MEDICAL CONDITIONS
Oral Cancer
The information provided below has been modified from that furnished by the National Institutes of Health and the National Cancer Institute of the United States of America.
What is the oral cavity?
This site deals with cancer of the oral cavity (mouth) and the oropharynx (the part of the throat at the back of the mouth). The oral cavity includes many parts: the lips; the lining inside the lips and cheeks, called the buccal mucosa; the teeth; the bottom (floor) of the mouth under the tongue; the bony top of the mouth (hard palate); the gums; and the small area behind the wisdom teeth. The oropharynx includes the back one-third of the tongue, the soft palate, the tonsils, and the back of the throat. Salivary glands throughout the oral cavity make saliva, which keeps the mouth moist and helps digest food.
What is cancer?
Cancer is a group of diseases. It occurs when cells becomes abnormal and divide without control or order. More than 100 different types of cancer are known. Each year, more than 30,000 people in the United States find out they have oral cancer.
Like all other organs of the body, the mouth and throat are made up of many kinds of cells. Cells normally divide in an orderly way to produce more cells only when the body needs them. This process helps keep the body healthy.
Cells that divide when new cells are not needed form too much tissue. The mass of extra tissue, called a tumor, can be benign or malignant.
Benign tumors are not cancer. They can usually be removed and, in most cases, they do not grow back. Most important, cells in benign tumors do not invade other tissues and do not spread to other parts of the body. Benign tumors are seldom a threat to life.
Malignant tumors are cancer. They can invade and damage tissues and organs. Also, cancer cells can break away from a malignant tumor and enter the bloodstream or the lymphatic system. This is how cancer spreads and forms secondary tumors in other parts of the body. The spread of cancer is called metastasis.
When oral cancer spreads, it usually travels through the lymphatic system. Cancer cells that enter the lymphatic system are carried along by lymph, an almost colorless, watery fluid containing cells that help the body fight infection and disease. Along the lymphatic channels are groups of small, bean-shaped organs called lymph nodes (sometimes called lymph glands). Oral cancer that spreads usually travels to the lymph nodes in the neck. It can also spread to other parts of the body. Cancer that spreads is the same disease and has the same name as the original (primary) cancer.
Early Detection
It is important to find oral cancer as early as possible because treatment works best before the disease has spread. The National Cancer Institute (NCI) encourages people to take an active role in the early detection of oral cancer by doing a monthly self-examination. This means looking in a mirror to check for any of the changes or symptoms described below.
Regular dental checkups that include an examination of the entire mouth are also important in the early detection of oral cancer or precancerous conditions. Your doctor should check your mouth as part of a routine physical exam.
What causes oral cancer?
Scientists at hospitals and medical centers all across the country are studying this disease to learn more about what causes it and how to prevent it. It is established that no one can "catch" cancer from another person: it is not contagious. Two known causes of oral cancer are tobacco and alcohol use.
Tobacco use; smoking cigarettes, cigars, or pipes, chewing tobacco, or dipping snuff, accounts for 80 to 90 percent of oral cancers. A number of studies have shown that cigar and pipe smokers have the same risk as cigarette smokers. Studies indicate that smokeless tobacco users are at particular risk of developing oral cancer. For long-time users, the risk is much greater, making the use of snuff or chewing tobacco among young people a special concern.
People who stop using tobacco, even after many years of use, can greatly reduce their risk of oral cancer. Special counseling or self-help groups may be useful for those who are trying to give up tobacco. Some hospitals have groups for people who want to quit. Also, the Cancer Information Service and the American Cancer Society may have information about groups in local areas to help people quit using tobacco.
Chronic and/or heavy use of alcohol also increases the risk of oral cancer, even for people who do not use tobacco. However, people who use both alcohol and tobacco have an especially high risk of oral cancer. Scientists believe that these substances increase each other's harmful effects.
Cancer of the lip can be caused by exposure to the sun. The risk can be avoided with the use of a lotion or lip balm containing a sunscreen. Wearing a hat with a brim can also block the sun's harmful rays. Pipe smokers are especially prone to cancer of the lip.
Some studies have shown that many people who develop oral cancer have a history of leukoplakia, a whitish patch inside the mouth. The causes of leukoplakia are not well understood, but it is commonly associated with heavy use of tobacco and alcohol. The condition often occurs in irritated areas, such as the gums and mouth lining of smokeless tobacco users and the lower lip of pipe smokers.
