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Oral Cancer: Symptoms, Diagnosis and Treatment

  • A cancer type that affects the lips, tongue, gums, cheeks, and roof or floor of the mouth
  • Symptoms usually start with a sore on the lips, gums, tongue or lining of the mouth
  • Treatments include surgery, radiation therapy, and chemotherapy
  • Involves Head & Neck Cancers Program and Yale cancer center

Overview

In medical circles, the mouth is referred to as the “oral cavity.” The category “oral cancers” includes those that affect the lips, the front two-thirds of the tongue, the gums, cheeks, and roof and floor of the mouth. Oral cancers are on the rise, particularly among young people, so it is important to learn about early signs and symptoms and, even better, how to prevent them. 

Here in the United States, about 34,000 people receive a diagnosis of oral cancer each year. More men than women are diagnosed with oral cancer, and its leading causes include tobacco and alcohol consumption.

Sometimes the first sign of oral cancer is a small and seemingly harmless sore, so it’s important to visit your dentist or doctor to discuss any concerns you might have about your lips and mouth. 

Treatments for oral cancers include surgery, radiation therapy and, in some cases, chemotherapy.

“Oral cancers are part of a larger group of cancers known as head and neck cancers,” says Heather Osborn, MD, a Yale Medicine surgeon who specializes in head and neck cancers. She sees patients at the Smilow Cancer Hospital at Yale New Haven and the Park Avenue Medical Center in Trumbull.

Within the Head & Neck Cancers Program, there is a multidisciplinary team of head and neck surgeons, radiation oncologists, medical oncologists, physical and speech therapists, nutritionists, advanced practice nurses and social workers, as well as patient advocates. “Our team approach means that patients newly diagnosed with head and neck cancer receive a carefully designed treatment plan and the support they need in their recovery,” Dr. Osborn says.

What is oral cancer?

In general, cancer is caused by a disruption in cellular activity, when normal cells reproduce uncontrollably or don’t die as they should.

Most cases of oral cancer affect squamous cells, which are thin, flat cells that line the surfaces of several organs in the body. This type of cancer is called oral squamous cell carcinoma. The remaining cancers are mostly adenocarcinomas (primarily affecting the salivary glands), sarcomas (primarily affecting the soft tissue in the mouth) and lymphomas (primarily affecting the tongue). And while somewhat rare, melanoma, a cancer of skin pigment cells, can also occur in the lips or in the mouth.

Who is at risk for oral cancer?

Oral cancer is far more common among men than women, and typically affects people older than 50. Most cases develop because of lifestyle factors, specifically alcohol consumption and the use of tobacco products, including cigarettes, cigars, chewing tobacco and vaping devices. Heavy smokers are 40 times more likely to develop a squamous cell cancer than non-smokers.

Exposure to sunlight and artificial sunlight from tanning beds also poses significant risk. Other risk factors include chronic irritation in the mouth, occupational exposures, poor oral hygiene, malnutrition, radiation exposure, Epstein-Barr virus infection, and a family history of the cancer. 

What are the symptoms of oral cancer?

Usually the first sign of oral cancer is a small sore, of which there are three types: white sores (leukoplakia), red sores (erythroplakia), or a combination white and red sores (erythroleukoplakia) on the lips, gums, tongue or lining of the mouth. Over time, these typically progress to a lump or thickening of the lips or gums; bleeding; pain; numbness in the lips or mouth; a change in voice; loose teeth; trouble chewing, swallowing or speaking; swelling of the jaw and a sore throat.  

How is oral cancer diagnosed?

The first step in identifying oral cancer is a thorough physical exam conducted by a doctor or dentist who examines your lips and oral cavity for any visible signs of abnormal sores or lumps. If an abnormality is spotted, he or she will recommend a biopsy of the sore or lump to determine whether cancerous cells are present. Additional tests may include endoscopy (a procedure involving the insertion of a thin camera to visualize internal parts of your body) and imaging (X-rays, MRI, CT and PET scans) to determine if oral cancer has spread to other areas of the body.  

What are the treatments for oral cancer?

Treatment of oral cancer varies, based on its stage (whether cancer has spread to other areas of your body), size and location of the tumor. Surgery to remove the cancer is the usual first-line treatment. Radiation therapy, which uses high-energy rays to kill cancer cells and stop new cancer cells from being produced, may be recommended as well. Chemotherapy introduces anticancer drugs to the body to kill cancer cells but isn’t usually advised unless the cancer has advanced to stage 3 or 4. 

What is unique about how Yale Medicine doctors care for patients with head and neck cancers?

Yale Medicine uses a multidisciplinary approach in the treatment of head and neck cancers. A team of doctors specializing in surgery, radiation and chemotherapy work together to make sure that you get the best possible treatment plan for your specific cancer.

Yale Medicine surgeons use minimally invasive surgical approaches when possible, including robotic surgery and laser microsurgery. This can help to reduce the side effects of treatment.

“Our team is committed to helping you find the best possible treatment plan for your cancer,” says Dr. Osborn, “and to continuing to support you throughout your treatment, rehabilitation and afterwards.”