Oral Cancer

What is Oral Cancer?

It is a known fact that cancer can develop in any part of the mouth. When it is found in the oral cavity, it is called oral cancer. It includes cancer found on the tongue, cheeks, sinuses, throat and more.

The oral cavity includes the lips, the inside lining of the lips and cheeks (buccal mucosa), the teeth, the gums, the front two-thirds of the tongue, the floor of the mouth that is below the tongue, the bony roof of the mouth called hard palate) and the area behind the wisdom teeth (called the retromolar trigone).

The oropharynx is the middle part of the throat, just behind the oral cavity. It is seen when your mouth is wide open and includes the base of the tongue (the back third of the tongue), the back part of the roof of the mouth called the soft palate, the tonsils, and the side and back walls of the throat.

The oral cavity and oropharynx help you perform many basic functions like breathing, talking, eating, chewing, and swallowing. The salivary glands present all over the oral cavity and oropharynx makes saliva or spit which is responsible for keeping your mouth and throat moist and helps with the digestion of food.

Oral Cancer
Oral Cancer

Signs and Symptoms of Oral Cancer

The most common signs & symptoms of oral cancer include:

  • A sore/swelling, lump or thickening on the lips or cheek or in the mouth that does not heal
  • A white or red patch on the gums, tongue, tonsil, or lining of the mouth
  • A sore throat or a feeling that something is caught in your throat that doesn’t go away
  • Trouble chewing or swallowing or moving your jaw or tongue
  • Numbness of the tongue, lip, or other areas of the mouth
  • Swelling or pain in the jaw
  • Dentures that start to fit poorly or become uncomfortable
  • Loosening of the teeth or pain around the teeth
  • Voice changes
  • A lump or mass in the neck or back of the throat
  • Pain in the ear
  • Weight loss

Many of these signs and symptoms can also be caused by diseases other than cancer. However, if you notice any of these conditions and they last for more than two weeks, you should consult your doctor or dentist to seek proper medical assistance. Early detection of cancer is the first step towards a successful treatment.

Risk Factors

Anything that increases a person’s chance of getting a disease such as cancer is called a risk factor. Different cancers have different risk factors. Lifestyle-related risk factors, like smoking or consumption of alcohol, can be easily remedied. Other factors, like a person’s age or family history, can’t be changed.

However, risk factors do not tell us everything. Having one or many risk factors does not definitively mean that a person will get the disease. Similarly, many people who get the disease have few or no known risk factors.

Oral cavity and oropharyngeal cancers are considered to be one of the many cancers in the head and neck area. These cancers often have many of the same risk factors listed below:

  • Tobacco and alcohol use
  • Betel quid and gutka
  • Gender
  • Excess body weight
  • Age
  • (UV) light
  • Poor nutrition
  • Genetic syndromes

Screening, Diagnosing & Staging

Screening Oral Cancer

Screening is the best way to protect you from oral cancer. Various tests are used to screen for different types of cancer when a person does not have symptoms.

There aren't standard or routine screening tests specifically for oral cavity and nasopharyngeal cancers. However, many screening tests for oral cavity and nasopharyngeal cancers are being studied in clinical trials.

Diagnosing Oral Cancer

Diagnosis of oral or oropharyngeal cancer can be done via many tests. However, not all tests described here will be used for every person. Here are a few factors your doctor may consider when choosing a diagnostic test:

  • The type of cancer suspected
  • Your signs and symptoms
  • Your age and general health
  • The results of earlier medical tests

The following tests may be used to diagnose oral or oropharyngeal cancer:

  • Physical examination
  • Endoscopy
  • Biopsy
  • Oral brush biopsy
  • HPV testing
  • X-ray
  • Barium swallow/modified barium swallow
  • Computed tomography (CT or CAT) scan
  • Magnetic resonance imaging (MRI)
  • Ultrasound
  • Positron emission tomography (PET) or PET-CT scan

Staging Oral Cancer

Once oral cancer has been diagnosed, the next step is to understand its extent or stage. Knowing the stage of cancer helps the doctor recommend what kind of treatment is best and can help predict a patient’s prognosis, which is the chance of recovery. There are different stage descriptions for different types of cancer.

TNM staging system.

One tool that doctors use to understand cancer's stage is the TNM system. Doctors use the results from diagnostic tests and scans to answer these questions:

  1. Tumor (T): How large is the primary tumor? Where is it located?
  2. Node (N): Has the tumor spread to the lymph nodes? If so, where and how many?
  3. Metastasis (M): Has cancer spread to other parts of the body? If so, where and how much?

Depending on whether the diagnosis is oral cancer, oropharyngeal cancer, or HPV-related oropharyngeal cancer, the TNM system will differ.

The answers and results of the TNM system help determine the stage of cancer for each person. There are 4 or 5 stages, depending on the diagnosis. Stage 0 (zero) is only used for non-HPV-related oropharyngeal cancer. Stages I through IV (1 through 4) are used for all types of oral and oropharyngeal cancers. The stage provides a common way of describing cancer, so doctors can work together to plan the best treatments.

Coping & Support

As you begin your cancer treatment, it's natural that you will be concerned about treatment-related side effects. Knowing that your health care team will strive to prevent and reduce side effects may be comforting. Palliative care, often known as supportive care, is an important aspect of your cancer treatment. Regardless of your age or stage of disease, it is a vital aspect of your treatment approach.

