unhealthy mouths with various oral health diseases

What is Oral Cancer?

Cancer is defined as the uncontrollable growth of abnormal cells that cause damage to surrounding tissues in the body. These cancerous cells spread over time through the lymph and blood systems. Cancer is separated into two categories, including:

  • Carcinoma this type of cancer begins in the skin or tissues.
  • Sarcoma this type of cancer begins in the bones, muscles, cartilage, fat, or blood vessels.

Oral cancer, also referred to as mouth cancer, begins with the development of abnormal carcinoma cells. It results in the growth of mouth sores that do not disappear on their own. The disease is life-threatening if it isn’t diagnosed or treated early on. Mouth sores, also called oral lesions, can appear in different areas of the oral cavity, including:

  • Cheeks
  • Gums
  • Tongue
  • Lips 
  • Palate (roof of the mouth)
  • Sinuses
  • Pharynx (throat)
  • Mouth Floor (under the tongue)

According to the National Institutes of Health (NIH), oral cancer is the sixth most common type of cancer in the world. The disease affects 275,000 people each year, although most of the cases occur in developing nations. In the U.S. alone, about 92,000 people are living with a type of oral cancer and approximately 53,000 new cases are diagnosed every year. 

8,000 Americans die of oral cancer each year. Although, the earlier the disease is caught, the easier it can be prevented and effectively treated.” 

What are Oral Lesions?

Oral lesions are ulcers or patches that form in the oral cavity, particularly on the mucous membrane. This includes the tongue, cheeks, gums, lips, palate, and other surrounding areas in the mouth.

Lesions are a common sign of oral cancer, although they are not always cancerous. The ulcers are preserved by inflammation and secondary infection.

A general dentist examines a potential cancerous lesion by looking for abnormal characteristics, including:

  • Size, Shape, and Color if the lesion’s borders, colors, and architecture change after detection.
  • Length of Time if a lesion has been present for more than two to three weeks, a more serious underlying condition, such as cancer, is possible.
  • Pain and Discomfort if the lesion causes pain and discomfort frequently and for long periods of time. 
  • Lymph Nodes cancerous lymph nodes are typically large and firm with no mobility.
  • Patient’s Symptoms weight loss, frail appearance, and fatigue are commonly associated with oral cancers. 
  • Genetics and History some diagnoses of oral cancer are not influenced by environmental factors. If a patient has a family history of oral cancer, they are more at risk of developing cancerous lesions. 

Causes, Signs & Symptoms

The leading cause of oral cancer is smoking or chewing tobacco. This includes cigarettes, cigars, or pipe smoking.

“About 53,000 new cases of oral cancer are diagnosed in the U.S. every year. 8 out of 10 patients are smokers.”  

Other less common causes of oral or mouth cancer include:

  • Smokeless tobacco users.
  • Genetics or family history of oral cancer.
  • Excessive alcohol consumption.
  • Excessive, long-term exposure to the sun.
  • Human papillomavirus (HPV).
  • Chronic, untreated dental diseases and infections

Most oral cancers are asymptomatic, which means a patient won’t show signs early on. Although, as the lesion grows, common signs of oral cancer include:

  • Swelling of the mouth.
  • Sores or lesions on the lips, inside the mouth, or neck. 
  • Development of lumps or bumps on the lips, gums, or areas inside the mouth.
  • White spots or a combination of white and red “speckles” in the mouth.
  • Unexplained sensations, including numbness, pain, or tenderness in the oral cavity. This includes the face, gums, tongue, lips, or neck. 
  • Frequent earaches and pain.
  • Bleeding in the mouth without a known cause. 
  • Pain or difficulty chewing or swallowing.
  • Uncontrollable weight loss.
  • Chronic sore throat or pain in the throat.

