include:

Using a Scope to Inspect Your Throat: During a procedure called, 'endoscopy,' a doctor might pass a lighted scope down the affected person's throat to look for signs that cancer has spread beyond the person's mouth.

Imaging Tests: A number of imaging tests may assist with determining whether cancer has spread beyond the person's mouth. Imaging tests may include X-rays, magnetic resonance imaging (MRI), computerized tomography scans (CT), or positron emission tomography (PET) scans. Not everyone requires each type of test; a doctor determines which ones are appropriate based upon the person's condition.

Stages of mouth cancer are indicated using Roman numerals I through IV. A lower stage indicates a smaller cancer confined to one area. A higher stage, such as stage IV, indicates a larger tumor, or that cancer has spread to additional areas of the person's neck, head, or other parts of their body. A person's cancer stage helps their doctor to determine the person's treatment options.

Mouth Cancer Treatments and Medications

Treatment for mouth cancer is dependent upon the cancer's stage and location, as well as the person's overall health and their personal preferences. The person might have only one type of treatment, or they may undergo a combination of cancer treatments. It is important for the person to discuss their options with their doctor.

Surgery and Mouth Cancer

Surgery for mouth cancer might include some different goals. The goals of a surgeon in relation to the mouth cancer a person experiences might include the following:

Surgery to Remove Cancer that has Spread to the Neck: If cancer cells have spread to the lymph nodes in a person's neck, their surgeon might recommend a procedure to remove cancerous lymph nodes and related tissue in their neck.

Tumor Removal Surgery: A surgeon may cut away the tumor and a margin of healthy tissue surrounding it. Smaller cancers might be removed through minor surgery. Larger tumors may need more extensive procedures. For example; removing a larger tumor might involve removing a section of the person's jawbone, or a part of their tongue.

Surgery to Reconstruct the Mouth: Following an operation to remove the person's cancer, their surgeon might recommend reconstructive surgery to restore the appearance of the person's face, or to help the person regain the ability to eat and talk. The surgeon may transplant grafts of skin, bone, or muscle from other parts of the person's body to reconstruct their face. Dental implants might be used to replace the person's natural teeth.

Bear in mind that surgery carries with it a risk of infection and bleeding. Surgery for mouth cancer often times affects a person's appearance, as well as their ability to eat, swallow, or speak. A doctor might refer the person to a specialist who can assist the person with coping with the changes.

Mouth Cancer and Radiation therapy

Radiation therapy uses high-energy beams such as X-rays to kill cancer cells. Radiation therapy may be delivered from a machine outside of the person's body, or from radioactive, 'seeds,' and wires placed near to the person's cancer. Radiation therapy may be the only treatment a person receives if they have an early-stage mouth cancer.

Radiation therapy can also be used following surgery. In other instances, radiation therapy might be combined with chemotherapy. The combination increases the effectiveness of radiation therapy, yet also increases the side-effects the person may experience. In instances of advanced mouth cancer, radiation therapy might help to relieve the signs and symptoms caused by the cancer such as pain. Side-effects of radiation therapy to a person's mouth may include:

• Fatigue
• Dry mouth
• Tooth decay
• Mouth sores
• Jaw stiffness
• Bleeding gums
• Red and burn-like skin reactions

Mouth Cancer and Chemotherapy

Chemotherapy is a type of treatment that uses chemicals to kill cancer cells. Chemotherapy drugs may be administered alone, in combination with other chemotherapy drugs, or in combination with other types of cancer treatments. Chemotherapy might increase the effectiveness of radiation therapy, so the two are often combined. Side-effects of chemotherapy depend on which drug the person receives. Common side-effects include nausea, vomiting and loss of hair.

Targeted Drug Therapy and Mouth Cancer

Targeted drugs treat mouth cancer by altering specific aspects of cancer cells that fuel their growth. 'Cetuximab,' is one targeted drug therapy that has been approved for the treatment of neck and head cancers in some situations. Cetuximab stops the action of a protein that is found in a number of types of healthy cells, but is more prevalent in some types of cancer cells. Additional targeted drugs are being studied in clinical trials. Targeted drugs may be used in combination with radiation or chemotherapy.

Oral, Head and Neck Cancer Awareness

Quick Facts: Mouth and Oral Cancer

• Anyone can get oral cancer, but the risk is higher if you are male, over age 40, use tobacco or alcohol or have a history of head or neck cancer.
• Survival rates for oral cancer depend on the precise site, and the stage of the cancer at diagnosis.
• Survival rates of patients diagnosed with oral cancer have not significantly improved in decades.
• Infection with human papillomavirus (HPV), particularly type 16, is a known risk factor and independent causative factor for oral cancer.
• Some studies in Australia, Brazil and Germany pointed to alcohol-containing mouthwashes as also being etiologic agents in the oral cancer risk family.
• Chewing betel, paan and Areca is known to be a strong risk factor for developing oral cancer.
• Oral cancer treatments may include surgery, radiation therapy or chemotherapy. Some patients have a combination of treatments.
• Surgical excision (removal) of the tumor is usually recommended if the tumor is small enough, and if surgery is likely to result in a functionally satisfactory result.

Statistics: Oral Cancer

• In the US oral cancer accounts for about 8 percent of all malignant growths.
• Men are affected twice as often as women, particularly men older than 40/60.
• In 2013 oral cancer resulted in 135,000 deaths up from 84,000 deaths in 1990.
• Five-year survival rates in the United States are 63%.
• 75 percent of oral cancers are linked to modifiable behaviors such as tobacco use and excessive alcohol consumption
• Oral cancer is the sixteenth most common cancer in the UK (around 6,800 people were diagnosed with oral cancer in the UK in 2011), and it is the nineteenth most common cause of cancer death (around 2,100 people died from the disease in 2012).