Understanding Oral Cancer of the Mouth and Tongue

Oral cancer is a type of head and neck cancer that affects the mouth. It can form in the lining of the cheeks, gums, roof of the mouth, tongue, and lips.

Risk Factors

Mouth and tongue cancer is often caused by a combination of risk factors.

• Tobacco use - Perhaps the most significant risk factor for developing oral cancer is tobacco use. Smoking cigarettes, cigars, and pipes all increase your risk of mouth and tongue cancer. Smokeless tobacco, often called "dip" or "chew," also heightens the risk.

• Alcohol consumption is another habit that is associated with the development of oral cancer.

• Human papillomavirus (HPV) -  Research strongly suggests that infection with the human papillomavirus (HPV) increases your risk of oral cancer, and it's thought HPV currently causes 72% percent of cancers in the back of the throat. HPV is a virus that is transmitted through sexual contact, like sexual skin-to-skin contact, vaginal/anal intercourse, and oral sex.

Symptoms

Dentists are now routinely screening patients for oral cancer during exams, but having an awareness of the symptoms of oral cancer is important as well.  These may include:

• A sore or blister in your mouth or on your lip that does not heal after two weeks
• A lesion on the tongue or tonsil
• White and red patches in the mouth or on lips that do not heal
• Bleeding from the mouth that is unrelated to an injury
• A change in the way teeth fit together, including how dentures fit, or loose teeth because of jaw swelling or pain
• Persistent earaches
• Difficulty swallowing, chewing, speaking, or moving the tongue

Diagnosis

If your health care professional finds anything suspicious in your mouth or on your tongue, then further evaluation is required to confirm the absence or presence of cancer.

This can be done by doing a biopsy of the abnormal area(s) of the mouth. A biopsy removes small amounts of tissue that is sent to a pathology lab for examination under a microscope.

If cancer is found, the stage of the disease is then determined. Staging refers to how far the oral cancer has spread. Further tests like dental x-rays, endoscopy, and other imaging tests may be used to determine how far the cancer has spread.

Treatment

Treatment for oral cancer heavily depends on the stage of the disease. More than one type of treatment may be used in treating oral cancer.  It's important to find a doctor experienced in treating oral cancers and to ask a lot of questions.  Consider getting a second opinion at a major cancer centre.  Studies suggest that treatments for oral cancer vary widely, and you would rather see a doctor who has performed 200 tongue surgeries than one who has done 2.  Even if a cancer can be removed fully - in other words, is likely curable - the amount of disability you have after ward may vary depending upon the experience of your surgeon. 

Keep in mind that by the time a cancer is found it has usually been growing awhile, and most of the time it doesn't have to be treated immediately.

 Certainly, it feels better to have your cancer removed sooner than later, but take the time before treatment to make sure you are being your own advocate in your cancer care, and getting the best treatment possible.  Methods of treatment include:

• Surgery - Surgery to remove cancerous tissue is a common method of treating oral cancer. For some people, surgery is the only type of treatment needed; for others, chemotherapy and radiation may also be needed. In some cases, lymph nodes in the neck may be also removed.

• Radiation Therapy - Radiation therapy uses certain types of high energy beams of radiation to shrink tumors or eliminate cancer cells.Radiation therapy works by damaging a cancer cell's DNA, making it unable to multiply. Although radiation therapy can damage nearby healthy cells, cancer cells are highly sensitive to radiation and typically die when treated. Healthy cells that are damaged during radiation are resilient and are often able to fully recover.

Two primary types of radiation therapy are external beam radiation therapy and internal beam radiation, also called brachytherapy. External beam radiation is much more common than internal beam radiation in treating oral cancer.  The most common side effects of radiation are fatigue and a rash that resembles sunburn.  Radiation to the head and neck may also cause hair loss, which unlike hair loss from chemotherapy, is often permanent.

• Chemotherapy - Chemotherapy may be prescribed to reduce the size of a tumor before radiation therapy or surgery or may also be given in conjunction with radiation treatments.  When chemotherapy is given before surgery in order to decrease the size of a cancer it is called neoadjuvant chemotherapy.  When it is given after a successful surgery in order to eliminate any cells left over that can't be seen on imaging tests, it is referred to as adjuvant therapy.Since chemotherapy attacks rapidly growing cells like cancer cells, it also affects normal rapidly growing cells such as those in the bone marrow, the gastrointestinal tract, and the hair follicles.  Thankfully treatments for the side effects of chemotherapy have improved greatly, and while hair loss is still common, many people do not experience the awful nausea and vomiting that was once a problem with this treatment.

After Treatment

It's been found that people who are successfully treated for oral cancer have a high risk of developing a second cancer somewhere in the oral cavity or gastrointestinal tract.  For this reason, it's now recommended that people who are done with treatment be treated with a year of the medication known as isotretinoin to attempt to reduce this risk.

Prognosis

The prognosis of oral cancers is in general very good but depends upon the stage.  For stage I and stage II cancers, the 5-year survival rate is 90 to 100% when treated with surgery and sometimes radiation therapy.  The survival rate is somewhat lower for those with stage III and stage IV disease, but with surgery and radiation therapy, well over half of people and sometimes up to 90% of people (depending on several factors) achieve good long-term control of their disease.

Prevention

Avoiding the known risk factors of oral cancer is the best way to prevent the disease. Many cases of oral cancer are related to tobacco and alcohol use, so avoiding both habits are key to preventing it.

Sun exposure can be related to cancer of the lips, so staying out of the sun and wearing a lip balm that contains sunscreen is also important.

Practicing safe sex is important in the prevention of oral cancer, and it's hoped that the HPV vaccine will reduce the number of people getting oral cancer in the future.  The HPV vaccine is recommended for children between the ages of 11 and 12, but can be given as young as age 9, or as late as age 26.

Visiting your dentist regularly may aid in the early detection of oral cancer. Your dentist is trained to look and feel for signs of the disease. Oral cancer screening involves visual examination of the mouth and dental x-rays. Newer screening tools like ​VELscope allow doctors to thoroughly look for signs of oral cancer that may not be visible to the naked eye. These newer screening tools are highly recommended for those who are at a higher risk of developing oral cancer, like those who smoke or consume alcohol.

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