Another condition, erythroplakia, appears as a red patch in the mouth. Erythroplakia occurs most often in people 60 to 70 years of age. Early diagnosis and treatment of leukoplakia and erythroplakia are important because cancer may develop in these patches.
People who think they might be at risk for developing oral cancer should discuss this concern with their doctor or dentist, who may be able to suggest ways to reduce the risk and plan an appropriate schedule for check-ups.
What are the symptoms of oral cancer?
Oral cancer usually occurs in people over the age of 40 but can develop at any age. These are some warning signs to watch for: - A sore in the mouth that does not heal;
- A lump or thickening in the cheek;
- A white or red patch on the gums, tongue, or lining of the mouth;
- Soreness or a feeling that something is caught in the throat;
- Difficulty chewing or swallowing;
- Difficulty moving the jaw or tongue;
- Numbness of the tongue or other area of the mouth; or
- Swelling of the jaw that causes dentures to fit poorly or become uncomfortable.
Any of these symptoms may be caused by cancer or by other, less serious problems. Don't wait for something to hurt. Pain is usually not an early symptom of oral cancer. It is important to see a dentist or doctor if any of these conditions lasts more than 2 weeks.
How is oral cancer diagnosed?
If an abnormal area has been found in the oral cavity, a biopsy is the only way to know whether it is cancer. Usually, the patient is referred to an oral surgeon or an ear, nose, and throat surgeon, who removes part or all of the lump or abnormal- looking area. A pathologist examines the tissue under a microscope to check for cancer cells.
Almost all oral cancers are squamous cell carcinomas. Squamous cells line the oral cavity.
If the pathologist finds oral cancer, the patient's doctor needs to know the stage, or extent, of the disease in order to plan the best treatment. Staging tests and exams help the doctor find out whether the cancer has spread and what parts of the body are affected.
Staging generally includes dental x-rays and x-rays of the head and chest. The doctor may also want the patient to have a CT (or CAT) scan. A CT scan is a series of x-rays put together by a computer to form detailed pictures of areas inside the body. Ultrasonography is another way to produce pictures of areas in the body. High-frequency sound waves ( ultrasound ), which cannot be heard by humans, are bounced off organs and tissue. The pattern of echoes produced by the waves creates a picture called a sonogram. Sometimes the doctor asks for MRI (magnetic resonance imaging), a procedure in which pictures are created using a magnet linked to a computer. The doctor also feels the lymph nodes in the neck to check for swelling or other changes. In most cases, the patient will have a complete physical examination before treatment begins.
How is oral cancer treated?
Treatment for oral cancer depends on a number of factors. Among these are the location, size, type, and extent of the tumor and the stage of the disease. The patient's age and general health are also considered. Treatment involves surgery, radiation therapy , or, in many cases, a combination of the two. Some patients receive chemotherapy , treatment with anticancer drugs.
For most patients, it is important to have a complete dental exam before cancer treatment begins. Because cancer treatment can make the mouth sensitive and more easily infected, doctors often advise patients to have any needed dental work done before treatment begins.
Most people with cancer want to learn all they can about their disease and their treatment choices so they can take an active part in decisions about their medical and dental care. The doctor is the best person to answer their questions. Also, the patient may want to talk with the doctor about taking part in a research study of new treatment methods. Such studies, called clinical trials, are designed to improve cancer treatment.
Many patients find it useful to make a list of questions before seeing the doctor. Taking notes can make it easier to remember what the doctor says. Some patients also find that it helps to have a family member or friend with them to take part in the discussion, to take notes, or just to listen.
There is a lot to learn about cancer and its treatment. Patients do not need to ask all their questions or understand all the answers at once. They will have many chances to ask the doctor to explain things that are not clear and to ask for more information.
Methods of Treatment
Patients with oral cancer may be treated by a team of specialists. The medical team may include an oral surgeon; an ear, nose, and throat surgeon; a medical oncologist; a radiation oncologist; a prosthodontist; a general dentist; a plastic surgeon; a dietitian; a social worker; a nurse; and a speech therapist.
