The term cancer refers to the uncontrollable growth of abnormal cells. These cancerous cells spread over time through the lymph and blood systems, causing damage to surrounding tissues in the body.

Oral cancer is the sixth most common type of cancer in the world. The disease affects 377,700 people each year.⁹ Most of the cases, however, occur in developing nations.

There are two different categories of cancer:

1. Squamous cell carcinoma — this type of cancer begins in the skin or tissues.
2. Sarcoma — this type of cancer begins in the bones, muscles, cartilage, fat, or blood vessels.

What is Oral Cancer?

Oral cancer begins with the development of abnormal carcinoma cells. Over time, growths (sores) appear in the mouth and do not disappear on their own.

In the early stages of oral cancer, the sore commonly appears as a painless white or red patch. Over time, a larger red patch or patches (ulcer) will form. The ulcer will continue to grow, thicken, and may eventually become painful.

The earlier the cancer is detected, the more effective treatment will be. The disease can be deadly if you do not receive oral cancer treatment early.

Signs of a Cancerous Lesion in the Oral Cavity

Most oral cancers are asymptomatic, so you may not notice signs early on. Lesions or patches in the oral cavity are one of the most common signs of oral cancer.

General dentists are trained to examine mouth lesions to look for abnormal characteristics that may suggest potentially cancerous lesions. These characteristics include:

• Size, shape, and color — If the lesion’s borders, colors, and architecture change over time.
• Length of time — If a lesion has been present for more than two to three weeks without any resolution, a more serious underlying condition, such as cancer, is possible.
• Lymph nodes — Cancerous lymph nodes are typically enlarged and firm to touch, with no mobility.
• Systemic symptoms — Some symptoms include unexpected weight loss, frail appearance, fatigue, and easy bruising.
• Genetics and history — If someone has a family history of oral cancer, they are more at risk of developing cancerous lesions.

Although lesions are a common sign of oral cancer, they are not always cancerous. The development of signs and symptoms depends on the type of cancer.

Risk Factors of Oral Cancer

The leading cause of oral cancer is the use of smokeless and smokable tobacco products. This includes cigarettes, chewing tobacco, cigars, and pipe smoking.

“About 54,000 new cases of oral cancer are diagnosed in the U.S. every year. 8 out of 10 patients are smokers.”¹⁰

Other less common risk factors of oral or mouth cancer include:

• Genetics or family history of oral cancer
• Alcohol use and abuse
• Excessive, long-term exposure to the sun
• Human papillomavirus (HPV)

How is Oral Cancer Diagnosed?

11,230 Americans die of oral cancer each year. However, early detection is necessary to prevent the spread of oral cancer. Treatment will also be more effective. ¹⁰

General dentists spend the most time treating people. This means they have the experience and expertise to detect and diagnose oral cancers early on.

There are two steps in determining if someone has oral cancer:

1. Physical Exam

During a physical exam for oral cancer, a dentist, oral surgeon, or doctor examines the mouth for potential abnormalities. They usually look for white patches (leukoplakia) and mouth sores (lesions or ulcers).

2. Biopsies

Next, the practitioner takes a biopsy of the abnormal growth(s) if they find anything suspicious. A doctor uses a scalpel or laser to remove a sample of cells from the lesion and surrounding tissues. Then they send it to a laboratory for testing to determine if it is cancerous.

A biopsy and pathologic evaluation are always required to properly diagnose cancer. A cancer diagnosis is only made after a biopsy confirms the presence of invasive cells.

Biopsies are typically necessary when a lesion is not healing on its own, is raised, and has asymmetric borders. The most difficult lesions to treat are “precancerous,” which means they have atypical and dysmorphic cellular characteristics.

Types of Biopsies

There are a few different biopsies depending on where the growth or white patches are located:

• Oral brush biopsy — A diagnostic test that detects early oral cancer (precancer) by using a small brush to remove a tissue sample from the mouth.
• Needle aspiration biopsy — A fine needle removes cells, tissues, or fluid samples.
• Incisional biopsy — A surgical incision is made through the oral mucosa to remove a small portion of the lesion.
• Excisional biopsy — The entire lesion is removed during an excisional biopsy, including 2mm of normal tissue around the ulcer.
• Speculoscopy — A special blue light is used to help predict if the lesion is cancerous, precancerous, or noncancerous.

Some procedures might cause minor pain or discomfort for a few days.