Diagnosis and Treatment of Oral Cancer

General dentists have the experience and expertise to detect and diagnose oral cancers early on. This is because 80 percent of dental practitioners are general dentists, which means they spend the most time treating patients. There are two steps in determining if a patient has oral cancer, including a physical exam and biopsies: 

Physical Exam — during a physical exam for detecting oral cancers, a dentist, oral surgeon, or doctor examines the mouth to find abnormalities, such as white patches (leukoplakia) and mouth sores (lesions or ulcers).

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

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

Biopsies are typically necessary when a lesion is raised and has asymmetric borders. The most difficult lesions to treat are “precancerous,” which means they have atypical and dysmorphic cellular characteristics. 

There are a few different types of 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. The sample is sent to a laboratory for further testing using computer-assisted analyses. 
  • Needle Aspiration Biopsy a fine needle is used to remove cells, tissues, or fluid samples. There may be some minor pain or discomfort for a few days following the procedure.
  • Incisional Biopsy a surgical incision is made through the skin to remove a sample of tissues or cells. There may be some minor pain or discomfort for a few days following the procedure.
  • Excisional Biopsy the entire lesion is removed during an excisional biopsy, including 2mm of normal tissue around the ulcer. This is typically used to remove lesions that are already cancerous. 
  • Speculoscopy a special blue light is used to examine the abnormalities to help predict if the lesion is cancerous, precancerous, or noncancerous. 

Cancer Stage Determination

After mouth cancer is diagnosed, a doctor determines the stage of the patient’s cancer. First, they inspect the patient’s throat using a small camera to determine if the signs of cancer spread beyond the mouth. Image tests, such as X-rays, CT scans, and MRI’s may also be used. Mouth and oral cancers are separated into four stages, including:

  • Stage I the cancerous tumor is smaller than 2 cm across and is only found in the oral cavity.
  • Stage II the cancerous tumor is between 2 cm and 4 cm across and is only found in the oral cavity.
  • Stage III the cancerous tumor is larger than 4 cm across and is only found in the oral cavity.
  • Stage IV — the cancerous tumor may be any size. Although, it is considered stage four when cancer spreads beyond the oral cavity to the neck or head.

Cancer Treatment Options

Depending on the stage of oral cancer (I, II, III, IV) and the location of the tumor or lesion, a patient will undergo a series of treatments and procedures. This may include surgery, radiation, chemotherapy, or a combination of the three. During oral cancer treatment, your dentist will work with an oral surgeon and an oncologist to coordinate your cancer treatment. First, an oral and maxillofacial surgeon removes the cancerous oral tumor. Then a patient undergoes radiation and chemotherapy (if necessary).

Surgical Options

There are three surgical treatment options available for oral cancer, including:

Tumor Removal

Small oral cancers, such as Stage I tumors, are typically removed through minor surgery. An oral surgeon will remove the cancerous cells along with healthy tissues surrounding the area to ensure the cancer is removed completely. Larger tumors may require partial removal of the jawbone or tongue depending on the location and severity. 

Neck Cancer Removal (Stage IV)

Large oral cancers (stage IV) commonly spread to the lymph nodes of the neck. The surgeon will remove the cancerous cells, lymph nodes, and surrounding neck tissues to ensure the cancer is completely removed. 

Mouth Reconstruction (if necessary)

Oral cancer removal is an invasive surgical procedure. Oral and maxillofacial surgeons may recommend skin, muscle, or bone grafts from other parts of a patient’s body to reconstruct the mouth after surgery. Many times, especially for Stage IV patients, dental implants are used to replace damaged natural teeth. 

Radiation

Radiation is a common treatment used for all types of cancers. Radiation therapy uses external beam radiation, x-rays, and protons to kill cancer cells. For oral cancer patients, radiation is used after surgery. In early cases, surgery is always used ahead of radiation, so I think this statement is backward. For more severe cases, surgery, radiation, and chemotherapy are all necessary. 

Chemotherapy

Chemotherapy is the most widely used treatment that uses chemicals to kill cancer cells. Radiation and chemotherapy are often combined to increase the effectiveness of both treatments. Common side effects of chemotherapy include hair loss, weight loss, vomiting, and nausea.