Surgery to remove the tumor in the mouth is the usual treatment for patients with oral cancer. If there is evidence that the cancer has spread, the surgeon may also remove lymph nodes in the neck. If the disease has spread to muscles and other tissues in the neck, the operation may be more extensive.
Radiation therapy (also called radiotherapy) is the use of high-energy rays to damage cancer cells and stop them from growing. Like surgery, radiation therapy is local therapy; it affects only the cells in the treated area. The energy may come from a large machine (external radiation). It can also come from radioactive materials placed directly into or near the tumor (internal radiation). Radiation therapy is sometimes used instead of surgery for small tumors in the mouth. Patients with large tumors may need both surgery and radiation therapy.
Radiation therapy can be given before or after surgery. Before surgery, radiation can shrink the tumor so that it can be removed. Radiation after surgery is used to destroy cancer cells that may remain.
For external radiation therapy, the patient goes to the hospital or clinic each day for treatments. Usually, treatment is given 5 days a week for 5 to 6 weeks. This schedule helps protect healthy tissues by dividing the total amount of radiation into small doses.
Implant radiation therapy puts tiny "seeds" containing radioactive material directly into the tumor or in tissue near it. Generally, an implant is left in place for several days, and the patient will stay in the hospital in a private room. The length of time nurses and other caregivers, as well as visitors, can spend with the patient will be limited. The implant is removed before the patient goes home.
Chemotherapy is the use of drugs to kill cancer cells. Researchers are looking for effective drugs or drug combinations to treat oral cancer. They are also exploring ways to combine chemotherapy with other forms of cancer treatment to help destroy the tumor and prevent the disease from spreading.
Clinical Trials
Researchers are developing treatment methods that are more effective against oral cancer, and they are also finding ways to reduce side effects of treatment. When laboratory research shows that a new methods has promise, doctors use it to treat cancer patients in clinical trials. These trials are designed to answer scientific questions about the new approach and to find out whether it is both safe and effective. Patients who take part in clinical trials make an important contribution to medical science and may have the first chance to benefit from improved treatment methods.
Clinical trials to study new treatments for oral cancer are under way in hospitals throughout the country. Some trials involve ways to shrink or destroy the primary tumor. In others, scientists are testing ways to prevent the cancer from coming back in the mouth or spreading to other parts of the body. Still others involve treatments to slow or stop cancer that has already spread.
Researchers are studying the timing of treatments and new ways to combine various types of treatment. For example, they are trying to increase the effectiveness of radiation therapy by giving treatments twice a day instead of once a day. They are also working with hyperthermia (heat) and with drugs called radiosensitizers to try to make cancer cells more sensitive to radiation. Researchers are also using drugs to help protect normal cells from radiation damage. In addition, they are exploring various new anticancer drugs and drug combinations.
People who have had oral cancer have an increased risk of developing a new cancer of the mouth or another part of the head or neck. Doctors are trying to find ways to prevent these new cancers. Some research has shown that a substance related to vitamin A may prevent a new cancer from developing in someone who has already been successfully treated for oral cancer.
Oral cancer patients who are interested in taking part in a trial should talk with their doctor. They may want to read What are Clinical Trials All About?, a booklet that explains what treatment studies are and outlines some of their possible benefits and risks.
One way to learn about clinical trials is through PDQ, a computerized resource developed by the National Cancer Institute. PDQ contains information about cancer treatment and an up-to-date list of trials all over the country. The Cancer Information Service can provide PDQ information to doctors, patients, and the public.
What are the side effects of treatment for oral cancer?
It is hard to limit the effects of therapy so that only cancer cells are removed or destroyed. Because healthy cells and tissues can also be damaged, treatment often causes unpleasant side effects.
The side effects of cancer treatment vary. They depend mainly on the type and extent of the treatment and the specific area being treated. Also, each person reacts differently. Some side effects are temporary; others are permanent. Attempts are made to plan the patient's therapy to keep side effects to a minimum. Patients are also very carefully monitored so that any problems which occur can be addressed.
Surgery to remove a small tumor in the mouth usually does not cause any lasting problems. For a larger tumor, however, the surgeon may need to remove part of the palate, tongue, or jaw. Such surgery is likely to change the patient's ability to chew, swallow, or talk. The patient may also look different.