Coping with physical side effects

  • The Types of Treatment section lists the most common physical side effects from each treatment option for oral and oropharyngeal cancer. Learn more about cancer's treatment methods and side effects as well as how to prevent or control them. The stage of cancer, the length and dose of treatment, and your overall health all have a role in how your physical health changes.
  • Talk to your healthcare team about how you're feeling on a frequent basis. Any new side effects or changes in current side effects must be communicated to them. They can identify strategies to reduce or manage your side effects if they know how you're feeling, make you feel more at ease and even prevent any unwanted effects from escalating.
  • It is beneficial to keep track of your side effects so that any changes can be explained to your healthcare provider. Learn why it's important to keep track of side effects.
  • Side effects might sometimes remain even after treatment has ended. These are what doctors refer to as long-term side effects and can appear months or years after treatment. The treatment of long-term and late side effects is a significant aspect of survivorship care. Read the section on follow-up care in this handbook or speak with your doctor for more information.

Coping with emotional and social effects

  • You will experience the emotional and social effects of your cancer diagnosis. This includes dealing with a variety of emotions such as despair, anxiety, and anger, as well as managing stress. It might be tough for people to explain their feelings to their loved ones at times. Some people have discovered that talking to an oncology social worker, counsellor, or religious leader can help them build more effective coping and communication strategies.
  • A separate section of this website contains coping strategies for emotional and social impacts. This section has a wealth of information and tools to help you locate the support and information you require.

Caring for a loved one with cancer

Family members and friends are frequently involved in the care of someone who has oral or oropharyngeal cancer. This is what it means to be a caretaker. Even if they reside far away, caregivers can provide physical, practical, and emotional support to the patient. Caring for someone else can be hard and emotionally draining. Caring for themselves is one of the most critical jobs for caregivers.

Caregivers may have a range of responsibilities on a daily or as-needed basis, including:

  • Providing support and encouragement
  • Talking with the health care team
  • Giving medications
  • Coordinating medical appointments
  • Providing a ride to and from appointments
  • Assisting with meals
  • Helping with household chores
  • Handling insurance and billing issues

Questions to ask the Health Care Team

Questions to ask

Q1. Questions to ask after getting a diagnosis

  • What type of oral or oropharyngeal cancer do I have? Where exactly is it located?
  • Is HPV a factor in my cancer?
  • Can you explain my pathology report (laboratory test results) to me?
  • What is the stage and grade of the cancer? What does this mean?

Q2. Questions to ask about choosing a treatment and managing side effects

  • What are my treatment options?
  • What clinical trials are available for me? Where are they located, and how do I find out more about them?
  • What treatment plan do you recommend? Why?
  • What is the goal of each treatment? Is it to eliminate the cancer, help me feel better, or both?
  • Who will be part of my health care team, and what does each member do?
  • Who will be leading my overall treatment?
  • Should I get a second opinion about my treatment plan?
  • If I am a smoker, will quitting help this treatment work better? Can you help me quit?
  • What are the possible side effects of each treatment, both in the short term and the long term?
  • What can be done to prevent or treat side effects?
  • How could this treatment affect my daily life? Will I be able to work, exercise, and perform my usual activities?
  • What problems with speech, swallowing, or shoulder motion will likely occur? What rehabilitation services are available? Can you provide a referral?
  • If my treatment will affect my ability to eat the foods I am used to, how will I receive proper nutrition? Should I talk with a registered dietitian?
  • Can you recommend an oncologic dentist whom I can see before treatment begins?
  • Can you recommend an oncologic speech pathologist whom I can see before treatment begins?
  • Should I see other specialists before treatment? Should I talk with a radiation oncologist, medical oncologist, or a reconstructive/plastic surgeon?
  • Could this treatment affect my sex life? If so, how and for how long?
  • Could this treatment affect my ability to become pregnant or have children? If so, should I talk with a fertility specialist before treatment begins?
  • If I'm worried about managing the costs of cancer care, who can help me?
  • What support services are available to me? To my family?
  • If I have questions or problems, who should I call?

Q3. Questions to ask about having surgery

  • What type of surgery will I have? Will lymph nodes be removed?
  • How long will the operation take?
  • How long will I be in the hospital?
  • Can you describe what my recovery from surgery will be like?
  • Whom should I contact about any side effects I experience? And how soon?
  • What are the possible long-term effects of having this surgery?
  • Will I need major reconstruction after surgery? If so, how will this affect my ability to speak and eat?
  • Will there be a need for a neck dissection (removal of lymph nodes)? If so, what type of dissection will be done? What does this mean?
  • Will this surgery affect my appearance in any way? If so, what can I expect?
  • How likely is it that I will lose my voice box (larynx)? If this is necessary, what are the options available for voice/speech rehabilitation?
  • Can you refer me to an experienced speech-language pathologist?

Q4. Questions to ask about having radiation therapy

  • What type of treatment is recommended?
  • What is the goal of this treatment?
  • How long will it take to give this treatment?
  • What side effects can I expect during treatment? Loss of saliva? Loss of taste? Difficulty swallowing?
  • Whom should I contact about any side effects I experience? And how soon?
  • What are the possible long-term effects of having this treatment?
  • What can be done to relieve the side effects?

Q5. Questions to ask about having therapies using medication

  • What type of treatment is recommended?
  • What is the goal of this treatment?
  • How long will it take to give this treatment?
  • Will I receive this treatment at a hospital or clinic? Or will I take it at home?
  • What side effects can I expect during treatment?
  • Whom should I contact about any side effects I experience? And how soon?
  • What are the possible long-term effects of having this treatment?
  • What can be done to relieve the side effects?

Q6. Questions to ask about planning follow-up care

  • What will rehabilitation after treatment consist of for me?
  • What are the chances of developing secondary cancer?
  • What long-term side effects or late effects are possible based on the cancer treatment I received?
  • What follow-up tests will I need, and how often will those tests be needed?
  • How do I get a treatment summary and survivorship care plan to keep in my personal records?
  • Who will be leading my follow-up care?
  • What survivorship support services are available to me? To my family?