How to Spot Oral Cancer and What to Do Next

Most of us do not think cancer of the mouth (oral) or throat (oropharyngeal) will ever be something we have to face. Oral and oropharyngeal cancers are not frequently discussed. There is minimal patient education provided on these cancers when we see our doctors or dentists. If identified early, these cancers can be treated and often cured.

What is oral cancer?

The term oral cancer includes cancers of the mouth involving the tongue, lips, inside lining of the cheeks, the gums, the hard part of the roof of the mouth, and the mouth floor. Oropharyngeal cancers include the back and sides of the throat, the soft part of the roof of the mouth, the tonsil area, and the base of the tongue. Both oral cancers and oropharyngeal cancers fall under the broader category of head and neck cancers.

Risk factors for oral cancers

Tobacco use of any kind, whether via cigarettes, a pipe, or chewing tobacco, is associated with an increased risk of developing oral and oropharyngeal cancer. The degree of risk worsens with the amount of tobacco used and the duration of the use. Drinking alcohol excessively (greater than twenty-one drinks per week) increases the risk of these cancers too. There is a six-fold risk of mouth and throat cancers with the combination of tobacco use and alcohol use.

Other common risk factors include:

• Male gender more often than female gender
• Age over 45 years
• Poor nutrition
• Excessive sun exposure, particularly to the lip
• Having a diagnosis of a disease of the mouth called lichen planus
• Prior radiation exposure
• Possibly chronic, improperly fitting dentures
• Being overweight
• Having the human papillomavirus type 16 (HPV-16)

Screening measures

Most of us have heard of screening tests like mammograms for breast cancer or colonoscopies for colon cancer, but what screening tests are there for mouth or throat cancer? There is no routinely recommended screening testing. Most often, these cancers are detected by an exam of the oral cavity by a dentist or hygienist or doctor.

Symptoms to report to a healthcare provider may include:

• A lump or bump in the mouth, on the lip, along the cheek, or in the neck
• A non-healing sore on the lip or inside the mouth
• Uncomfortably fitting dentures
• A sore throat that will not go away
• A painful place in the mouth or around the teeth
• Hoarseness or a change in the voice
• Red or white spots that are persistent anywhere in the mouth
• Jaw pain or loss of jaw mobility

How is oral cancer diagnosed?

If a medical provider, dentist, or patient detects a mass in the mouth or throat, the next step is to determine whether the mass is cancerous or benign (non-cancerous). There will likely be a need for a referral to a specialist, such as an otolaryngologist that specializes in ear, nose, and throat diseases. A biopsy of the abnormal place in the mouth or oropharynx is necessary. This can be done with the use of a fiber optic scope, via a needle aspirate sample, or with a brush sample, depending on the location of the mass. HPV testing can be done on the biopsy sample.

If malignant (cancerous) when the results return, imaging with x-rays, ultrasound, computed tomography (CT) scan, or magnetic resonance imaging (MRI) may be done of the area to see the anatomy more thoroughly. It is also possible that a positron emission tomography (PET) scan may be ordered to evaluate the area of concern and the rest of the body from the neck down.

Oral cancer treatment options

Once proven malignant, oral and oropharyngeal cancers will be staged. The stage is based on the biopsy and imaging findings, and according to a nationally recognized staging system.

TNM Staging

T—Tumor (size, location)

N—Node (Is cancer in the lymph nodes? How many and what location?)

M—Metastasis (Is there a spread of cancer to other parts of the body?)

The TNM results then help determine the stage I up to stage IV. Once staged, treatment can be recommended. A team of multi-specialty medical providers will be involved.

At the earliest stage, some of these cancers can be treated with surgery alone. Beyond the earliest stages, treatment options may include surgery, chemotherapy, radiation, targeted therapies, and immunotherapy. Additional support from speech therapy to improve speech and swallowing or physical therapy to improve jaw or neck muscle movement may be needed for these common treatment-related aftereffects. Sometimes, reconstructive surgery is also necessary.

Advanced mouth and throat cancers

Oral and oropharyngeal cancers can metastasize or spread to distant parts of the body. When this happens, the cancer is much less likely to be cured, and often requires ongoing life-long treatment. Treatment is intended to help relieve a person’s symptoms and improve their quality of life. There is an estimated average 20 to 40 percent five-year relative survival rate when this type of cancer has metastasized. Detecting oral and oropharyngeal cancers early is the key to having the best chances for a cure.

How to prevent oral cancer

Noticing a potential mouth or throat cancer early is key, but even more critical is preventing these cancers in the first place.

Prevention tips:

• Wear sunscreen on your face and lips, use sun-protective clothing, or limit your sun exposure.
• Do not use any tobacco products.
• Consume moderate amounts of alcohol.
• Keep up with at least annual dental visits to have your mouth examined, and if you wear dentures, ensure they fit correctly.
• Eat plenty of fruits and vegetables, as part of an all-around healthy diet.

Oral and oropharyngeal cancers are identified on an oral exam by a medical or dental professional in most cases, but noticing symptoms on your own and not being afraid to report them as early as possible is essential to the diagnosis and treatment. Overall, there is a need for more awareness of these cancers, their symptoms, and how to prevent them.