After surgery, the patient's face may be swollen. This swelling usually goes away within a few weeks. However, removing lymph nodes can slow the flow of lymph, which may collect in the tissues. This swelling may last for a long time.
Before starting radiation therapy, a patient should see a dentist who is familiar with changes this therapy can cause in the mouth. Radiation therapy can make the mouth sore. It can also cause changes in the saliva and may reduce the amount of saliva, making it hard to chew and swallow. Because saliva normally protects the teeth, mouth dryness can promote tooth decay. Good mouth care can help keep the teeth and gums healthy and can make the patient feel more comfortable. The health care team may suggest the use of a special kind of toothbrush or mouthwash. The dentist usually suggests a special fluoride program to keep the teeth healthy. To help relieve mouth dryness, the health care team may suggest the use of artificial saliva and other methods to keep the mouth moist. Mouth dryness from radiation therapy goes away in some patients, but it can be permanent.
Weight loss can be a serious problem for patients being treated for oral cancer because a sore mouth can make eating difficult. In many cases, it helps to have food and beverages in very small amounts. Many patients find that eating several small meals and snacks during the day works better than trying to have three large meals. Often, it is easier to eat soft, bland foods that have been moistened with sauces or gravies. Thick soups, puddings, and high-protein milkshakes are nourishing and easy to swallow. It may be helpful to prepare other foods in a blender. Special liquid dietary supplements for patients who have trouble chewing can also be suggested. Drinking lots of fluids helps keep the mouth moist and makes it easier to eat.
Some patients are able to wear their dentures during radiation therapy. Many, however, will not be able to wear dentures for up to a year after treatment. Because the tissues in the mouth that support the denture may change during or after treatment, dentures may no longer fit properly. After treatment is over, a patient may need to have dentures refitted or replaced.
Radiation therapy can also cause sores in the mouth and cracked and peeling lips. These usually heal in the weeks after treatment is completed. Often, good mouth care can help prevent these sores. Dentures should not be worn until the sores have healed.
During radiation therapy, patients may become very tired, especially in the later weeks of treatment. Resting is important, but doctors usually advise their patients to try to stay reasonably active. Patients should match their activities to their energy level. It is common for radiation to cause the skin in the treated area to become red and dry, tender, and itchy. Toward the end of treatment, the skin may become moist and "weepy." There may be permanent darkening or "bronzing" of the skin in the treated area. This area should be exposed to the air as much as possible but should also be protected from the sun. Good skin care is important at this time, but patients should not use any lotions or creams without checking with the doctor. Men may lose all or part of their beard, but facial hair generally grows back after treatment is done. Usually, men shave with an electric razor during treatment to prevent cuts that may lead to infection. Most effects of radiation therapy on the skin are temporary. The area will heal when the treatment is over.
The side effects of chemotherapy depend on which drugs that are given. In general, anticancer drugs affect rapidly dividing cells, such as blood cells that fight infection, cells that line the mouth and the digestive tract, and cells in hair follicles. As a result, patients may have side effects such as a lower resistance to infection, loss of appetite, nausea, vomiting, or mouth sores. They also may have less energy and lose their hair.
The side effects of cancer treatment are different for each person, and they may even be different from one treatment to the next in the same person. Doctors, nurses, and dietitians can explain the side effects of cancer treatment and can suggest ways to deal with them.
What is rehabilitation for oral cancer?
Rehabilitation is a very important part of treatment for patients with oral cancer. The goals of rehabilitation depend on the extent of the disease and the treatment a patient has received. The health care team makes every effort to help the patient return to normal activities as soon as possible. Rehabilitation may include dietary counseling, surgery, a dental prosthesis, speech therapy, and other services.
Sometimes a patient needs reconstructive and plastic surgery to rebuild the bones or tissues of the mouth. If this is not possible, a prosthodontist may be able to make an artificial dental and/or facial part (prosthesis). Patients may need special training to use the device.
Speech therapy generally begins as soon as possible for a patient who has trouble speaking after treatment. Often a speech therapist visits the patient in the hospital to plan therapy and teach speech exercises. Speech therapy usually continues after the patient returns home.
What happens after treatment for oral cancer?
Regular follow-up exams are very important for anyone who has been treated for oral cancer. The physician and the dentist watch the patient closely to check the healing process and to look for signs that the cancer may have returned. Patients with mouth dryness from radiation therapy should have dental exams three times a year.
