Lip & Oral Cancer

Each year in the United States, more than 21,000 men and 9,000 women are diagnosed with oral cancer. Most are over 60 years old.

• The oral cavity includes the following:
• The front two thirds of the tongue.
• The gingiva (gums).
• The buccal mucosa (the lining of the inside of the cheeks).
• The floor (bottom) of the mouth under the tongue.
• The hard palate (the roof of the mouth).
• The retromolar trigone (the small area behind the wisdom teeth).

Risk Factors

Tobacco and alcohol use can affect the risk of developing lip and oral cavity cancer.

Risk factors for lip and oral cavity cancer include the following:

• Using tobacco products.
• Heavy alcohol use.
• Being exposed to natural sunlight or artificial sunlight (such as from tanning beds) over long periods of time.
• Being male.
• Being infected with human papillomavirus (HPV).

Diagnosis

Many of the following symptoms are not from oral cancer. However, if you find any of these, you should contact your physician or dentist so they can diagnose and treat the areas of concern as soon as possible. Symptoms of oral cancer include:

• Patches inside your mouth or on your lips:
  • White patches are the most common and can become cancerous.
  • Mixed red and white patches are more likely than white patches to become malignant.
  • Red patches are brightly colored, smooth areas that often become cancerous.
• A sore on your lip or in your mouth that doesn't heal
• Bleeding in your mouth
• Loose teeth
• Difficulty or pain when swallowing
• Difficulty wearing dentures
• A lump in your neck
• An earache that doesn't go away
• Numbness of lower lip and chin

If you have symptoms that suggest oral cancer, your doctor or dentist will check your mouth and throat for red or white patches, lumps, swelling, or other problems. A physical exam includes looking carefully at the roof of your mouth, back of your throat, and insides of your cheeks and lips. The floor of your mouth and lymph nodes in your neck will also be checked.

The removal of a small piece of tissue to look for cancer cells is called a biopsy. Usually, a biopsy is done with local anesthesia. A biopsy is the only sure way to know if the abnormal area is cancer.

A few methods that are also used in the diagnosis process are as follows:

• X-rays: An x-ray of your entire mouth can show whether cancer has spread to the jaw. Images of your chest and lungs can show whether cancer has spread to these areas.

• CT scan: An x-ray machine linked to a computer takes a series of detailed pictures of your body. You may receive an injection of dye. Tumors in your mouth, throat, neck, lungs, or elsewhere in the body can show up on the CT scan.

• MRI: A powerful magnet linked to a computer is used to make detailed pictures of your body. An MRI can show whether oral cancer has spread.

• Endoscopy: The doctor uses a thin, lighted tube (endoscope) to check your throat, windpipe, and lungs.

• PET scan: You receive an injection of a small amount of radioactive sugar. The radioactive sugar gives off signals that the PET scanner picks up. The PET scanner makes a picture of the places in your body where the sugar is being taken up. Cancer cells show up brighter in the picture because they take up sugar faster than normal cells do. A PET scan shows whether oral cancer may have spread.

Staging

For oral cancer, Stages I and II are combined and classified as “early cancer”. Stages III and IV are classified as “advanced cancer.” Here are the details of each class:

Early Cancer

Stage I or II oral cancer is usually a small tumor (smaller than a walnut), and no cancer cells are found in the lymph nodes.

Advanced Cancer

Stage III or IV oral cancer is usually a large tumor (as big as a lime). The cancer may have invaded nearby tissues or spread to lymph nodes or other parts of the body.

Treatment Options

People with early oral cancer may be treated with surgery or radiation therapy. People with advanced oral cancer may have a combination of treatments. For example, radiation therapy and chemotherapy are often given at the same time. Another treatment option is targeted therapy.

Surgery

Surgery to remove the tumor in the mouth or throat is a common treatment for oral cancer. Sometimes the surgeon also removes lymph nodes in the neck. Other tissues in the mouth and neck may be removed as well. You may have surgery alone or in combination with radiation therapy.

Surgery to remove a small tumor in your mouth may not cause any lasting problems. For a larger tumor, however, the surgeon may remove part of the palate, tongue, or jaw. This surgery may change your ability to chew, swallow, or talk. Also, your face may look different after surgery. You may have reconstructive or plastic surgery to rebuild the bones or tissues of the mouth.

Radiation Therapy

Radiation therapy can be used to treat the area where the patient is affected by oral cancer. This type of treatment focuses on treating the specific area(s) where the cancer was found.

Chemotherapy

Chemotherapy uses drugs to kill cancer cells. The drugs that treat oral cancer are usually given through a vein (intravenous). The drugs enter the bloodstream and travel throughout your body.

Chemotherapy and radiation therapy are often given at the same time. You may receive chemotherapy in outpatient therapy at a cancer center like ours.

Chemotherapy and radiation therapy can cause some of the same side effects, including painful mouth and gums, dry mouth, infection, and changes in taste. Some anticancer drugs can cause bleeding in the mouth and a deep pain that feels like a toothache.

Targeted Therapy

Some people with oral cancer receive a type of drug known as targeted therapy. It may be given along with radiation therapy or chemotherapy. Cetuximab (Erbitux) was the first targeted therapy approved for oral cancer. Cetuximab binds to oral cancer cells and interferes with cancer cell growth and the spread of cancer. You may receive cetuximab through a vein once a week for several weeks at the doctor's office.

Visit the National Cancer Institute where this information and more can be found about Lip and Oral Cancer or ask your cancer care team questions about your individual situation.

Lo que usted necesita saber sobre el cáncer del del labio y la cavidad oral.