Types of Oral and Oropharyngeal Cancers

There are many types of oral and oropharyngeal cancers. Here is an overview:

Oropharyngeal Cancer

Oropharyngeal cancers are squamous cell carcinomas that can develop in or on different areas of the mouth, throat, and nose. There are two types of throat or tonsil cancer:¹¹

1. HPV-associated — caused by an oral papillomavirus infection
2. Non-HPV-associated — caused by tobacco smoking and alcohol use

Oral Cancer

Oral cancer can develop in different ways. Cancer sores in the mouth (oral lesions) can appear in different areas of the oral cavity.

Unlike oropharyngeal cancer, oral cancer develops in the mouth. It can affect the lips, gums, jaw, cheeks, and tongue.⁸

The different types of oral cancer include:

• Adenocarcinoma — develops inside the salivary glands
• Sarcoma — develops from abnormalities in bone, cartilage, muscle, or other tissue
• Oral malignant melanoma — develops in the cells that produce skin pigment or color (melanocytes)
• Lymphoma —  develops in the lymph nodes but can also grow in the mouth  

Symptoms of Oral and Oropharyngeal Cancer

The following symptoms can indicate oropharyngeal cancer or other conditions. Contact a doctor immediately if you notice these symptoms:

• A chronic or persistent sore throat
• Pain or difficulty with swallowing
• Difficulty opening your mouth or moving your tongue
• Unexplained weight loss
• Voice changes that do not go away
• Chronic ear pain
• Lumps in the back of your throat or mouth.
• Lumps on your neck
• Coughing up blood
• Lesions or patches around the mouth
• Swelling in the mouth
• White spots or white and red “speckles” in the mouth

What are The Stages of Cancer?

After your doctor diagnoses you with mouth cancer, they can determine the stage of your cancer.

First, they inspect your throat using a small camera to determine if the cancer has spread beyond the mouth. Imaging, such as X-rays, CT scans, and MRI scans, may also be used.

Oral cancers can be classified as belonging to one of four stages, including:

• I — The cancerous tumor is smaller than 2 cm across and is only found in the oral cavity.
• II — The cancerous tumor is between 2 cm and 4 cm across and is only found in the oral cavity.
• III — The cancerous tumor is larger than 4 cm across and has spread to a lymph node on the same side of the tumor.
• IV — The cancerous tumor may be any size. Stage four is also when cancer spreads beyond the oral cavity to the neck or head.

How is Oral Cancer Treated?

Depending on the stage of oral cancer and the location of the tumor or lesion, you will undergo a series of treatments. This may include:

1. Surgery
2. Radiation
3. Chemotherapy

During oral cancer treatment, your dentist will work with an oral surgeon and an oncologist to coordinate your cancer treatment. The plan may include a combination of these three procedures.

First, an oral and maxillofacial surgeon removes the cancerous oral tumor. Then you will undergo radiation and chemotherapy (if necessary).

Surgical Options

There are a few surgical treatment options for oral cancer, depending on the location of the tumor, including:

• Primary tumor surgery — Tumor removal through the mouth or an incision in the neck.
• Glossectomy — Partial or total removal of your tongue.
• Mandibulectomy — Partial or total removal of the lower jaw.
• Maxillectomy — Partial or total removal of the upper jaw.
• Sentinel lymph node biopsy — Test to see if cancer has spread beyond the original oral cancer.
• Neck dissection — Removal of lymph nodes from your neck.

In some cases, you might have to get reconstructive surgery. The surgeon may take healthy bones and tissue (skin, muscle, or bone) from other areas of your body to repair the defect left behind after the tumor has been removed.

Dental implants may be used to replace damaged natural teeth.

Non-Surgical Treatments for Oral Cancer

There are non-surgical treatment options for oral cancer. However, your healthcare provider may combine these options with surgery.

These treatment options include:

• Radiation therapy — Uses radiation to kill cancer cells or keep them from growing.
• Chemotherapy — Uses chemicals and drugs that kill cancer cells.
• Immunotherapy — Biological therapy that engages your immune system to fight the disease.
• Targeted therapy — Uses drugs or other substances to target certain cancer cells without hurting normal cells.

In many cases, radiation and chemotherapy are often combined to increase the effectiveness of both treatments. This combination is usually used when someone has advanced cancer.

Common side effects of chemotherapy include hair loss, weight loss, vomiting, and nausea. However, chemo side effects can vary from person to person.

 Summary

Oral cancer begins with the development of abnormal carcinoma cells. This causes growths (sores) to appear in the mouth. They will not disappear on their own.

There are two types of mouth cancers, oral and oropharyngeal. Both cancers develop inside or around the mouth, such as the lips or throat.

Treatment for oral cancer depends on the stage of a person’s cancer. Surgical and non-surgical treatments are available.