The patient may need to see a dietitian if weight loss or eating problems continue. Most doctors urge their oral cancer patients to stop using tobacco and alcohol to reduce the risk of developing a new cancer.
Living with a serious disease is not easy. Cancer patients and those who care about them face many problems and challenges. Finding the strength to cope with these difficulties is easier when people have helpful information and support services. Several useful booklets, including Taking Time: Support for People with Cancer and the People Who Care About Them, are available from the Cancer Information Service.
Cancer patients may worry about holding their job, caring for their family, or conducting daily activities. Worries about tests, treatments, hospital stays, and medical bills are common. Doctors, nurses, and other members of the health care team can calm fears and ease confusion about treatment, working, or daily activities. Also, meeting with a nurse, social worker, counselor, or a member of the clergy can be helpful to patients who want to talk about their feelings or discuss their concerns about the future or about personal relationships.
Friends and relatives, especially those who have had personal experience with cancer, can be very supportive. Also, many patients find it helps to discuss their concerns with others who are facing similar problems. Cancer patients often get together in support groups, where they can share what they have learned about cancer and its treatment and about coping with the disease. It is important to keep in mind, however, that each patient is different. Treatments and ways of dealing with cancer that work for one person may not be right for another, even if they both have the same kind of cancer. It is a good idea to discuss the advice of friends and family members with the doctor.
Often, a social worker at the hospital or clinic can suggest groups that can help with rehabilitation, emotional support, financial aid, transportation, or home care. The American Cancer Society is one such group. This nonprofit organization has many services for patients and their families. Local offices of the American Cancer Society are listed in the white pages of the telephone directory.
Information about other programs and services is available through the Cancer Information Service. The toll-free number is 1-800-4-CANCER.
What does the future hold for patients with oral cancer?
Patients and their families are naturally concerned about what the future holds. Sometimes they use statistics to try to figure out whether the patient will be cured or how long he or she will live. It is important to remember, however, that statistics are averages based on large numbers of patients. They cannot be used to predict what will happen to a certain patient because no two cancer patients are alike. The doctor who takes care of the patient knows his or her medical history and is in the best position to discuss the person's outlook (prognosis).
People should feel free to ask the doctor about their chance of recovery, but not even the doctor knows for sure what will happen. When doctors talk about surviving cancer, they may use the term remission rather than cure. Even though many patients with oral cancer recover completely, doctors use this term because oral cancer can recur.
What resources are available to patients with oral cancer?
Information about oral cancer is available from several sources, including the ones listed below. You may wish to check for additional information at your local library or bookstore and from support groups in your community.
Cancer Information Service (CIS) 1-800-4-CANCER
The Cancer Information Service, a program of the National Cancer Institute, is a nationwide telephone service for cancer patients, their families and friends, the public, and health care professionals. The staff can answer questions in English and Spanish and can send booklets about cancer. They also know about local resources and services. One toll-free number, 1-800-4- CANCER (1-800-422-6237), connects callers with the office that serves their area.
American Cancer Society (ACS)
1599 Clifton Road, N.E.
Atlanta, GA 30329
1-800-ACS-2345
The American Cancer Society is a voluntary organization with a national office and local units all over the country. It supports research, conducts educational programs, and offers many services to patients and their families. To obtain free booklets about services and activities in local areas, call the Society's toll-free number, 1-800-ACS-2345 (1-800-227-2345), or the number listed under "American Cancer Society" in the white pages of the telephone book.
National Institute of Dental Research
Building 31, Room 2C35
9000 Rockville Pike
Bethesda, MD 20892
The National Institute of Dental Research, an agency of the Federal Government, is concerned with the causes, prevention, diagnosis, and treatment of oral and dental diseases. It can supply free printed material about oral health during and after cancer treatment. Oral Cancer At A Glance - Oral cancer is caused by tobacco (smoking and chewing) and alcohol use.
- A sore in the mouth that does not heal can be a warning sign of oral cancer.
- A biopsy is the only to know whether as abnormal area in the oral cavity is cancer.
- Treatment of oral cancer depends on the location, size, type, and extent of the tumor, as well as the age and health of the patient.
- Surgery to remove the tumor in the mouth is the usual treatment for patients with oral cancer.
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